High nurse and doctor turnover linked to hospital deaths

Researchers analysed data from all 148 NHS acute trusts in England collected between 1 April 2010 and 30 March 2019 to see if there was a link between staff turnover and adverse patient outcomes.

“Ministers need to pay attention and take urgent action to keep highly skilled nurses in the profession"

Patricia Marquis

The study included data from more than 236,000 nurses and 41,800 senior doctors as well as 8.1 million patient records.

The researchers found that an increased rate of nurse turnover was linked to a greater risk of patient death within 30 days of being admitted to hospital.

When the monthly nurse turnover rate increased by one standard deviation – the equivalent of 20 additional nurses quitting a hospital trust – the all-cause mortality rate went up by an additional 35 deaths per 100,000 hospital admissions, the analysis showed.

At the national level, this equates to an additional 239 deaths per month.

When the monthly turnover rate for senior doctors went up by one standard deviation – equivalent to around seven additional senior doctors quitting an NHS hospital trust – there was an increase in all-cause mortality rate of 14 deaths for every 100,000 hospital admissions. At the national level this equates to 96 additional deaths per month.

Lead researcher on the study and associate professor in economics at the University of Surrey Dr Giuseppe Moscelli said these findings underscored the “vital role” that stable staffing played in ensuring patient safety.

“High turnover rates are not simply an administrative issue; they have real, life-or-death implications for patients,” he said.

“It's time for healthcare leaders to focus on retention strategies that prioritise workforce stability.”

In their conclusion, the researchers recommended that healthcare policymakers should focus on factors that can ameliorate the retention of hospital staff, including pay packages, staff engagement, retention of key coworkers, and more favourable working conditions.

Dr Moscelli added: "With the mounting pressure on NHS resources, it is essential that we invest in our healthcare workforce.

“Retaining skilled healthcare professionals is not just a cost-saving measure; it is crucial for safeguarding patient lives.”

Patricia Marquis

Executive director of the Royal College of Nursing (RCN) England Patricia Marquis said that this study added to the “growing body of evidence” about the link between lower nurse numbers and patient deaths.

“Ministers need to pay attention and take urgent action to keep highly skilled nurses in the profession,” she said.

“Wherever you look, shifts routinely don’t have enough registered nurses to keep patients safe. This has become normalised and is unacceptable,” Ms Marquis said.

“Boosting recruitment into the profession is crucial to patient safety, but so too is giving experienced staff a reason to stay.

“Unrelenting pressures, low pay and delivering compromised care are forcing thousands of nurses to quit and it is patients who are paying the price.”

Ms Marquis repeated the RCN’s call for nurse-to-patient ratios to be enshrined in law in every country in the UK.