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Nursing assistants provide little help

Wednesday, 26 October 2016


The addition of nursing assistants to hospital wards does not improve patient outcomes, according to new research from ECU's School of Nursing and Midwifery.

Researchers from the School of Nursing and Midwifery examined the records of patients who spent time in surgical, medical or rehabilitation wards in metropolitan Perth hospitals between 2006 and 2010.

They measured the rates of mortality, failure to rescue, falls, urinary tract infections (UTI), pressure injuries, pneumonia and sepsis in wards with nursing assistants compared to those without nursing assistants.

Additional staff no benefit

Lead researcher and Dean of the School of Nursing and Midwifery Professor Di Twigg said the research only looked at wards where nursing assistants had been employed in addition to, not as a replacement for, existing nurses.

“We hypothesised that the addition of nursing assistants would have improved patient outcomes due to the additional help they could provide to regulated staff on the wards,” she said.

“However, we found that the addition of nursing assistants had a significant adverse impact on three measures, failure to rescue, UTI and falls.

“We found that one measure, mortality, showed an improvement with the addition of nursing assistants.”

Skill mix a factor

Helen Myers, who also contributed to the research, said one potential reason that the addition of nursing assistants did not lead to better patient outcomes was because the overall skill mix of the staff on the ward was reduced.

“Although adding nursing assistants to wards did not reduce the number of registered nurses, it still diluted the overall skill mix on the ward,” she said.

“The association between poorer skill mix and increased adverse patient outcomes has also been identified in some previous ECU research in WA hospitals.

“This study serves as a reminder that diluting the skill mix may be detrimental to the quality of care and should be implemented only with careful consideration.”


Professor Twigg said that nursing assistants were deployed in a variety of ways resulting in wide variation in how they are utilised.

“If nursing assistants are to be added to the existing staffing complement, there  should be clear implementation guidelines and training in delegation, accountability  and team work to ensure consistent role utilisation” she said.

Professor Christine Duffield, Dr Lucy Geldera, Dr Judith Pugh and Dr Michael Roche also contributed to the research.

The impact of adding assistants in nursing to acute care hospital ward nurse staffing on adverse patient outcomes: An analysis of administrative health data’ was recently published in the journal International Journal of Nursing Studies.


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