Using nurses trained in other countries to fill gaps caused by shortages of nurses trained at home is not without risks to quality of care, according to a study done in the United Kingdom and published in the research and policy journal BMJ Open. The study was conducted through a collaboration of researchers from the University of Pennsylvania School of Nursing, the University of Southampton in the U.K., and the Florence Nightingale School of Nursing and Midwifery at King’s College London.
The study of more than 12,000 patients in a representative sample of 31 National Health Service Trusts in England analyzed the annual patient survey conducted by the NHS to determine factors that influence patients’ satisfaction with their hospital care.
The study, the largest of its kind according to Penn Nursing author Hayley Germack, BSN, PhD, RN, showed that every 10-point increase in the percentage of non-U.K. educated nurses at the hospital bedside is associated with 10% lower odds of patients giving their hospital an excellent or very good rating, according to the release. That is, patients cared for in hospitals in which 30% of bedside care nurses were trained outside of England were 30% less likely to rate their hospitals as very good overall.
Patients in hospitals with more nurses trained abroad also were significantly less likely to report being treated with respect and dignity, getting easy to understand answers to their questions, and having the purpose of their medications explained.
The proportion of non-U.K. educated nurses employed in the NHS hospitals studied varied widely from 1% to 50% of bedside care professional nurses. “This study was motivated by findings from a previously published U.S. study documenting higher mortality for patients in U.S. hospitals that employed more non-U.S. educated nurses, and evidence that NHS hospitals were increasing nurse recruitment abroad despite public concerns about quality,” said study senior author Linda H. Aiken, PhD, RN, FAAN, FCRN, director of Penn Nursing’s Center for Health Outcomes and Policy Research.
Co-author Peter Griffiths, PhD, chairman of health services research at the University of Southampton, added, “National workforce planning in England has failed to consistently deliver enough professional nurses to work in the NHS. Relying on bringing in large numbers of foreign educated nurses to make up the shortfall is not a simple solution and may not be effective.”
There are more qualified domestic applicants to nursing schools in both the U.K. and the U.S. than can be admitted, according to the release. Building an adequate, domestic supply of nurses is in the best interests of the public in both England and the U.S., the authors concluded.
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