International studies reveal patients worse off with downgraded nurse leaders

Reducing the role of nurse managers increases nurse workloads and reduces patient outcomes, according to international studies.

Restructuring the health system and reducing the role of nurse managers increases nurse workloads and reduces patient outcomes, according to international studies conducted after an overhaul of the heath care systems in New Zealand (McCloskey et al, 2005)1, Canada, United States, England, Scotland and Germany (Aiken et al, 2001).

In 1993, the New Zealand (NZ) government implemented a restructure of its health system, which aimed to make the system more efficient, cost effective and improve patient outcomes.

Like the situation currently being attempted by some AHSs in NSW, the NZ restructure saw nurse managers replaced with non-nurse business managers, who were handed control over nursing budgets.

Hospital nursing staff were reduced across the structure and nursing leadership structures were dismantled.

Another similarity was that little consultation occurred with the nurses and health professionals working in the NZ health system before the restructure was implemented.

The fall out was that within three years health care costs had increased by 40% and waiting lists for surgery had grown.

The business managers were placed under enormous pressure to meet unattainable financial targets and many quit their positions within three years of the restructure’s commencement.

McCloskey’s study reveals that the NZ restructure with the deletion of nurse leaders increased nurse workloads down the line.

The study also adds to a body of evidence concerning the relationship between nurse workloads and increases in adverse patient outcomes. It concludes: ‘Lower staffing levels caused by reengineering and the associated increased nursing workload can lead to hurried, delayed, omitted, fragmented or erroneous care.’

Another major international study2 looks at the effects of reengineering of the health care systems in five countries – Canada, United States, England, Scotland and Germany. Based on surveys of 43,329 nurses from 71 hospitals, the study shows a high level of dissatisaction among nurses and increased nurse workloads when budgetary and operational responsibility is placed in the hands of administrators. The study provides further proof of the direct correlation between the ratio of nurses to patients’ health outcomes.

1 McCloskey B and Diers D. ‘Effects of New Zealand’s health reengineering on nursing and patient outcomes’, Medical Care (Vol. 43, Number11, Nov 2005)
2 Aiken LH, Clarke S, Sloane D. ‘Nurses’ reports on hospital care in five countries’, Health Affairs 2001