1. Howard Catton Head of Policy The business case for nursing

2. Projections: % Change in NHS nurses 2006/7 to 2015/16, England (wte) (sources: Buchan and Seccombe /RCN Policy Unit,2007; WRT 2008)

3. RCN Evidence Base for Future Nurse Reductions in: Patient Mortality Respiratory, Wound and Urinary Tract Infections Number of Falls Incidence of Pressure Sores Medication Errors Improvements in: Patient Functional Independence Patient Experience and Perceptions of Health Care http://www.rcn.org.uk/support/policy/policy briefings

4. As workloads in hospitals increase, so does mortality... But as nurse education increases, mortality decreases … Deaths per 1000 patients with complications* Staffing (Patients per nurse) Education (% of nurses with degrees) *Adjusting for patient and hospital characteristics L. Aiken, Univ. of Pennsylvania

5. Inpatient Mortality Rates in 118,803 English Surgical Patients From 30 Trusts in Relation to Nurse Staffing Levels Crude mortality rate % Rafferty, Clarke, Aiken et al., in review

6. Dr Foster Intelligence; Nursing Times, 31 March 09 147 Trusts Those with a low nurse per bed ratio were twice as likely as those with a high ratio to have a high HSMR Mid Staffs, Maidstone & Basildon Reg v Non Reg and Clinical Staff per Bed ratio

7. L. Aiken, Univ. of Pennsylvania Patient to Nurse Ratios Important in Nurse Retention Higher burnout and greater job dissatisfaction (precursors of turnover) are strongly related to patient-to-nurse ratios. An increase of 1 patient per nurse increases the probability of –high levels of burnout by 23% –job dissatisfaction by 15%

8. Good HR T& D Team Working Appraisal - All reduce mortality West et al; 2002 “Services better at Trusts with the happiest nurses” Nursing Times, 23 March 2010

9. L. Aiken, Univ. of Pennsylvania Onerous Workloads and Chaotic Environments: Latent Conditions Creating Possibility of Errors

10. State of the Art Metrics for Nursing; Griffiths, Kings Univ 08 “Front Runners” Failure to Rescue HCAI HCA pneumonia Pressure Ulcers Falls Staffing levels, patterns and satisfaction

11. National Nursing Research Unit, Kings College 09 “better clinical and cost outcomes are achieved by a qualified nursing workforce comprised primarily of RNs” “there is little evidence to suggest a benefit from replacing unlicensed NAs with LPNs”

12. Specialist Nurses, Changing Lives Saving Money. RCN 2010 Reduce Emergency Admissions Increase Independence Health Education and Prevention Advice Care Planning and Co-ordination High Patient Satisfaction

13. “Interventions by specialised nurses were shown to have a beneficial impact on a range of outcomes for LTC when compared with usual care.” “There is no clear evidence of a differential effect on outcomes between nurses as first contact and providers of ongoing primary care when compared with doctors, though patient satisfaction may be higher with nurse led care.” EPPI Centre, Institute of Education, University of London 2009

14. “Secondary prevention care for heart disease provided by specialist cardiac nurses and general practice nurses compared with GPs was found to improve mortality rates, general health, diet and levels of exercise and anginal symptoms. Other comparative benefits include increased patient follow up rates and reduced hospital admissions.” EPPI Centre, Institute of Education, University of London 2009

15. Dall et al, Medical Care January 09 $1.3 bn per year productivity Reduction 3.6m hospital days $6.1bn medical savings 133,000 RNs save 5,900 lives per year

16. CNO / NHS Institute for I&I High Impact Changes Pressure ulcers occur in 4-10% of patients admitted to acute hospital in the UK Costs range (1-4) £1K - £24K Av DGH £1m - £3m Total cost for UK £1.4bn - £2.1bn

17. REGISTERED NURSES PATIENT OUTCOMES x

19. Key Questions for a Trusts Board Patient/Quality Care Impact Assessment Actual v Establishment Staffing Levels Reg v Non Reg Ratio Nurse to Bed and Patient Ratios Spend on Training and CPD

20. Who said ………….. “One has to grow hard but without ever losing tenderness”