December 16, 2015

Lower patient satisfaction associated with nurses educated abroad

By: OR Manager

Many countries, including the United States and United Kingdom, rely on nurses trained abroad during times of nursing shortages. However, little is known about how this practice affects quality of care and patient satisfaction.

A new study examines whether patient satisfaction with nursing care in National Health Service hospitals in the UK was associated with the proportion of non-UK educated nurses providing care. Led by Linda H. Aiken, PhD, FAAN, FRCN, RN, professor of nursing at the University of Pennsylvania School of Nursing, Philadelphia, and director of Penn Nursing’s Center for Health Outcomes and Policy Research, the study included more than 12,500 patients.

This is the first quantitative study to determine the association between employment of nurses trained abroad and patient satisfaction. The study was undertaken because of findings from a recent US study that documented higher mortality rates for patients in US hospitals that employed more non-US educated nurses, and evidence that hospitals in the UK were increasing nurse recruitment abroad despite public concerns about quality.

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The new study found that each 10-point increase in the percent of non-UK educated nurses at the bedside was associated with a 12% lower odds of patients giving their hospital an excellent or very good rating, and a 13% lower odds of patients agreeing that they always had confidence and trust in nurses.

Patients in hospitals with more non-UK educated nurses also were significantly less likely to report:

• being treated with respect and dignity

• receiving easy-to-understand answers to their questions

• having the purpose of their medications explained.

The lower patient satisfaction reported by patients cared for in hospitals that employed many nurses educated abroad could not be explained by other features, such as poorer nurse staffing; poorer work environments; hospital location; or size, high technology, or teaching status. Lower patient satisfaction also was not explained by the characteristics of the patients providing ratings.

The findings suggest that there is an important link between employing a lot of nurses educated abroad and lower patient satisfaction. The researchers say their results have important implications for nurse workforce planning. ✥



Germack H D, Griffiths P, Sloane D M, et al. Patient satisfaction and non-UK educated nurses: A cross-sectional observational study of English National Health Service Hospitals. BMJ Open. Published online December 2, 2015.

Neff D F, Cimiotti J, Sloane D M, et al. Utilization of non-US educated nurses in US hospitals: Implications for hospital mortality. Int J Qual Health Care. 2013;25:366-372.

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