The role of nurse education in improving patient outcomes and patient satisfaction with nursing care: A multiple case study of nursing teams in three hospitals across Ireland and Germany.
Background: International large scale research has found that nurse education at degree level contributes to reduced mortality and failure to rescue rates. The influences of hospital and national contexts and of different types of nurse education levels towards improved patient care seem often overlooked. Aim and objectives: The aim of this study was to explore the role of nurse education in improving patient outcomes and patient satisfaction with nursing care, taking into account different types of nurse education levels within different hospital based and country specific contexts. The objectives were: (1) to explore and compare nurse education levels, hospital and nurse structures, care processes and patient related outcomes for selected nursing teams from the Irish and German arms of the RN4CAST project (2) to explore factors other than nurse education affecting patient outcomes, including country specific factors. Methodology: A multiple case study design was utilised to conduct an in depth exploration of the findings generated from the Irish and German arms of the RN4CAST (Nurse Forecasting: Human Resources Planning in Nursing) project. Three nursing teams, with different proportions of degree (pre registration, post registration and international degree) and apprenticeship trained nurses working in hospitals in Ireland and Germany were selected. Data were explored and compared based on Donabedian's (2005) Structure Process Outcome model for health care practice. Patient outcomes included falls with injury, medication errors and pressure ulcers developed after admission. Patients rated nurse communication, pain control and discharge information provided. Findings: Findings suggest that degree level education, and type of degree, play a role in improving patient related outcomes. The team with both degree and apprenticeship trained nurses reported the best patient outcomes, which were also attributed to better working conditions and lower levels of hospital bed occupancy. Country specific factors such as nurse to patient ratios and skill mix further affected the care provided by the nursing teams. Conclusion: This study provides new insights into the role of nurse education in improving patient related outcomes. It also provides new information about hospital based and country specific contexts, within which nurses with different educational backgrounds provide care.