Countries with High Registered Nurse (RN) Concentrations Observe Reduced Mortality Rates of Coronavirus Disease 2019 (COVID 19)
BACKGROUND The novel coronavirus disease 2019 (COVID 19) pandemic has generated many questions on its screening, diagnosis and management. One important question emerging from this discussion of regional differences pertains to the healthcare workforce not just in absolute numbers but also in terms of skill mix. As nurses comprise over half the skilled healthcare workforce worldwide, it is important to consider them as part of a health systems strengthening approach to quality improvement. We sought to investigate the influence of the registered nurse (RN) concentration and the impact on COVID 19 mortality between countries worldwide. METHODS We conducted an observational cohort study to examine the association between COVID 19 mortality rates and concentrations of registered nurses. Data on nursing concentrations by country provided from the World Health Organization were merged with March 2020 COVID 19 mortality rates. Descriptive statistics, geographical information systems (GIS) mapping and multilevel linear regression with mixed effects were applied to examine this association with regional clustering of countries. FINDINGS In total, 172 countries were included in the analysis. These results indicated that for every 1.0 increases in RN per 1,000 individuals in a country, there was a decrease in COVID 19 mortality of 1.98 per 1 million individuals (p=0.003) INTERPRETATION High nursing concentrations are strongly associated with reduced mortality rates of COVID 19. The key to address the needs of current and future COVID 19 outbreaks, or for that matter, any infectious disease outbreak of this magnitude is to prepare a highly trained, versatile nursing workforce. Funding Statement: William Padula is supported by grants from the U.S. National Institutes of Health (KL2 TR001854) and the Bill Melinda Gates Foundation. Declaration of Interests: None.
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