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Studies have repeatedly examined the effects of overworking doctors on patient care and found that generally speaking, doctors are efficient at doing their jobs even if they are tired or slightly sleep deprived. In a new study, researchers shifted the focus from doctors to nurses. They reported that nurses who have heavier workloads and lower education levels were tied to poorer patient outcome post-surgery.

"A safe level of hospital nursing staff might help to reduce surgical mortality, and challenge the widely held view that nurses' experience is more important than their education," the study's leader, Linda Aiken, a professor from the University of Pennsylvania School of Nursing, said according to Philly.

For this European study, the researchers administered questionnaires to more than 26,500 nurses. The team also looked at the medical records on over 420,000 patients aged 50 or over who were treated at 300 hospitals from nine countries. These patients had undergone common surgical procedures, which included gall bladder surgery and joint replacement. Before determining the patient's risk of death, the researchers accounted for age, sex, type of surgery and other health conditions.

The researchers discovered that each time a nurse's workload increased per patient, the surgical patient's risk of dying within 30 days after his/her surgery increased by seven percent. The researchers also found that for every 10 percent increase in the number of nurses that have a bachelor's degree, the risk of death for the surgical patient after 30 days fell by seven percent.

The researchers calculated that if hospitals organized workload so that the nurses cared for an average of six patients and if at least 60 percent of the nurses had a bachelor's degree, risk of death post surgery would fall by almost 30 percent.

After identifying workload and education levels as contributing factors to a patient's risk of dying, the researchers examined these levels across the countries. They found that on average, in Spain there were 12 patients per seven nurses. In Belgium, there were 10 patients per eight nurses. In Ireland, there were six patients for every nine nurses and five patients per two nurses in Norway. In Spain and Norway, the nurses all had a bachelor's degree, whereas only 10 percent and 28 percent had a bachelor's degree in Switzerland and England respectively.

"Our findings emphasize the risk to patients that could emerge in response to nurse staffing cuts under recent austerity measures, and suggest that an increased emphasis on bachelor's education for nurses could reduce hospital deaths," Aiken said.

The study was published in The Lancet.