Nurse Staffing Levels Linked to Patient Outcomes

Both the number and type of nurses have a direct effect on safety outcomes and a patient’s well-being.

Safety outcomes include falls and the management of symptoms, such as nausea and vomiting. In a study published inBMJ Open, investigators found that when aspects of care are delegated to unregistered nurses or health care support workers, there is an increase in patient falls, which could lead to poorer patient outcomes.

The investigators obtained large volumes of routinely collected hospital data for the study. They considered the analysis and different possible scenarios, such as replacing 6 health care support workers with 6 registered nurses on wards that had the highest incident of falls, which could decrease the monthly total number of falls by 15%, according to the study.

In terms of patient well-being, falls are costly and result in distress, injury, pain, loss of confidence, loss of independence, and a severe impact on personal finances and mortality. It was estimated in 2007 that falls in the hospital cost the National Health Service (NHS) more than £15 million per year.

“We must look at the usefulness of the currently collected data and how it might be used to shape hospital safety,” said investigator Alison Leary, professor at London South Bank University’s (LSBU) School of Health and Social Care. “This was a very exciting project to work on as it’s a different way of thinking about the contribution nurses make to patient safety. We were very surprised that so many signals emerged from the data and it is useful that we were able to feed the new knowledge back to the Trust who then used it in many different ways to look at patient safety.”

Although the research was only conducted at one hospital in England, the techniques can be applied to centers as long as good quality data available, the authors noted.

“As a volunteer/patient advisor and user I was able to relay my experience gained by talking to hundreds of patients over many years,” said co-investigator Malcolm Gough. “I think this is only the tip of the iceberg as there is so much more information available to work with.”

The study was led by LSBU and funded by NHS England.

“This exciting opportunity to work across sectors to identify previously invisible insight demonstrates the advantages of working together, including with patients and Malcolm’s experiences were vital to our understanding of the data in the real world,” said Dr Sarahjane Jones, Senior Research Fellow, Centre for Social Care, Health, and Related Research, Birmingham City University. “Further work is needed to establish the extent of these relationships across more organizations.”