Researchers Link Hospital Nurse Staffing to Patient Outcomes
New findings from the UK suggest that patients in hospital have a higher risk of dying when there are less nurses (Low Nurse Staffing) on staff than typically required. Additionally, researchers found that higher levels of temporary nursing staff were also linked to increased patient mortality. The findings suggest that increasing the amount of nursing staff may lead to improved patient outcomes.
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Nursing Times reports that the NHS trust study, titled “Nurse staffing, missed vital signs observations and mortality in hospital wards”, was conducted by researchers at the University of Southampton. Early findings were presented at the Royal College of Nursing’s international nursing research conference in Oxford. The findings have not been fully published yet.
Other studies have investigated this issue, but the findings have been disputed because researchers were unable to show that nurse staffing was directly related to patient mortality. These findings were also based on data from overseas.
The latest study links low nurse staffing to patient deaths. Researchers used data from 32 general medical and surgical wards in a large NHS hospital in England between 2012 and 2015. The analysis contained data from 111,000 patients and three million sets of vital signs observations. During the study period, 5.2 percent of patients died.
Patient Death Linked to Low, Temporary Nurse Staffing
Researchers found that during the first five days of hospitalization, the risk of mortality increased by three percent for every day that a general medical or surgical ward was staffed with fewer nurses than typically required. The analysis also revealed that high-risk patients were also affected; low staffing increased the risk of their observations not being taken.
Furthermore, increased nursing was linked to improved patient care. The study found that the likelihood of vital signs being missed dropped by two percent for every additional hour of nursing care provided in a 24-hour period.
Patients also had a higher risk of dying when there were higher levels of temporary nurse staffing. Mortality rose by 12 percent when temporary nurses provided 1.5 hours or more of care during a 24-hour period. On average, each patient received roughly 4.7 hours of nurse care daily. The risk of death increased when about one-third of that care was delivered by a temporary nurse.
The risk of mortality also increased when patient stays occurred during periods with high patient turnover. In other words, the risk of dying was higher when there were higher numbers of patients being admitted for each nurse. Additionally, the risk of mortality rose by 4 percent for each day a patient was on a general ward staffed with fewer care assistants than typically required.
“This is an early analysis but these latest findings are consistent with a growing body of research that suggests having sufficient numbers of professional nurses spending time with patients and providing direct care will result in the best outcomes,” said lead researcher Professor Peter Griffiths to Nursing Times. “This is one of the first studies that directly links the nursing a patient receives to outcomes,”
“The problems associated with the use of temporary nurses shown here highlights problems that arise from the significant shortage of nurses that is being experienced by the NHS,”
Studies examining the relationship between nurse staffing and patient outcomes has been correlational, meaning they do not indicate a causal relationship. In January 2015, the Minnesota Department of Health released a report to the state legislature titled “Hospital Nurse Staffing and Patient Outcomes”. The report said that “A review of the substantial body of evidence, including many recent studies, indicates there is a positive association between levels of nurse staffing and certain patient outcomes. Higher levels of nurse staffing were shown to be correlated with lower patient mortality, reduced patient falls, and fewer drug administration errors.”
“At this point, available studies do not prove causal relationship, or indicate that changes in patient outcomes are solely the result of nurse staffing decisions; they also do not identify points at which staffing levels become unsafe or begin to have negative effects on outcomes.”