“Findings about staffing levels are not new but are still unheard”

This month saw the publication of our latest research on nurse staffing levels in the BMJ Open. In most respects, the findings are not new or surprising: hospitals with fewer nurses tended to have higher mortality rates. So what was new and why is (another) study showing the same thing important?

Well, for one thing, the finding is not entirely obvious. Not all studies have found an association and it is possible – even likely – that medical staffing levels, which tend to be closely related to nurse staffing levels, are more important when looking at mortality rates. This creates a problem as most existing research ignores medical staffing and can therefore be dismissed by those who choose to do so. Our study included staffing by doctors and still showed an association between mortality among medical patients and registered nurse staffing on medical wards.

Perhaps more interesting though is what we didn’t find. We looked at staffing by healthcare support workers (generally healthcare assistants on hospital wards). This is important, given current interest in reconfiguring the nursing workforce, increasing the number of support workers and measuring contact between all ward nursing staff and patients with no regard to professional qualification.

Current policies are based on the presumption that these unregistered staff can support the work of registered nurses and, to some extent, be a substitute for them. It is an appealing solution to shortages of registered nurses and, as a bonus, means using staff who are paid less. But our results give no indication that such substitution is possible with regard to patient safety.  In fact some of our findings indicated that hospitals that employed more support workers per bed had higher mortality rates.

Full story in The Nursing Times 24 February 2016