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Major study: 75% of nurses believe too few staff to provide quality care

EXCLUSIVE: A major survey of nursing workforce and care has revealed significant variation in skill mix, and added to evidence of the strong link between staff levels and service quality.

The final results report from the RN4CAST study into nursing workforce – due to be published later this week – was shared exclusively with Nursing Times.

In England the study has involved gathering responses from nurses on more than 3,000 nurses, at 31 hospital trusts and on 400 general medical and surgical wards. It was led by the National Nursing Research Unit at King’s College London and the University of Southampton.

The research found that the average proportion of registered nursing staff – compared to unregistered healthcare assistants – on day shifts was 56%. Dame Christine Beasley, the previous chief nursing officer for England, has previously said the ratio of nurses to assistants should not fall below 60:40.

The research found the proportion of registered nurses to assistants varied from 43% to 68% between trusts.

There was also a more than two-fold variation in the ratio of patients to registered nurses from 5.2 patients per nurse at one trust to 10.9 at the trust with the highest nurse staffing levels.

When surveyed, fewer than a quarter - 24% - of nurses said there were enough staff to get work done while 27% felt there were enough registered nurses to provide quality care.

Nurses were also asked about patient safety on their ward. Where they said it was “excellent”, there was an average of seven patients per registered nurse, compared to more than nine where patient safety was “poor” or “failing”.

In an earlier stage of results previously reported by Nursing Times, 86% of nurses said at least one necessary activity was left undone on their last shift due to lack of time. Those on wards with fewer registered nurses per patient were more likely to report work left undone.

Professor Peter Griffiths, one of the authors at the University of Southampton, said: “The most striking finding is the huge amount of variation that we see across the country both in overall staffing levels but particularly registered nurse staffing levels and the skills mix on the wards.

“We’re seeing some fairly strong associations between staffing levels and missed care and staffing levels and nurses’ perception of quality.”

Jane Ball, another author and deputy director of the National Research Unit at King’s College London, warned about dissatisfied staff leaving: “With training places being cut we can’t afford to have the workforce further depleted because nurses are leaving.

“Just under a quarter said they’d like to leave the profession altogether. That’s expensive because it’s not just about recruiting a new member of staff to an organisation but losing expertise from the system altogether.”

Readers' comments (10)

  • Good research emerging underpinning common feelings across ward based profession.
    Next, primary care!

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  • great to see that there is some research been done in this area, it is much needed.

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  • This does not surprise me!

    What does amaze me is that Nurses continue to allow a)Themselves to be exploited and B) Patients to be put at risk.

    Advice on Whistle Blowing is available from the CQCO on 08000 724725 or Public Concern at Work ( a Charity) will also provide free and confidential advice on 020 7404 6609. Trade Union/Professional organisations will also assist.

    The phones should be red hot !!

    Refuse to be exploited !
    Demand a safe car environment for your patients !

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  • As a nurse on a medical ward I am exhausted and pulled in so many directions its a wonder I have not snapped.
    I feel like a punch bag as apparantly everything that goes wrong is the fault of the band 5 nurse.


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  • michael stone

    'Professor Peter Griffiths, one of the authors at the University of Southampton, said: “The most striking finding is the huge amount of variation that we see across the country both in overall staffing levels but particularly registered nurse staffing levels and the skills mix on the wards.

    “We’re seeing some fairly strong associations between staffing levels and missed care and staffing levels and nurses’ perception of quality.”'

    I await the actual report with interest, but I'm not entirely sure if the data was collected to prove the following or not - is there a definite, strong, correlation between 'nurses perception of quality' and measured quality (adverse incidents, patient ourcomes, etc) ?: because if that link is established, then it strengthens 'reporting by nurses'. If it isn't established, some people will use 'it is just what nurses are saying - there isn't real evidence to back it up' as an argument.

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  • Good point mike

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  • Staffing levels can make or break a ward lets be honest.
    The best nurse in the world cannot function without adequate support from co-workers.
    Stop blaming the nurse we are not superhuman, I await this report with great interest.

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  • what will happen now that the 'evidence' is there - can we book agency staff for when our ward runs on its normal skill mix of 50:50 with one RN per 12 patients?

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  • Anonymous | 27-Jul-2012 8:03 am

    Two questions

    1) Why would you want agency staff? Wouldn't an increase in the wards base establishment be preferable ?

    2) What have you done about the wards staffing level? 1-12 sounds to me to be boarding on, if not actually, dangerous.

    If true the CQC who at long last have recognised staffing to be important would be very interested in your situation and in
    all probability would make an unannounced visit !

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  • Hi All
    Addition to the last point.
    I worked as a Staff Nurse on a 24 bed stroke/rehab/medical ward. Permanent nights.
    Start of night shift at 1930. 5 Staff. 2 RGN & 3 HCA.
    2100 - 1 RGN & 1 HCA. And that was every night. Staff all moved to other opening escalation wards. I left, stating my concerns.
    Oh - It's under 'Special Measures'

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