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Invest in nursing staff wellbeing to improve patient outcomes, urge King's College researchers

Enhancing the wellbeing of staff at work not only improves their life quality for but also the quality of patient experience, according to leading UK nurse researchers.

They said their findings demonstrated the “importance of investing in and supporting individual staff at work”.

Their call comes at a time when nurses are increasingly warning they are under pressure from cuts to staff, at risk from burnout and that patient care has worsened as a result. A survey carried out by Nursing Times in February this year found more than half of nurses believed their ward or unit was dangerously understaffed.

The academics, from the National Nursing Research Unit at King’s College London, said while it was “reasonable to presume” that patients received better care from nurses who felt happier in their work, little research had previously been done to prove it at ward or team level.

As a result, they studied links between patients’ experience of healthcare and staff wellbeing eight settings in four different trusts in England.

These comprised an emergency admissions unit, a maternity unit, an older patient’s ward, a haemato-oncology ward, two adult community nursing service teams, a community matron service and a rapid response team.

Overall, the study involved 200 hours of observation, interviews with 100 patients and 86 staff, and surveys of 500 patients and 300 staffs.

Analysis by the researchers identified seven staffing factors linked to good patient-reported experience. These included high levels of support from colleagues, low emotional exhaustion, support from managers and the trust and a good work “climate” at both local and organisation level.

“If staff wellbeing at work is good, it is likely that staff will perform better in their jobs, rather than the other way round,” the study authors concluded.

The researchers also noted that sickness absence should be viewed as a “barometer” of wellbeing issues that affect care quality, with high levels “indicative of a poor work climate”.

They recommended measures including the appointment by trusts of a board executive champion for staff health and wellbeing, and that occupational health departments should view sickness absence as an issue for the organisation rather than the individual.  

“This study strongly suggests that there is a relationship between staff wellbeing and staff reported patient care performance and patient-reported patient experience,” they stated.

“Seeking systematically to enhance staff wellbeing is, therefore, not only important in its own right but can also improve the quality of patient experience,” the authors added.

The research is highlighted in the NNRU’s latest Policy Plus research summary report, which was published last week.

The findings echo those of the seminal Boorman report – formally known as the independent NHS Health and Wellbeing Review – which was published in 2009 under the previous government.

The report, which was commissioned by the Department of Health, highlighted the “relationship between staff health and wellbeing and performance on such key issues as patient satisfaction”.

It made 20 national recommendations, which the then health secretary Andy Burnham said he was committed to implementing.  


We will be having a live Twitter Chat on staff wellbeing and its effect on patients, at 1pm Wednesday 8th May. Follow #NTtwitchat and use this hashtag in your tweets to join in the conversation.


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Readers' comments (31)

  • It would be interested to know how many nurses suffer chronic back pain and continue to 'turn in' despite their pain.

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  • this has been studied in nursing and in other services for many long years. isn't it now time to act on the recommendations of the numerous reports and texts written on this matter?

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  • The fact that ANY so called manager needs to undertake this kind of research is ridiculous.

    ANY manager worth his or her salt knows this instinctively. Just like a sheep dog rounds up anything.

    Not forgetting that the NHS some years ago - as stated in one of the falsely entitled documents called NHS PLAN - it stated:-

    After four years research it has shown that if you value and involve your staff; they and their work quality improves, sickness and absenteeism falls as does staff turnover.

    So it goes to show that these researchers never read any of the many documents [more than one a year] Entitled NHS PLAN.

    Mind you the way the entire NHS staff are being abused I doubt if ANY of the NHS managers from top to bottom have read any of the documents.

    Their attitude and actions, suggest the definitely did not read that or have totally ignored it.

    Until they draw up a proper detailed plan for the entire NHS, they are going to continue to jump from one "VISION" to another.

    There never has been a detailed plan CPA] for the NHS. Just one reshuffle after another.

    You would have laughed if you were to learn that say the London Shard or the A 380 or the Channel Tunnel had never been planned in detail [CPA] and construction went ahead just on a "VISION".

    Well that is what is happening to the NHS.

    Another [the biggest] reshuffle not planned. Doomed to fail just like all the other reshuffles.

    Who will suffer ? the staff that glue the bits together to provide the best they can under ridiculous situations.

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  • What happened to :-

    Nurse health and well being should be 'core principle' for NHS trusts


    Wards dangerously understaffed, warn more than half of nurses

    The government, the top Dept' of Health managers and the top NHS managers, have ripped the NHS to shreds for many years.

    They now have proposed to put it all in the hands of private enterprise - the PRIVATELY employed GP service.

    Who as a matter of interest receive an NHS pension.

    How many other PRIVATE contractors [as are GPs] receive NHS pensions.

    So are GPs PRIVATE contractors or not ? If they are let them provide their own pensions.

    Nuring staff get paid far less than their Australian counterparts and doctors receive 2 to 3 times more pay than their French counterparts.

    You cannot put a defined budget on health care - FACT.

    You can only determine that which will and will not be treated and ensure ALL departments a managed efficiently.

    For example, just take:-

    Catering as shown on TV.

    Works / estates - One assessed as 33% then the engineers withdrew so the building section reassessed at 97% efficient - what does that say about the engineers ? - less than 3% !!!

    And there are more departments like that.

    The NHS efficiency can not be managed just by cutting budgets nor just by looking at ward staff and waiting lists.

    The NHS is a Lego Land of interconnected and inter reliant services.

    That is why you need a set of Critical Path Analysis [detailed plans costed and time scaled] for the entire service. Until then they are flying by the seat of their pants [ 2 instead of 5 nurses to run a full long day shift - not one manager rolled up their sleeves, preferring to stay at their desk]

    The faults lay at many levels from the VERY top to the very bottom. Plus too much reliance on qualifications and too little on experience.

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  • Oh, I do love it when "Researchers" decide to study things that are blatantly obvious to everyone (bar them apparently) and then present the findings as surprising! You could perform the same research (adjusted accordingly) at a National Bank and find that Customer Experience would be better when staff felt valued and appreciated as the staff would be more personable and communicate better.

    It is all well and good keep on coming out with studies and reports saying front-line staff need more support, nurturing, valueing etc but as long as Management at all levels have only economics as a consideration, then these reports are, essentially, worthless. Until we can get rid of the millions of unecessary "managers" and other extraneous staff from the NHS, front-line staff will continue to feel pressured, non-valued, isolated and disatisfied and it will continue to impact on patient care (not because we don't care but because we have the inability to perform our jobs as well as we need due to decisions beyond our control). Perhaps at some point, Academics somewhere will do research where it is really needed: How many Managers in the NHS are actually not needed?

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  • It is always disappointing, if not completely predictable, to read that the National Nursing Research Unit once again takes pelters about their research. Managers did not undertake this research. It says nowhere that they did, yet people are still asserting that researchers = managers. Nursing is an evidence-based profession, yet nurses scorn the evidence and blame the researchers.

    I would like to see some research done into just why UK nurses are so ignorant, apathetic and ineffective in bringing about change. I want to know why they refuse to take action against the conditions which endanger themselves and their patients. I would like to know why they turn on those who provide evidence that would benefit them and attack their integrity. I suspect that it has a lot to do with victim culture, poor education (where nurses are churned out ill-prepared to challenge and argue for their patients) and the fact that it is much much easier to moan and blame someone else.

    Here's an idea. Use the evidence provided and challenge the government, policy-makers and managers with it to provide the right working environment for nurses.

    Nah. That would make too much sense. You'd need to go to Australia to find such forward thinking nurses.

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  • Anonymous | 7-May-2013 7:05 pm

    the only thing I disagree with you is that you don't need to go as far as Australia to meet such forward thinking nurses. you just need to cross the English Channel or the North Sea! Possibly the Irish Sea as well?

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  • Anonymous | 7-May-2013 7:30 pm
    Anonymous | 7-May-2013 7:05 pm

    You are probably right. I have worked in Oz, but not Europe.

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  • The idea of spending money to get better staff and patient care is currently failing at the "spending" part of that proposal. Even with research demonstrating comprehensive cost benefits of that investment, I doubt we'll be able to move past that nearsightedness at the trust management level. I'm all for fighting to see that change, but I'll be awful lonely out there by myself.

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  • Anonymous | 7-May-2013 10:08 pm

    "I'm all for fighting to see that change, but I'll be awful lonely out there by myself."

    Indeed. And that is the real problem here.

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  • yes, 10:31pm, I agree and I often feel out in the cold by trying to change things alone, by organising work place meetings and approaching management.
    It is all very well 7.05pm criticising us stupid, sheepish backward thinking English nurses. But is there any suggestion on how to move forwards without sticking out your neck and losing your job/prospects of promotion/progression? No. Just how marvellous every one else is.
    I too have worked in Oz, NZ and the US, and believe me they are no better than us, (sometimes they are insufferably worse), they just have different approaches to the funding of nurse training and health care.

    I understand why others don't want to rock the boat, most need their jobs. But solidarity amongst the nursing profession is needed now more than ever before, otherwise we will see ourselves slipping backwards and losing the respect of the public we are supposed to serve. This Government have a lot to answer for, and will not be satisfied until they have demoted us to ancilliary workers, the mere handmaidens they have always believed us to be.
    So for all of our sakes, it is about time ALL nurses found their backbone and started to protest at not only working conditions, but the way the entire health service is taking an enormous nose dive.

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  • Anonymous | 7-May-2013 11:07 pm
    Anonymous | 7-May-2013 7:05 pmm

    " stupid, sheepish backward thinking English nurses."

    Your words. Not mine. However, I do tend to agree. I too stick my neck out, have done for years and continue to do so. I am surprised that you rush to the defence of those who are content to let you do so alone. My initial comment was in response to the destructive and short-sighted criticism of researchers. It is symptomatic of the mentality of nurses in this country that they turn their frustrations in the wrong direction at an easy target. And inevitable that they take offence and become defensive, as you have, when they are criticised for their own lack of action.

    I worked in Oz (have no desire to work in the US) and my experience is of much better working conditions, patient care and solidarity amongst colleagues the likes of which is NEVER seen in the UK. As another commenter has posted, it happens in other countries not too far from us.

    This country is slipping further down the world ranks of decent nursing care. I agree with your last why defend those who continue to do nothing, whilst criticising those who advocate the opposite?

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  • Anonymous | 7-May-2013 11:07 pm from 10.31pm, 7 May 2013.

    I actually agree with the above post and his/her previous comment.

    Further to my own post. If nurses acted together and for one another instead of leaving a few to hang out to dry, then investment in staff wellbeing would be very near the top of priorities for the NHS.

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  • like in all other jobs, everyone feels they have to cover their own back. if you make a mistake then don't rely on any support, you will always be on your own. to think otherwise is naive.

    it's obvious that if you have happy staff then the work place will be happier, research like this is done all the time all over the world. at the moment nurses and other health care workers are not happy, patients are not happy, relatives are not happy.

    many health workers just want to go into work, do their job to their best ability and go home. we don't want to fight anymore, it's taken it's toll on us, we can't deal with this anymore.

    we don't want to have 'issues' every day, be criticised in the press, live in constant fear of being reported or struck off for something we haven't even done. we don't want to have to go home and constantly worry about something that might or might not have happened on our shift and the potential outcome.

    this is the reality of nursing.

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  • Anonymous | 8-May-2013 5:54 pm

    Are you happy with that? Do you think that it is acceptable to state that "this is the reality of nursing" and leave it at that? You are not saying anything new. It is easy to say "I don't want this to happen".

    " we don't want to fight anymore"

    Are you serious? You never even started! Furthermore, you are not prepared to fight. That is why things will only get worse for nurses in this country.

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  • Anonymous | 8-May-2013 5:54 pm

    research like this is done all the time all over the world.

    is it? can you provide any links? i'm struggling to find anything comprehensive.

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  • Anonymous | 8-May-2013 6:40 pm

    may I answer pending a reply from Anon 5.54 pm

    this may help for a start. NT has many articles on the subject, presumably NHS and UK

    If the link doesn't work I found it just by entering the keyword 'wellbeing' in the search box at the top of the page. There are also associated links to articles to be found on the RH column of this article and others.

    I will go to google and see if I can find anything else internationally. It is something we studied on a management course and I subject I find of great importance and interest. If I find anything else for you I will post it later.

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  • Anonymous | 8-May-2013 6:40 pm

    further to my above comment:

    In Google Scholar and in Google – keywords ‘wellbeing studies nursing’
    As well as ‘international wellbeing studies in nursing’.

    These articles will give links to further studies on the subject.
    A more generalised search on wellbeing of staff can also be found in works on management theory.

    Like the introduction of the concept of general management into healthcare in the 1980s, and ‘Customer as King’, 'Quality Cycles' from Japan and a few others, there was a wave in the 1990s of staff being the most costly and valuable resource in any organisation and they should be looked after, as well as their physical and mental health, and valued, supported and offered job satisfaction and further training to get the maximum out of them. This generated a volume of research with all sorts of new initiatives being set up in all types of organisations including health care providers such as better occupational health, better shifts and working conditions, rest rooms for short naps, sporting facilities, clubs, counselling services, childcare facilities, professional and non professional courses, etc. but as soon as austerity came in early in the 21st century most of these quickly died out.

    A useful and interesting resource of a more general nature but also relevant to nursing is ‘Psychology at Work’, Ed. Peter Warr, Penguin.
    Hope this is helpful.

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  • ICN
    Position Statements 2000 [Occupational health and safety for nurses]

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  • Anonymous | 8-May-2013 8:00 pm

    cheers for the links. i'll have a look at them. i've read some work from the nineties and early noughties though nothing recent and comprehensive. i feel that austerity has rather thrown the baby out with the bath water which is why i am pleased to see some current research being carried out. thanks again for the links.

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