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‘No s**t Sherlock’: we know nurse numbers matter, but now we can prove it

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  • Study provides first England-specific evidence of importance of nurse numbers
  • Link between nurse:patient ratios and patient mortality applies to NHS
  • Missed nursing care confirmed as increasing patients’ risk of death

Our report on the study confirming the direct link between low nurse staffing and risk of patient mortality has attracted a plethora of critical comments on the Nursing Times Facebook page. Many questioned the need for research that simply confirms what everyone has known since the dawn of time. In fact the most popular comment was ‘No s**t Sherlock’.

So why do the team at the University of Southampton spend so much time investigating this issue if it’s so obvious? They do it because some people claim this is in fact not known and the evidence is not convincing – and unfortunately it’s primarily the people who make strategic decisions about the nursing workforce, both at local and national level.

Of course the policymakers have access to the huge body of research proving the link between nurse numbers and patient safety. And of course they’ve seen it – to avoid it would involve closing their eyes, sticking their fingers in their ears and singing loudly to themselves until it goes away.

So given all this evidence, why do we have a shortage of nurses that can only get worse as the baby boomer nurses reach retirement age? Governments have had decades to prepare by training more nurses, yet as recently as 2012 they were cutting nurse training places. And why were NHS trusts cutting nursing posts only a year after increasing them in response to the Francis report?

The decision-makers have justified ignoring the evidence because much of it is from international studies – they claim it doesn’t apply to the NHS or the UK. And that’s why the Southampton team’s latest study is so important – its results are based on NHS data. It may not tell you anything you didn’t already know, but it does mean national and local decision makers can no longer hide behind the fantasy that nurse numbers are crucial to patient safety everywhere in the world except here.

The team has not only confirmed the link between patient safety and the ratio of registered nurses to patients, but has also shown in another study that the increased risk of patient death is associated with incomplete nursing care.

Again, no surprises – too few nurses means some patients will miss out on some aspects of nursing care, or receive it from untrained staff who don’t have the skills to recognise when patients’ needs change.

Nursing is an evidence-based profession, so it’s disappointing to see nurses criticising research that proves what we knew all along. Knowing isn’t the same as proving – whether we’re talking about evidence on drugs, clinical interventions or workforce planning.

I’m not saying the study will lead to an overnight U-turn from those disputing the mountain of evidence on nurse numbers, but they can no longer claim it’s ‘nothing to do with us guv’. The Southampton team’s results can be used to challenge those who play fast and loose with nursing posts when they need to balance the books. It may not be new information, but it is new – and important – evidence.

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