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Direct link between low nurse staffing and risk of patient mortality revealed by study

  • 15 Comments

The risk of a patient dying increases “significantly” following a period in hospital during which the number of nurses falls below the required level, according to emerging findings from a new study thought to be the first of its kind in England.

Previous research has often been contested because it has not been possible to show how staffing directly links to mortality – only that there is an association – and has also been based on data from overseas.

“These latest findings…suggest having sufficient numbers of professional nurses… providing direct care will result in the best outcomes”

Peter Griffiths

But in this latest study at an NHS trust, academics from the University of Southampton have shown that over the first five days of hospitalisation, for every day a patient was on a general medical or surgical ward with nurse staffing below what was typically required, the risk of death increased by 3%.

High-risk patients (those with an early warning score above six) were also more at risk of their observations not being taken when on a ward with lower numbers of nurses.

The academics found that, for every additional hour of care provided to a patient by a nurse in a 24-hour period, there was a 2% decrease in the likelihood of vital signs observations being missed.

“This is one of the first studies that directly links the nursing a patient receives to outcomes”

Peter Griffiths

In addition, higher levels of temporary nurse staffing were linked to an increased risk of patient death.

When 1.5 or more hours of nurse care were provided by temporary nurses to a patient in a 24-hour period, the risk of death increased by 12%.

The hospital’s average number of hours of nurse care per patient per day was 4.7, indicating that when around a third of those hours were delivered instead by a temporary nurse, the risk of mortality was heightened.

Patients whose stays included days with high patient turnover – in terms of admissions per nurse – were also associated with a significant increase in risk of death.

Meanwhile, for each day a patient was on a general ward that was staffed below what was typically required in terms of the number of care assistants, the risk of death increased by 4%.

The study results were based on data from 32 general medical and surgical wards in a large NHS hospital in England between 2012 and 2015.

“The problems associated with the use of temporary nurses shown here highlights problems that arise from the significant shortage of nurses”

Peter Griffiths

It involved analysing around 914,000 patient days from 111,000 patients and three million sets of vital signs observations. Overall, 5.2% of patients died in hospital during that time.

The results from the study, called Nurse staffing, missed vital signs observations and mortality in hospital wards, have yet to be published in full, but early findings were presented at the Royal College of Nursing’s international nursing research conference in Oxford this month.

“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 Professor Peter Griffiths, who led the research.

“This is one of the first studies that directly links the nursing a patient receives to outcomes,” he told Nursing Times.

peter griffiths

peter griffiths

Peter Griffiths

“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,” he said.

Professor Griffiths also noted the national shortage of nurses could worsen in future years due to the requirement for students to take out loans for nurse training from this autumn. He highlighted that applications to pre-registration courses had dropped compared to last year.

The results from this study – which found higher temporary staffing increased the risk of mortality – showed the possible consequences of future shortages, as managers may be forced to fill more shifts with agency or bank workers, he added.

  • 15 Comments

Readers' comments (15)

  • The risk of a patient dying increases “significantly” following a period in hospital during which the number of nurses falls below the required level.

    I would have thought this was obvious.

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  • This is no new news or finding. It's an obvious thing. What the research report presented here failed to do was to mention that minimum required number of nurses per patients (nurse to patients ratio). The "minimum nurse ratio" is still not clear in some hospitals.

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  • The finding may seem obvious - indeed it confrims other research. however because most of that research is from the US there has been considerable resistance, indeed denial, by those responsible for workforce and staffing to accept it. So this research, carefuly done and in an English hopsitla is very welcome and necessary.

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  • In other news, Pope comes out as Catholic

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  • In light of this data and the current UK nursing shortage, it is a concern that NMC testing processes are blocking university prepared (bachelors and masters prepared) US nurses hoping to work in the UK. This most significantly refers to their OSCE test; a very costly practice based testing scenario which does not support preparatory practice. The best way for any such nurse to pass this test is to first enter the UK system as an HCA, which NMC does not yet regulate, to allow practice experience. Certainly the NMC/UK has the right to block highly trained US nurses but perhaps not the best way to manage current NHS challenges.

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  • Yeah can't understand why nobody would want to train for tuition fees of 9.5k a year, no bursary, earn far less than any other graduate at £21000 a year before deductions which basically put them on not much more than minimum wage, no respect off patients or relatives, not supported by upper management, no chance of any pay rise and a thankless job to boot! This will get far worse unless the government starts appreciating what nurses do and stop treating us like idiots.

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  • Why has it taken so very long to do this study into the obvious?

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  • What a surprise !

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  • No shit Sherlock springs to mind but seriously, this study doesn't really help - we could close wards and redistribute nurses so that each ward was safely staffed but then we'd have even less beds than we do now. We need a long term plan from the NHS hierarchy to resolve this issue for all our sakes. As others have said, while nurses now have to fund their studies and start their career deeply in debt with no opportunity to earn what other graduates, do this situation will only get worse. I'm at a loss as to where we are heading

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  • It doesn't take a genius to work these findings out!it's always spouted out like projectile vomit but what's the point if nothing ever changes !

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