Registered nurses are too often viewed as task completers rather than as being critical to safety, researchers have warned.
Despite repeated evidence showing a relationship between nurse staffing and patient safety, they found this had “little impact on policy”.
“Nursing is not simply the delivery of tasks it requires continuous decision making and the assessment of risk”
Alison Leary, from London South Bank University, and Geoffrey Punshon, from University of South Eastern Norway, made the observations in a new report published in the British Medical Journal.
The article –called Determining acute nurse staffing: a hermeneutic review of an evolving science – evaluated existing studies on hospital nurse staffing.
Out of 769 studies reviewed, 767 demonstrated some association between nurse staffing and factors such as safety, staff or patient satisfaction, working conditions, and work left undone.
However, none were found to have examined nursing in terms of being a safety critical industry or a profession highly reliant on knowledge.
“This might be because the approach to workforce modelling in nursing is focused on linear, deterministic approaches such as time and motion or time filled with tasks,” the review said. “This is more akin to workforce modelling in the service industries.”
In addition, the report found nursing workload was usually calculated as “countable tasks”, which was “likely to be an oversimplification of complex work” and did not recognise other factors such as the contribution nurses made to workplace culture and climate.
“The nature of these relationships should be further examined in order to determine nurse staffing”
There was deemed to be “overall benefit” in having registered nurses with a degree level qualification in the workforce, the review said.
It stated: ”Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution.
”The nature of these relationships should be further examined in order to determine nurse staffing,” it said. “The body of knowledge appears substantial and complex yet appears to have little impact on policy.”
The review suggested that evidence from other safety critical displines could be better utilised and applied to nursing.
Asked what readers should take away from the review findings, Professor Leary told Nursing Times: “There is a lot of evidence to support a relationship between registered nurse staffing and patient safety but it’s rarely used by decision makers.
“Nursing is not simply the delivery of tasks it requires continuous decision making and the assessment of risk,” she said. “Nursing is a knowledge intensive occupation that is safety critical.”
Professor Leary said viewing nurses as safety critical could help people understand the “risk good nursing care manages”, which she added “largely goes unnoticed”.