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Higher nurse ratio improves care, finds major study


Increasing the ratio of registered nurses to patients significantly improves the perceived quality of care on hospital wards, according to early findings from a major study.

Researchers at King’s College London and Southampton University last week presented preliminary findings from a survey of 400 wards across more than 46 hospitals in England, showing the impact of reducing numbers of registered nurses.

The findings revealed the number of patients per nurse on day shifts varied from five to 10. Skill mix was also varied, with registered nurses comprising between 43% and 68% of all nursing staff across different wards.

Overall, 31% of the 3,000 nurses taking part rated care in their ward as excellent, while half said it was good and a fifth said it was poor or fair.

But those who said it was poor or fair worked in wards that had on average nine patients per nurse. This dropped to seven patients per nurse on average for those who described the care as excellent.

Southampton University professor of health services research Peter Griffiths told Nursing Times: “This shows there are consequences for reducing the registered nurse workforce. It strongly suggests that the push to substitute nursing aides for registered nurses as a cost saving measure is unlikely to achieve adequate quality of care.”

Trusts planning to swap nurses with healthcare assistants or assistant practitioners needed to monitor the impact on care, he warned.

Professor Griffiths added: “Mid Staffordshire Foundation Trust provides a fantastic narrative of a trust that was experimenting with its workforce but didn’t see the need to monitor the consequences.”

He admitted nurses’ perceptions of care quality were not necessarily accurate, but said research had shown they were often closely linked with more objective measures.

The research also found that three quarters of nurses surveyed said that on their last shift they lacked time to comfort or talk with patients, while 40% said patient surveillance had suffered. A third said patients’ oral hygiene had been neglected.

Asked about “negative events” that happened on a monthly basis in their wards, 55 per cent said pneumonia, half said urinary tract infections and 44 per cent said patients had injured themselves after falling. 

The final report on Human Resources Management for Nursing in Europe, a study on the impact of nurse deployment on patient safety is expected to be published by the end of the year.


Readers' comments (31)

  • And we had to spent money on that study. Any nurse could have told you that already. But with all the staff reduction this will never happen.

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  • Hasn't this already been established?

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  • You don't say!!!! Some Europe countries, Canada and Australia have been doing this for usual the UK is behind in the times....or just burying it's head in the sand.

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  • Britain seems to be satisfied with spending vast amounts of money setting up teams and departments to investigat problems, writing endless reports on those they manage to discover or perceive themselves to be problems, they are past masters at stating the obvious and try to take credit for what they consider their own major discoveries and revelations before the reports are filed to gather dust and moving on to the next problem. The press get hold of many of these which then run the risk of becoming totally distorted.

    What never seems to happen is the provision of solutions to all these problems let alone the implementation of tenable solutions possibly because of lack of funding due to misappropriation of resources.

    Sometimes as a result of reports new 'experimental' committees are set up to patch up old dysfunctional systems which provides more jobs with large salaries for doing nothing because the staff do not have front line experience and fail to listen to those that do!

    As the commentator says above most other European countries manage as do even the newer members of the EU which are developing at a faster rate than Britain seems to be because of they have the right mental attitude and approach to providing healthcare.

    Why does Britain, with all its resources, remain so backward in its thinking. Are people still sitting back and revelling in its ??? ' glorious' ???? past? It seems that Britain is totally profit driven whilst forgetting the essential sector required to service the individuals who are working to provide the generation of profit and wealth as well as the poorer members of society and the sick. Why is the profit making sector supported so well to the detriment of the service sector and its employees. They should be on an equal footing as one cannot survive without the other!!!!!

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  • No s**t sherlock!!!!!

    For crying out loud, there have been studies PROVING this for years!!! Other countries have had Nurse/patient ratios enshrined IN LAW for a long time!! It is about time this backward country catches up.

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  • There was 'Monitor' in the 1980's, which calculated staffing levels against patient dependancy. It was a huge investment to implement, only to be abandonded as it proved that more staff were needed, therefore more cost...deja vue, deja vue. But 'they' have got to be seeing to doing', then chuck it out. When will we wake up to see how we are manipulated, we are sitting ducks.

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  • Richard White

    These valid comments from readers merit an editorial from Nursing Times. How many times do we need to prove what is common general knowledge? Next it will be nutrition, then nurse training and so on.............What is the RCN saying publicly on these matters?

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  • going round, and round, and round, and round, and round, and round, and round, in circles but going nowhere, nowhere, nowhere, nowhere, nowhere, just going round and round and round and round and round and round! stuck record, getting tiring. nobody there to listen and provide answers. what are we to do? accept life in a hamster wheel going round and round and round and round until we are carted off to a care home to finish off in further discomfort!

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  • Lack of qualified staff on busy general wards also leads to an increase in ICU admissions...this in itself must account of an incredible amount of extra money, not to mention the suffering its causes. Even 10 years ago we did not see the levels of patients being admitted with acute renal failure caused by UTIs and dehydration, not to mention sepsis and pneumonia. Talk to any ICU outreach nurse and the picture painted is truely scary. Not just lack of skilled RNs but also junior doctors being left to fend without adequate support. Having witnessed first hand when an elderly neighbour was admitted to a local MAU (not my own trust but I doubt this would have made a difference) the 48 hours he was there, he saw only HCAs on a regular basis- the RNs only had time to administer his IV drugs and the doctors were like ghosts- only evidence being written comments in the notes. I spent 16 hours sat with him as he was scared of being left alone. The RNs knew I was a nurse myself and just kept apologising. I monitored his fluid input and output as no-one else was doing so. I had a stand-up row with the "hostess" when she gave him food that he hadn't ordered that was cold and nutritionally inadequate. I already had a fair idea of how bad MAU would be from my own trust but it was a real eye-opener. Nearly 50 beds and never more than 5 RNs (including the nurse-in-charge) for the dayshift and 3 to 4 on the nightshift. I had to close my eyes and try and ignore what was happening to other patients. The nurses were visibly overstretched and stressed. Most that I talked to were hating their jobs- when they found out that I worked in ICU the comment was always "are there any jobs coming up"... I have written to the unit manager and the CEO listing everything that I witnessed and linked in papers on staffing levels but have yet to have a response, says it all really.

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  • Denise lockyer

    For goodness sake! What a waste of money this study was! Any nurse could have told them that, in ANY hospital !

    I truly believe that the common sense gene of these managers /bureaucrats , call them what you like has been removed!

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