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Nurse wellbeing has 'direct impact' on patient care

  • 51 Comments

Levels of satisfaction and wellbeing among NHS staff have a direct impact on patients’ experiences of healthcare, according to a major study by leading UK nurse researchers.  

Investing in staff wellbeing is, therefore, not only important for the nursing workforce but also for quality of care overall, they argue.

The three year study was carried out by the National Nursing Research Unit at King’s College London and Southampton University and aimed to determine which particular staff attitudes and behaviours impacted on patient experiences.

It involved over 200 hours of direct care observation at four trusts – two acute and two in the community – as well as hundreds of interviews and surveys of patients, frontline staff and senior managers.

Glenn Robert, healthcare quality and innovation chair at the NNRU, said the study showed interpersonal relationships with staff were “critical to patient experience”, but the level of such connections was “often poor”.

“Patients want staff to show genuine interest in them as people; to be non-judgemental and competent; continuity of staff enhances levels of trust and the confidence felt by patients that their care needs are fully understood,” he said.

But Professor Robert added: “Staff often reported not being able to deliver the care they wanted to, citing insufficient staffing levels and competing demands on their time as preventing them from delivering the high quality care they wished to give”.

NNRU director and lead study author Jill Maben said the findings were “significant” for proving the importance of staff wellbeing, while acknowledging they might seem obvious to many nurses.

“While it may appear self-evident that patients’ experiences and the quality of health care they receive are influenced by the experiences of the staff providing that care, there was limited UK research that explored this link,” she said.

“This study strongly suggests that patient experiences are better when staff feel they have a good working environment, support from co-workers and their manager and low emotional exhaustion.”

Professor Maben added that the study highlighted the “importance of the team” and the “critical role” of the team leader role in “supporting and nurturing staff and in building a strong climate for patient care”.

 

  • 51 Comments

Readers' comments (51)

  • Tiger Girl

    '“While it may appear self-evident that patients’ experiences and the quality of health care they receive are influenced by the experiences of the staff providing that care, there was limited UK research that explored this link,” she said.'

    Why on earth cannot we just use a bit of common sense, and put research efforts into looking at things we probably are not already almost certain of - this is another one, where a contrary finding would seem 'inexplicable' !

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  • A three year study to come up with this!!!!

    I could have concluded this study in 3 seconds.

    What a waste of time and money.

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  • It's my experience that it takes little to make a person feel valued. This information could have been gathered for 25% of the cost if, indeed it needed to be done, and the money spent on investing in our nurses e.g funded professional development instead of being told there's no time or money available.

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  • michael stone

    I'm with Tiger Girl on this - concentrate on useful research !

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  • Susan Markham

    Nurse wellbeing has 'direct impact' on patient care?

    Well call me an idiot (and I mostly am) but I could have come to that conclusion thirty years ago without the “three year study that was carried out by the National Nursing Research Unit at King’s College London and Southampton University.”

    How much of a slice of the NHS pie did these numpties get to tell us something that we already knew?

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  • tinkerbell

    well nock me down with a feather! Who'd have thought?

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  • Yeah but in fairness; given the often facile drive for an evidence base, isn't it handy to actually have one that reminds people (managers, accountants, politicians etc) that in order to drive up standards of care they have to actually look after nurses?

    Next time someone wants to cut staff numbers, pay, supervision etc there is a pretty big bit of evidence to point at and say; 'hang on, why are you sabotaging standards of care?'

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  • This is one of the articles that makes the blood boil. In my experience nurses are badly treated, badly paid and dumped on at every opportunity while others get the prizes for pruning the budgets.
    Now to discover that the abuse of willing staff may affect them and how they treat the patients has been a wonderful way to keep the non touch academics in jobs and away from contributing to making improvements in practice and care. Who paid for that?

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  • Tiger Girl

    mark radcliffe | 16-Nov-2012 2:49 pm

    But politicians simply ignore any evidence that doesn't suit their objective !

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  • Mark is right on this but it's a chicken & egg scenario in as much as the while the research is ongoing there are cutbacks on resources, support and nurses, leaving us at a point where the outcomes will have less of an impact. Surely there's some middle ground, shorter research, lower costs and efforts made where they count - with the nurses.

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  • Nick Clegg spoke of the ideal of a "John Lewis economy"ie look after your staff and the staff will deliver for you. Happy staff = happy customers.

    The government are aware of this without the need for expensive research. They choose to ignore it as a model for the Health Service as it would cost too much.

    Why bother when good will and dedication are free.

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  • tinkerbell

    mark radcliffe | 16-Nov-2012 2:49 pm

    Good point, at least now we can point them to this major study and let that be an end to stating the 'bleedin obvious'.

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  • why don't they just believe what we tell them. what a waste of time and money - 3 years is outrageous.

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  • This does seem to be a very obvious conclusion to a lengthy period of study , at what cost to the nhs I wonder. Happy parents =happy children happy nurses = happy patients . Its not rocket science but plain common sense. Come on ladies, drop the granduer and get down on the shop floor .

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  • Did anyone read the research? It's a wide-ranging and comprehensive study which can and should be used as evidence in any case being made to the PTB re: staffing levels, resources, pay, pensions, etc., etc.

    Susan Markham | 16-Nov-2012 11:40 am

    "How much of a slice of the NHS pie did these numpties get to tell us something that we already knew?"

    Research money mostly comes from endowments, academic institutions, charitable contributions and the CSO. It is not taken from frontline care and cannot be used for anything other than research.

    Anonymous | 16-Nov-2012 3:43 pm

    "Who paid for that?"

    Not you.


    Tiger Girl | 16-Nov-2012 3:48 pm

    "But politicians simply ignore any evidence that doesn't suit their objective !"

    That's no excuse not to gather the evidence! Of course the conclusions of this study have been obvious to us for years, but without quantified and qualified evidence, our complaints can and are easily dismissed.

    The problem here is that these people have provided properly researched, good quality evidence and, instead of using it to take the fight to the government, we think that it is more constructive to call the researchers "numpties"!

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  • michael stone

    Anonymous | 17-Nov-2012 12:58 pm

    While it is logically true that in science having the evidence base counts, Tiger Girl is also correct: politicians simply ignore, or evade, any inconvenient evidence. And getting more NHS staff employed, comes down to politics.

    It is all very frustrating !

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  • DH Agent - as if ! | 17-Nov-2012 1:49 pm

    I did not state that Tiger girl was not correct in her assertion that government chooses to ignore evidence! My point was that this is no reason not to gather it in the first instance. And, of course, evidence and the gathering of it is certainly not the exclusive preserve of science! Neither is the study simply about "..getting more NHS staff employed..."!

    Nurses (and others) who obviously have not bothered to read the research have chosen place the researchers in the firing line for abuse. The National Nursing Research Unit, the only facility of its kind in the UK, produces evidence for the NURSING WORKFORCE to improve the lot for nurses and patients.

    Now, I have nothing against nurses having a moan. God knows, I do it myself and it is good to vent. However, nurses have done, and continue to do, absolutely NOTHING to take on this or any previous government. If they really want to improve their lot and that of their patients, save the NHS or whatever, then attacking those who are handing them the bullets for the gun is completely self-destructive.

    Yes. It is all very frustrating!

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  • tinkerbell

    Anonymous | 17-Nov-2012 2:42 pm

    thanks for making your point. Now I agree. If at first glance it seems unnecessary to state the obvious, if you are doing it to prove to the government a case, then i am totally behind anyone who is at least TRYING to do something constructive. I hope it has the effect that is sorely needed. Well done in that case to those involved.

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  • now that the evidence is there what is being done about improving staffing levels, reducing workload and making nurses happier? who is going to have the ba**s to stand up to our critics, and especially the media, and say that we are doing our best so please just leave us alone - you think you can do a better job then come and show us.

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  • Anonymous | 17-Nov-2012 4:02 pm

    What to do with the evidence? Well, that is up to us, is it not?

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  • tinkerbell

    Do we need a union to decide whether or not we take industrial action, anyone know the answer?

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  • tinkerbell

    cos' i'm fed up with waiting for them to do something about this devastation of our nursing profession.

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  • I think this research is good practice for a student first steps into doing research.
    Its easy and you cannot go wrong as common sense tells you so.
    It can also be valuable for stupid people who don't know better.

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  • this is research? three years seems to be an awful long time and only 200 hours were actually spent observing nurses, the rest was collating paperwork. the evidence was always there, any nurse in any hospital will tell you that they are completely stressed out, any OH department in any hospital can supply figures and show examples of work related stress and how it affects care.

    anyone who has either sat in on a disciplinary hearing or been the subject of one will tell you that stress, over-work, depression, lack of support all contribute to errors being made.

    any GP will tell you that there has been a significant rise in stress related illnesses amongst health workers.

    any caring patient and relative will tell you how they see the nurses rushing around, there are never enough of them, they don't know how they manage and there are even those who criticise the media for all the spiteful things they say about the staff.

    if nurses are under-par then the care they give is going to be under-par but nothing will change, it never does because we are just expected to put up and shut up.

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  • tinkerbell

    Anonymous | 18-Nov-2012 9:51 am

    Exactly, but i am remaining optimistic that the tide is about to turn and that we are getting the wind in our sails to take ACTION, i am just unsure when the unions will be balloting their members and can we take action without them if they don't.

    Anyone know the answer please?

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  • michael stone

    Anonymous | 17-Nov-2012 2:42 pm

    I don't disagree with you - but there isn't an unlimited amount of funding for research, and there is not an infinite number of researchers.

    The NHS/HC seems to spend quite a lot of time, proving things are true, when in reality any proof that they were untrue would strike one as so weird that one would tend to look very closely at the methodology employed, instead of believing the result.

    Although this isn't scientific - so as someone with a science doctorate I shouldn't really say it - there are some things that seem so blindingly obvious, that spending a lot of time, effort and perhaps money proving them, seems to be the wrong approach.

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  • This type of research needs to be done...after all, we are in an "Evidence-Based" profession. It may well prove what every single nurse knows but at least it is now, technically, on record rather than just being verbally said.
    Having said that, I do not see how it will make the slightest bit of difference mainly due to the fact that NHS Trust bosses already know that reducing front-line staff affects patient care and yet are choosing to carry on with job cuts anyway. Why? because Finances have become the only thing that concerns them now..patient care and safety are fast becoming an afterthought or not a thought at all. This has been born out by the CQC and their critical findings on some Trusts (my Trusts was forced to take on more nurses after the CQC noted that the large number of nursing staff cuts have dangerously endangered patient safety).
    Where do we take this research? Government? Trust Bosses? The Conservative/Lib Dem Government don't give a damn about the NHS....they would use this research as another tool to argue that privatisation is necessary; NHS bosses would just ignore it and carry on; Unions would say all the right things about it (We have said it all along, this is a travesty, staff cuts must stop etc) and then ultimately do nothing as they are toothless. And if neither Government or the NHS Bosses won't listen, then who is left?

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  • tinkerbell

    WE are left! We take it to the streets, we organise rallys' we raise our media profile y organising the press to be there we are are marching, if this feckless government are out to destroy nursing, if the unions are taking our union fees for doing feck all, then only we are left to do it for US and OUR patients.

    We can do this, we just ALL have to agree and work out a united strategy across the UK. Anyone up for the job? Seriously.

    Do we agree?

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  • DH Agent - as if ! | 18-Nov-2012 12:12 pm

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  • DH Agent - as if ! | 18-Nov-2012 12:12 pm

    The NNRU is an independent body. It is not run by the NHS.

    The NNRU researchers came up with a study proposal which THEY (as nurses) felt was very relevant to nurses and patients, designed the study, campaigned to various organisations for the funding and went about gathering good quality, robust evidence to back the conclusions reached. The methodology will stand up to any scrutiny, and questioning the integrity of the study is rather cheap.

    A government may choose to ignore proven evidence, but that does not make it less true nor should it ever be used as an excuse not to carry out the research in the first place. It most certainly beats the pants off the anecdotal evidence of nurses who moan constantly (with good reason), but then do nothing to change their situation or move the status of their profession forward. If you are going to argue your position, it is always more than a little handy to have evidence to back it up. This is one set of nursing colleagues who have actually got off their backsides and done something.

    As a non-nurse, you probably don't see the value of the research. However, as someone who claims to possess a doctorate, your reasoning baffles me.

    The question now is whether or not nurses and their unions take this research on board to help their cause.


    Anonymous | 18-Nov-2012 9:51 am

    "this is research?"

    Yes, it is. The same stringent and necessary protocols and governance that are applied to all research were applied to this study. Ethics approval alone, to allow the study to commence, can take months, designing the study, going cap-in-hand to a variety of sources for funding, writing protocols (often sent back several times before they are finally approved), recruiting participants, carrying out the study, ensuring that data is clean and of good quality, producing study conclusions, etc must be done within strict guidelines and scrutiny. Also, due to the nature of research work, be assured that all the researchers were involved in other research programmes and studies running concurrently.


    tinkerbell | 18-Nov-2012 1:25 pm

    "WE are left!"

    Precisely, Tinkerbell.

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  • Anonymous | 18-Nov-2012 9:51 am

    One last point.

    Do you know the first question you would be asked by any of the 'Powers That Be', (who wouldn't, if their life depended on it, seek the opinion of 'anyone who has either sat in on a disciplinary hearing or been the subject of one', 'any GP' or 'any caring patient and relative'), after reading through your comments?

    "Where's your evidence?"!

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  • anon 4.01 - plenty of evidence, you just need to know where to look.

    nothing will be done with the results of this study, there have been plenty of similar studies carried out in other countries.

    it's all just rubbish, nurses who feel threatened do not give 100% to the job.

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  • Even though it's a no-brainer to us nurses this is a great bit of research. It gives us evidence to argue for more staff, better management, education etc.

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  • Anonymous | 18-Nov-2012 5:25 pm
    Well, nothing will be done by you will it?
    Others have had to do the research and I suppose others will have to fight your corner for you. Pah!




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  • Mike Stone
    Tut, tut, Dr Stone, rubbishing the scientific method. Would you be interested in buying the prototype perpetual motion machine that I have built, or learn the secret of transmuting lead into gold, £200,000 for the lot ( and for anyone else on here who has got the cash), sorry can't give any proof about that claim until the cash is safely deposited in my Caymen Island bank account!
    Research takes a long, long, long time to devise, gather and then collate ( the mathematics really would be a struggle for most, even for those nurses not suffering from Dyscalcula. Chi squared etc, etc), but one wonders whether this study is flawed merely because of sample size.
    I was always under the impression that you need probably 10 times as many subjects as this to truly allow for statistical differences to make themselves felt ( for example Gallup poles at elections have a sample size of about 1500-2000 to be 'accurately' extrapolated to the rest of the population).
    Sometimes nursing does seem to be about teaching yer gran ter suck eggs, but we need to move away from anecdotes, God knows we have done enough (accidental) harm over the years because we have gone down the old-wives tale path instead of the scientific.

    Tinkerbell
    Aren't you going to join the new male nurses union? Free movember for all the ladies who want to join{ those of you who haven't already got one, ahem} ( p.s. has anyone heard about the new 'charity' fundraiser for hisute ladies called 'Fannuary'? Or did I have a very vivid dream!))

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  • tinkerbell

    redpaddys12 | 18-Nov-2012 10:58 pm

    if only there was something to join. I've got a union but never hear diddley squat from them.

    I've got colleagues who just agree with everything i say but don't offer any suggestions about what to do about it all.

    Think i am going to have to take my soap box to Hyde Park and rouse a rabble there with the local down and outs or join the sally army and get myself a tambourine.

    It is a bit concerning to me that i am starting to feel deflated, there is so much hot air but no action. Maybe we can get a balloon in the air but not much else going.

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  • I have read this report which states "our results support what we already suspected".

    It also bases its findings on wards typically care for 25 patients - 6-7 nursing staff on a day, 4-5 on a night shift, 8 patients per RN during the day, 10.8 patients per RN on a night shift. Where I work we are obviously completely off the scale, apparently the lowest staffing ratio was 10.9 patients per RN on a shift - I have 14.

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  • anon 9.4`1 - what will you do with this research? what steps have you taken to try and improve the situation.

    I would be grateful for any help you can offer me. So far I have written to everyone I can possibly write to, have completed these 'surveys' and submitted many many incident reports, I sit in on management meetings and patient group meetings, took part in the industrial action back in the 90's when the London hospitals were closed - what else do you think I and others (like yourself) can do?

    UNISON carried out a 24hr survey and came to the same conclusion as this survey.

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  • michael stone

    Anonymous | 18-Nov-2012 3:50 pm

    I did not question the methododlogy of this study - I questioned its usefulness !

    redpaddys12 | 18-Nov-2012 10:58 pm

    Well, that's the point - none of us would easily accept that perpetual motion machine, would we, because our 'body of understanding' would entirely collapse if we could find such a thing (although modern quantum physics, and especially these 'dark forces', do raise issues about that).

    But you need to have worked out how to improve nurse wellbeing to the optimum 'resources in and patient benefit out' balance point, for this research (and I admit I have not looked at it) to really be objectively useful - and I would be amazed, if it ahd managed to do that !

    Surely starting with some hard facts about nursing numbers and staffing mixes re measurable patient outcomes and patient complaint levels, would be a better place to start this from ?

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  • Anonymous | 18-Nov-2012 9:41 pm
    I addressed my comment to Anonymous | 18-Nov-2012 5:25 pm because I am sick of nurses who moan and don't do anything about it. Whether or not you are the same person I'm happy to answer your comment.
    I have done all the things that you have and are doing, been on strike, out on marches, days of action, written to MPs, etc and I will continue to do so. I am glad that you are another of the minority who do something. But most nurses do none of that. I agree with Anonymous | 18-Nov-2012 3:50 pm , Charlie Spencer | 18-Nov-2012 7:50 pm and others. This study (it's not a survey. Huge difference) is done and it is up to us to use it and other evidence to make our case. For me the issue is nurses themselves. Rubbishing the research and those who carried it out is typical of the defeatist and divisive attitude that exists in nursing. That's the real problem.

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  • DH Agent - as if ! | 19-Nov-2012 11:14 am

    'this research (and I admit I have not looked at it)'

    Clearly. Which explains your ill-informed post.

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  • Well, I for one am glad of this research because it makes a refreshing change to read something that supports nurses and doesnt just criticise them and make them out to be uncaring, money grabbing scoundrels! At last someone has taken the time and effort to research whether 1) patient care is being maintained effectively and 2) how nurses can be supported to provide better patient care instead of just blaming us and telling us to try harder!

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  • I would like it if this research had improved staffing numbers, staff-patient ratios, nurses well-being. but it hasn't. The next phase apparently is to look at how it affects mortality rates. We know what the conclusion will be but it will be years until nurses actually see any improvement following this study.

    This was part of the RN4CAST study that we all heard about months ago, it's not a new thing.

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  • Anonymous | 20-Nov-2012 6:33 am

    'I would like it if this research had improved staffing numbers, staff-patient ratios, nurses well-being. but it hasn't.'

    Which is the fault of apathetic nursing workforce, not the researchers. No. it isn't a new thing and yet most nurses have never heard of it......a pro-active profession like Doctors, Teachers, etc. would have known about this type of study and used it, instead of drifting along in ignorance (about this and many other useful evidence). When are we going to stop blaming everyone other than ourselves for our situation?

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  • Yet another case of research funds and 3 years "study" being wasted.

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  • Three years pay for coming up with that crap???

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  • Well I see both sides of the coin after reading most of the comments, and I still feel it is valuable for stupid people, so what we have to do, is workout how we can use this research/study to make a connection to the stupid people who are maintaing low staffing levels and giving us poor working conditions.

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  • Anonymous | 20-Nov-2012 9:41 am

    'Three years pay for coming up with that crap???'

    And it will still be way more than you and many of your colleagues have done!

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  • Anonymous | 20-Nov-2012 6:16 pm

    And it will still be way more than you and many of your colleagues have done!

    or will ever do i'm afraid. it's easier to moan and do nothing. but thats nurses for you.

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  • perspicacious!

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