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The editor

The relationship between nursing numbers and patient care needs careful scrutiny

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The debate over what is the ‘right’ number of nurses for a hospital to employ is too often conducted through comparison with historical staffing levels or with reference to available finance. Both are unreliable guides.

A more robust approach to the issue is to examine the nature of the hospital’s workload and the other significant influences on patient admission -such as the number of GPs in that particular area.

Lord Darzi’s NHS Next Stage Review has ushered in an era in which the health service will take such clinical factors as its guide - for example through the development and publication of quality accounts.

One of the nursing profession’s key responses to the Darzi agenda was last autumn’s publication of the State of the Art Metrics for Nursing, which proposed the establishment of measures to better understand the contribution of the profession to patient care.

‘The message of the research we publish this week is clear – after adjusting for the relevant influences – there is a strong relationship between nursing numbers and patient mortality rates’

Now the authors of that report have more closely examined the issue of the relationship between nursing numbers and clinical performance - as measured by the relative mortality rates within a trust - exclusively for Nursing Times.

The message of the research is clear - after adjusting for relevant influences - there is a strong relationship between the nursing workforce and patient mortality.

There is also a strong relationship between nursing numbers and length of hospital stay, which in itself is a proxy for poor care.

People’s first reaction, when presented with information which raises awkward questions, is to query the data’s accuracy and relevance. No doubt this will be how many will respond to theses findings.

The researchers are quick to point out that more work is needed in order to fully understand the relationship between nurse numbers and patient care.

The data must also be considered alongside other factors - as our research shows not all trusts with lower than average staffing levels have poor mortality rates.

But senior nurses have been surprised to see nursing workforce levels vary by as much as 90% in trusts of a similar nature. Equally some trusts with poor mortality rates that have already begun exploring the contribution of nursing to that performance have been very disturbed by what they found.

We hope and expect the most important contribution of the research we publish this week will be in stimulating the debate over which is the most robust way of determining the contribution of nursing
to high-quality care.

Nursing Times is committed to being a leading contributor to that ongoing debate.

Alastair McLellan, editor, Nursing Times

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