Abstract
We present an overview of the research evidence on nurse staffing levels in acute hospitals, and how it has been applied to policy and practice, focussing primarily on the UK. Drawing on research reviews and examples of specific studies, we outline the current state of knowledge. Much of the evidence comes from cross‐sectional studies. More recently, longitudinal studies allow a causal link between staffing and outcomes to be inferred. Lack of specificity on staffing levels has hindered application of research findings to practice; research rarely specifies how many nurses are needed for safe and effective care. The most significant impediment to achieving safe staffing has been an underestimation of the number of RNs needed and overestimation of the potential for substitution, resulting in low baseline staffing and a national shortage of RNs. Repeatedly, new staffing solutions are sought rather than tackle the problem of too few RNs head‐on.
Highlights
This paper was prompted by an invitation by the Royal College of Nursing Strategic Research Alliance to produce an overview of the research evidence on nurse staffing levels, the strengths and weaknesses, and how evidence has been applied to policy and practice
We were commissioned to evaluate how the national safe staffing policies introduced after Francis had been implemented in National Health Service (NHS) acute hospitals and whether evidence-based guidelines and other policies made a difference to safe staffing in practice. (Ball et al, 2019) Based on an analysis of national workforce data, a national survey of Directors of Nursing in all acute hospital Trusts, and case studies, we found a number of positive changes: new approaches to staff planning and rostering, and increased board awareness of safe staffing
The evidence described in this paper demonstrates the potential consequences of shortages of Registered Nurses on duty in terms of adverse patient outcomes including, but not limited to, the risk of death
Summary
INTRODUCTION AND AIMThis paper was prompted by an invitation by the Royal College of Nursing Strategic Research Alliance to produce an overview of the research evidence on nurse staffing levels, the strengths and weaknesses, and how evidence has been applied to policy and practice. The basic principle that healthcare providers must have sufficient nursing staff on duty to provide care safely and effectively is enshrined in various guidance and regulations influencing the National Health Service (NHS) in the UK. NHS organizations are expected to ensure that staffing is sufficient to fulfil this patient right, and staff are expected to raise concerns if conditions for safe care are not in place. This expectation is underpinned by a legal duty for NHS organizations to “encourage and support all staff in raising concerns at the earliest reasonable opportunity about safety, malpractice or wrongdoing at work, responding to and, where necessary, investigating the concerns raised and acting consistently with the Employment Rights Act 1996.”. The Code instructs: “You must act without delay if you believe that there is a risk to patient safety or public protection.” (NMC, 2018)
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