Abstract
BackgroundThe shortage of health workers is a global phenomenon. To meet increasing patient demands on UK health services, providers are increasingly relying on temporary staff to fill permanent posts. This study examines the occurrence of ‘care left undone’, understaffing and temporary staffing across acute sector settings.Methods“Secondary data analysis from an RCN administered online survey covering nurses from hospitals and trusts across all four UK countries. Staffing and ‘care left undone’ measures were derived from the responses of 8841 registered nurses across the UK. A locally smoothed scatterplot smoothing regression analysis (Loess) was used to model the relationship between any ‘care left undone’ events and full complement, modest and severely understaffed shifts, and proportions of temporary staff.ResultsOccurrence of ‘care left undone’ was highest in Emergency Departments (48.4%) and lowest in Theatre settings (21%). The odds of ‘care left undone’ increase with increasing proportion of temporary staff. This trend is the same in all understaffing categories. On shifts with a full quota of nursing staff, an increase in the proportion of temporary staff from 0 to 10% increases the odds of care left undone by 6% (OR = 1.06, 95% CI, 1.04–1.09). Within the full quota staffing category, the difference becomes statistically significant (p < 0.05) on shifts with a proportion of temporary nursing staff of 40% or more. On shifts with a full quota of nursing staff the odds of a ‘care left undone’ event is 10% more with the proportion of temporary nursing staff at 50%, compared to shifts with modest understaffing of 25% or less with no temporary nursing staff (OR = 1.1, 95%CI, 0.96–1.25).ConclusionThe odds of a ‘care left undone’ event are similar for fully staffed shifts with a high temporary nursing staff ratio compared to severely understaffed shifts with no temporary nursing staff. Increasing the proportion of temporary nurse staff is associated with higher rates of self-reported care left undone by nursing staff. This has significant implications for nurse managers and policy makers.
Highlights
The shortage of health workers is a global phenomenon
We identified from the dataset, and excluded staff working in public health, outpatient, neonatal, maternity, inpatient children & young people, inpatient learning disability, inpatient mental health environments
We have only examined the association between staffing levels, proportion of temporary staff and selfreported nursing ‘care left undone’
Summary
The shortage of health workers is a global phenomenon. The global shortage of professional health care staff can have adverse effects on the delivery of health care [1]. The World Health Organisation (WHO) estimates that, by 2030, there will be a worldwide net shortage of 15 million doctors, nurses and other health workers [2]. Where modelling of nurse workforce supply has occurred, four out of five predict shortages in the medium term (UK, Ireland, Canada and Australia) [3]. The focus of this research is the UK health service workforce, where staffing shortages within the National Health Service (NHS) are prevalent. A recent press release by the Health Foundation, King’s Fund and Nuffield Trust predicts that the current gap of 40,000 nursing vacancies could worsen significantly, with nurse shortages doubling by 2023/24 [5]
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