Registered nurse, health care support worker, medical staffing levels and mortality in English Hospital Trusts: a cross-sectional study
Registered nurse, health care support worker, medical staffing levels and mortality in English Hospital Trusts: a cross-sectional study
Objectives: To examine associations between mortality and registered nurse (RN) staffing in English hospital trusts taking account of medical and healthcare support worker (HCSW) staffing.
Setting: Secondary care provided in acute hospital National Health Service (NHS) trusts in England.
Participants: Two data sets are examined: Administrative data from 137 NHS acute hospital trusts (staffing measured as beds per staff member). A cross-sectional survey of 2917 registered nurses in a subsample of 31 trusts (measured patients per ward nurse).
Outcome measure: Risk-adjusted mortality rates for adult patients (administrative data).
Results: For medical admissions, higher mortality was associated with more occupied beds per RN (RR 1.22, 95% CI 1.04 to 1.43, p=0.02) and per doctor (RR 1.10, 95% CI 1.05 to 1.15, p <0.01) employed by the trust whereas, lower HCSW staffing was associated with lower mortality (RR 0.95, 95% CI 0.91 to 1.00, p=0.04). In multivariable models the relationship was statistically significant for doctors (RR 1.08, 95% CI 1.02 to 1.15, p=0.02) and HCSWs (RR 0.93, 95% CI 0.89 to 0.98, p<01) but not RNs (RR 1.14, 95% CI 0.95 to 1.38, p=0.17). Trusts with an average of ?6 patients per RN in medical wards had a 20% lower mortality rate compared to trusts with >10 patients per nurse (RR 0.80, 95% CI 0.76 to 0.85, p<0.01). The relationship remained significant in the multivariable model (RR 0.89, 95% CI 0.83 to 0.95, p<0.01). Results for surgical wards/admissions followed a similar pattern but with fewer significant results.
Conclusions: Ward-based RN staffing is significantly associated with reduced mortality for medical patients. There is little evidence for beneficial associations with HCSW staffing. Higher doctor staffing levels is associated with reduced mortality. The estimated association between RN staffing and mortality changes when medical and HCSW staffing is considered and depending on whether ward or trust wide staffing levels are considered.
1-16
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Murrells, Trevor
9a57589a-d893-415c-8c3d-8b25d052f42c
Jones, Simon
f5d66e16-2c8e-4d48-ab97-0715a6e85c46
Rafferty, Anne Marie
d82c2661-2b39-447c-b975-c42834480975
9 February 2016
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Murrells, Trevor
9a57589a-d893-415c-8c3d-8b25d052f42c
Jones, Simon
f5d66e16-2c8e-4d48-ab97-0715a6e85c46
Rafferty, Anne Marie
d82c2661-2b39-447c-b975-c42834480975
Griffiths, Peter, Ball, Jane, Murrells, Trevor, Jones, Simon and Rafferty, Anne Marie
(2016)
Registered nurse, health care support worker, medical staffing levels and mortality in English Hospital Trusts: a cross-sectional study.
BMJ Open, 6 (2), .
(doi:10.1136/bmjopen-2015-008751).
(PMID:26861934)
Abstract
Objectives: To examine associations between mortality and registered nurse (RN) staffing in English hospital trusts taking account of medical and healthcare support worker (HCSW) staffing.
Setting: Secondary care provided in acute hospital National Health Service (NHS) trusts in England.
Participants: Two data sets are examined: Administrative data from 137 NHS acute hospital trusts (staffing measured as beds per staff member). A cross-sectional survey of 2917 registered nurses in a subsample of 31 trusts (measured patients per ward nurse).
Outcome measure: Risk-adjusted mortality rates for adult patients (administrative data).
Results: For medical admissions, higher mortality was associated with more occupied beds per RN (RR 1.22, 95% CI 1.04 to 1.43, p=0.02) and per doctor (RR 1.10, 95% CI 1.05 to 1.15, p <0.01) employed by the trust whereas, lower HCSW staffing was associated with lower mortality (RR 0.95, 95% CI 0.91 to 1.00, p=0.04). In multivariable models the relationship was statistically significant for doctors (RR 1.08, 95% CI 1.02 to 1.15, p=0.02) and HCSWs (RR 0.93, 95% CI 0.89 to 0.98, p<01) but not RNs (RR 1.14, 95% CI 0.95 to 1.38, p=0.17). Trusts with an average of ?6 patients per RN in medical wards had a 20% lower mortality rate compared to trusts with >10 patients per nurse (RR 0.80, 95% CI 0.76 to 0.85, p<0.01). The relationship remained significant in the multivariable model (RR 0.89, 95% CI 0.83 to 0.95, p<0.01). Results for surgical wards/admissions followed a similar pattern but with fewer significant results.
Conclusions: Ward-based RN staffing is significantly associated with reduced mortality for medical patients. There is little evidence for beneficial associations with HCSW staffing. Higher doctor staffing levels is associated with reduced mortality. The estimated association between RN staffing and mortality changes when medical and HCSW staffing is considered and depending on whether ward or trust wide staffing levels are considered.
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Accepted/In Press date: 27 October 2015
Published date: 9 February 2016
Organisations:
Faculty of Health Sciences
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Local EPrints ID: 385272
URI: http://eprints.soton.ac.uk/id/eprint/385272
PURE UUID: d8970e43-648a-4d79-b9e5-9bce9566bb62
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Date deposited: 18 Jan 2016 14:55
Last modified: 15 Mar 2024 03:51
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Author:
Jane Ball
Author:
Trevor Murrells
Author:
Simon Jones
Author:
Anne Marie Rafferty
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