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Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records

Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records
Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records
Context: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.

Objectives: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.

Design and setting: Cross-sectional analysis combining nurse survey data with discharge abstracts.

Participants: Nurses (N=3984N=3984) and general, orthopaedic, and vascular surgery patients (View the MathML sourceN=118752) in 30 English acute trusts.

Results: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12–49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.

Conclusions: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.
0020-7489
175-182
Rafferty, Anne Marie
d82c2661-2b39-447c-b975-c42834480975
Clarke, Sean P.
7ecc2197-ce55-4782-affd-339ff6618a0a
Coles, James
83b1d707-8f94-44be-bcd6-43fe9c8fe90a
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
James, Philip
13400610-2831-4c76-9333-03ca9174fc39
McKee, Martin
00241cff-34ff-4459-9263-c806a14deb6b
Aiken, Linda H.
6110096b-bab9-41a7-89f4-d7043011d6d9
Rafferty, Anne Marie
d82c2661-2b39-447c-b975-c42834480975
Clarke, Sean P.
7ecc2197-ce55-4782-affd-339ff6618a0a
Coles, James
83b1d707-8f94-44be-bcd6-43fe9c8fe90a
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
James, Philip
13400610-2831-4c76-9333-03ca9174fc39
McKee, Martin
00241cff-34ff-4459-9263-c806a14deb6b
Aiken, Linda H.
6110096b-bab9-41a7-89f4-d7043011d6d9

Rafferty, Anne Marie, Clarke, Sean P., Coles, James, Ball, Jane, James, Philip, McKee, Martin and Aiken, Linda H. (2007) Outcomes of variation in hospital nurse staffing in English hospitals: Cross-sectional analysis of survey data and discharge records. International Journal of Nursing Studies, 44 (2), 175-182. (doi:10.1016/j.ijnurstu.2006.08.003).

Record type: Article

Abstract

Context: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention.

Objectives: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care.

Design and setting: Cross-sectional analysis combining nurse survey data with discharge abstracts.

Participants: Nurses (N=3984N=3984) and general, orthopaedic, and vascular surgery patients (View the MathML sourceN=118752) in 30 English acute trusts.

Results: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12–49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals.

Conclusions: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.

Full text not available from this repository.

More information

Accepted/In Press date: 15 August 2006
e-pub ahead of print date: 24 October 2006
Published date: February 2007
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 389794
URI: http://eprints.soton.ac.uk/id/eprint/389794
ISSN: 0020-7489
PURE UUID: bb77e0ac-c597-48d1-a1f4-6cf0529c058e
ORCID for Jane Ball: ORCID iD orcid.org/0000-0002-8655-2994

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Date deposited: 15 Mar 2016 12:28
Last modified: 17 Dec 2019 01:34

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Contributors

Author: Anne Marie Rafferty
Author: Sean P. Clarke
Author: James Coles
Author: Jane Ball ORCID iD
Author: Philip James
Author: Martin McKee
Author: Linda H. Aiken

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