The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study

Abstract

Background: The Safer Nursing Care Tool (SNCT) is a system designed to guide decisions about nurse staffing requirements on hospital wards, in particular the number of nurses to employ (establishment). The SNCT is widely used in English hospitals but there is a lack of evidence about how effective and cost-effective nurse staffing tools are at providing levels needed for safe and quality patient care.
Objectives: To determine whether the SNCT corresponds to professional judgement, assess a range of options for using the SNCT and model the costs and consequences of various ward-staffing policies based on SNCT acuity/dependency measures.
Design and Setting: Observational study on medical/surgical wards in four NHS hospital Trusts using regression, computer simulations and economic modelling. We compared effects and costs of a ‘high’ establishment (set to meet demand on 90% of days), the ‘standard’ (mean-based) establishment and a ‘flexible (low)’ establishment (80% of the mean) providing a core staff group that would be sufficient on days of low demand, with flexible staff redeployed/hired to meet fluctuations in demand.
Main Outcomes: Professional judgement of staffing adequacy and reports of omissions in care, shifts staffed more than 15% below the measured requirement, cost per patient day and cost per life saved.
Data Sources: Hospital administrative systems, staff reports and national reference costs.
Results: 81 wards participated (85% response) with data linking SNCT ratings and staffing levels for 26,362 wards*days (96% response). According to SNCT measures, 26% of all ward days were understaffed by 15% or more. Nurses reported that they had enough staff to provide quality care on 78% of shifts. When using the SNCT to set establishments, on average 60 observations would be needed for a 95% confidence interval 1 whole time equivalent either side of the mean.
Staffing levels below the daily requirement estimated using the SNCT were associated with lower odds of nurses reporting ‘enough staff for quality’ and increased reports of missed nursing care. However, the relationship was effectively linear with staffing above the recommended level associated with further improvements.

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Identifiers

ORCID for Peter Griffiths: orcid.org/0000-0003-2439-2857

ORCID for Christina Saville: orcid.org/0000-0001-7718-5689

ORCID for Jane E Ball: orcid.org/0000-0002-8655-2994

ORCID for Alejandra Recio Saucedo: orcid.org/0000-0003-2823-4573

ORCID for Thomas Monks: orcid.org/0000-0003-2631-4481

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