Performance of the Safer Nursing Care Tool to measure nurse staffing requirements in acute hospitals: a multicentre observational study

Abstract

Objectives: the best way to determine nurse staffing requirements on hospital wards is unclear. This study explores the precision of estimates of nurse staffing requirements made using the Safer Nursing Care Tool (SNCT) patient classification system for different sample sizes, and investigates whether recommended staff levels correspond with professional judgements of adequate staffing.

Design: observational study linking datasets of staffing requirements (estimated using a tool) to professional judgements of adequate staffing. Multi-level logistic regression modelling.

Setting: 81 medical/surgical units in 4 acute care hospitals

Participants: 22,364 unit days where staffing levels and SNCT ratings were linked to nurse reports of staffing adequacy

Primary outcome measures: SNCT-estimated staffing requirements and nurses’ assessments of staffing adequacy.

Results: the recommended minimum sample of 20 days allowed the required number to employ (the establishment) to be estimated with a mean precision (defined as half the width of the confidence interval as a percentage of the mean) of 4.1%. For most units, much larger samples were required to estimate establishments within +/- 1 whole-time-equivalent staff member. When staffing was lower than that required according to the SNCT, for each hour per patient day of registered nurse staffing below the required staffing level, the odds of nurses reporting that there were enough staff to provide quality care were reduced by 11%. Correspondingly, the odds of nurses reporting that necessary nursing care was left undone were increased by 14%. No threshold indicating an optimal staffing level was observed. Surgical specialty, patient turnover and more single rooms were associated with lower odds of staffing adequacy.

Conclusions: the SNCT can provide reliable estimates of the number of nurses to employ on a unit, but larger samples than the recommended minimum are usually required. The SNCT provides a measure of nursing workload that correlates with professional judgements, but the recommended staffing levels may not be optimal. Some important sources of systematic variations in staffing requirements for some units are not accounted for. SNCT measurements are a potentially useful adjunct to professional judgement, but cannot replace it.

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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 Ball: orcid.org/0000-0002-8655-2994

ORCID for David Culliford: orcid.org/0000-0003-1663-0253

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

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