Nurse understaffing associated with adverse outcomes for surgical admissions.

Background: Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes.

Methods: A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties.

Nursing Team Composition and Mortality Following Acute Hospital Admission.

Importance: Many studies show the adverse consequences of insufficient nurse staffing in hospitals, but safe and effective staffing is unlikely to be just about staff numbers. There are considerable areas of uncertainty, including whether temporary staff can safely make up shortfalls in permanent staff and whether using experienced staff can mitigate the effect of staff shortages.

Objective: To explore the association of the composition of the nursing team with the risk of patient deaths.

Inpatient midwifery staffing levels and postpartum readmissions: a retrospective multicentre longitudinal study.

Background: Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality.

Costs and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A systematic review.

Background: Extensive research shows associations between increased nurse staffing levels, skill mix and patient outcomes. However, showing that improved staffing levels are linked to improved outcomes is not sufficient to provide a case for increasing them. This review of economic studies in acute hospitals aims to identify costs and consequences associated with different nurse staffing configurations in hospitals.

Staffing levels and hospital mortality in England: a national panel study using routinely collected data.

Objectives: Examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Most studies investigating the association between hospital staffing levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups.

The association between multi-disciplinary staffing levels and mortality in acute hospitals: a systematic review.

Objectives: Health systems worldwide are faced with the challenge of adequately staffing their hospital services. Much of the current research and subsequent policy has been focusing on nurse staffing and minimum ratios to ensure quality and safety of patient care. Nonetheless, nurses are not the only profession who interact with patients, and, therefore, not the only professional group who has the potential to influence the outcomes of patients while in hospital.

Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies.

Background: The contribution of registered nurses towards safe patient care has been demonstrated in many studies. However, most of the evidence linking staffing levels to outcomes is cross-sectional with intrinsic limitations including an inability to establish that presumed cause (staffing) precedes the effect. No reviews have summarised longitudinal studies considering nurse staffing and patient outcomes.

Ward staffing guided by a patient classification system: A multi-criteria analysis of "fit" in three acute hospitals.

Aims: To assess how well the Safer Nursing Care Tool (SNCT) predicts staffing requirements on hospital wards, and to use professional judgement to generate hypotheses about factors associated with a "poor fit".

Background: The SNCT is widely used in the UK, but there is scant evidence about factors that influence the quality of staffing decisions based upon such patient classification systems.

Methods: Secondary analysis of data from 69 wards in three acute hospitals to assess the precision of the estimated staffing requirement, variation of estimates, correspondence with professional judgement and achieved staffing levels.

Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study.

Background: In the face of pressure to contain costs and make best use of scarce nurses, flexible staff deployment (floating staff between units and temporary hires) guided by a patient classification system may appear an efficient approach to meeting variable demand for care in hospitals.

Objectives: We modelled the cost-effectiveness of different approaches to planning baseline numbers of nurses to roster on general medical/surgical units while using flexible staff to respond to fluctuating demand.

Design And Setting: We developed an agent-based simulation, where hospital inpatient units move between being understaffed, adequately staffed or overstaffed as staff supply and demand (as measured by the Safer Nursing Care Tool patient classification system) varies.

The association between 12-hour shifts and nurses-in-charge's perceptions of missed care and staffing adequacy: a retrospective cross-sectional observational study.

Background: Due to worldwide nursing shortages and difficulty retaining staff, long shifts for nursing staff (both registered nurses and nursing assistants) working in hospitals have been adopted widely. Because long shifts reduce the daily number of shifts from three to two, many assume that long shifts improve productivity by removing one handover and staff overlap. However, it is unclear whether staffing levels are more likely to be perceived as adequate when more long shifts are used.

The association between 12-hour shifts and nurses-in-charge's perceptions of missed care and staffing adequacy: a retrospective cross-sectional observational study.

Background: Due to worldwide nursing shortages and difficulty retaining staff, long shifts for nursing staff (both registered nurses and nursing assistants) working in hospitals have been adopted widely. Because long shifts reduce the daily number of shifts from three to two, many assume that long shifts improve productivity by removing one handover and staff overlap. However, it is unclear whether staffing levels are more likely to be perceived as adequate when more long shifts are used.

The association between 12-hour shifts and nurses-in-charge's perceptions of missed care and staffing adequacy: a retrospective cross-sectional observational study.

Background: Due to worldwide nursing shortages and difficulty retaining staff, long shifts for nursing staff (both registered nurses and nursing assistants) working in hospitals have been adopted widely. Because long shifts reduce the daily number of shifts from three to two, many assume that long shifts improve productivity by removing one handover and staff overlap. However, it is unclear whether staffing levels are more likely to be perceived as adequate when more long shifts are used.

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

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.

Costs and consequences of using average demand to plan baseline nurse staffing levels: a computer simulation study.

Background: Planning numbers of nursing staff allocated to each hospital ward (the 'staffing establishment') is challenging because both demand for and supply of staff vary. Having low numbers of registered nurses working on a shift is associated with worse quality of care and adverse patient outcomes, including higher risk of patient safety incidents. Most nurse staffing tools recommend setting staffing levels at the average needed but modelling studies suggest that this may not lead to optimal levels.

Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion.

Background: The importance of nurse staffing levels in acute hospital wards is widely recognised but evidence for tools to determine staffing requirements although extensive, has been reported to be weak. Building on a review of reviews undertaken in 2014, we set out to give an overview of the major approaches to assessing nurse staffing requirements and identify recent evidence in order to address unanswered questions including the accuracy and effectiveness of tools.

Methods: We undertook a systematic scoping review.

How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing.

Despite a long history of health services research that indicates that having sufficient nursing staff on hospital wards is critical for patient safety, and sustained interest in nurse staffing methods, there is a lack of agreement on how to determine safe staffing levels. For an alternative viewpoint, we look to a separate body of literature that makes use of operational research techniques for planning nurse staffing. Our goal is to provide examples of the use of operational research approaches applied to nurse staffing, and to discuss what they might add to traditional methods.

Operational research techniques applied throughout cancer care services: a review.

Cancer is a disease affecting increasing numbers of people. In the UK, the proportion of people affected by cancer is projected to increase from 1 in 3 in 1992, to nearly 1 in 2 by 2020. Health services to tackle cancer can be grouped broadly into prevention, diagnosis, staging, and treatment.