The effect of hospital nurse staffing models on patient and staff-related outcomes
International Journal of Nursing Practice
Place of Publication
School of Nursing and Midwifery
Many countries are experiencing a shortage of nurses and this demand is set to increase and present staffing crises in the coming decade (WHO, 2013). Simultaneously, the number of people requiring hospital level care has grown (ICN, 2013) and the acuity of patients increased (Needleman, 2013). Although the response to the projected shortfall of nurses in some countries has led to a recent prediction of an excess supply of nurses, for example in the USA (HRSA, 2015), the issue of geographical distributional imbalance remains. With 40% of nurses predicted to retire in the next ten years in developed countries (WHO, 2013), the global long-term picture remains unclear.
In response to shortages of qualified nurses, changes in patient care needs and cost containment imperatives, new models for staffing hospital units have been introduced. These include changes in the mix of qualified and unqualified staff within the hospital workforce, the mix of nurses with different qualifications and different levels of experience, and the way in which nursing staff are allocated to hospital units and to individual patients (ICN, 2013). Recent research into staffing levels in the UK (Griffiths et al., 2016) suggests an association between higher numbers of nurses and doctors per patient and a reduction in mortality. Ward-based RN staffing was found to be significantly associated with reduced mortality for medical patients. To ensure quality of care is maintained it is vital to understand the impact of changes to models of staffing.
Despite the important implications for healthcare provision of the effects of changes to nurse staffing, the majority of public policy driving these changes is not underpinned by evidence, in part at least because of the paucity of credible evidence linking changes in the hospital nurse work force to patient outcomes (Butler et al., 2011).