A protocol to measure the impact of intentional changes to nurse staffing and skill‐mix in medical and surgical wards

Document Type

Journal Article

Publication Title

Journal of Advanced Nursing




School of Nursing and Midwifery / Centre for Nursing, Midwifery and Health Services Research




Department of Health and Health Research Board under research grant FSN‐2017‐001


Drennan, J., Duffield, C., Scott, A. P., Ball, J., Brady, N. M., Murphy, A., ... Griffiths, P. (2018). A protocol to measure the impact of intentional changes to nurse staffing and skill‐mix in medical and surgical wards. Journal of Advanced Nursing, 74(12), 2912-2921. Available here


Aim: The aim of this research is to measure the impact that planned changes tonurse staffing and skill‐mix have on patient, nurse, and organizational outcomes.

Background: It has been highlighted that there are several design limitations instudies that explore the relationship between nurse staffing and patient, nurse andorganizational outcomes; not least that the vast majority of research in this areaemanates from studies that are predominantly observational in design. There arelimited studies that measure nurse, patient, organizational, and economic outcomesusing a longitudinal design following a planned change in nurse staffing.

Design: The research will employ a longitudinal, multimethod approach to evaluatethe impact that planned changes in nurse staffing and skill‐mix have on wards inthree pilot hospitals.

Methods: Administrative data collection will take place on a shift‐by‐shift basisprospectively over a three‐year period including the measurement of nursing sensi-tive outcomes: cross‐sectional patient experience data and nurse outcomes (nursingwork, job satisfaction, burnout, missed care) will be collected at intervals prior to,during and after the implementation of planned changes in nurse staffing and skill‐mix. Data will be analysed using interrupted time‐series models, adjusted for key hospital, ward and patient‐level factors. An economic costing of the changes willfurther investigate the resources required for the intervention that can then beaggregated to a national level for future roll‐out plans.

Discussion: The study aims to provide evidence on the impact of planned changesto nurse staffing and skill‐mix based on a systematic approach using a longitudinaldesign and to determine the extent to which the approach can be implemented at anational level.



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