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Patient safety: over-reliance on temporary nurses heightens risk of ward deaths

Southampton study points to importance of overall make-up of staff 

Southampton study points to importance of overall make-up of staff 


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Hospitals’ reliance on bank and agency nursing staff can increase risk of patient death during the hospital stay by 12%, say researchers. 

A study by the University of Southampton used data on 138,133 patients admitted to a large hospital in the south of England between April 2012 and April 2015.

They found the risk of death increased by 12% for every day a patient experienced high levels – 1.5 hours or more per day – of nurse temporary staffing, such as bank or agency staff.

No harm associated with moderate use of bank or agency nurses

There was no evidence of harm associated with a modest use – under 1.5 hours a day – of care from temporary nurses for required staffing levels to be maintained.

Furthermore, a moderate increase in the risk for death applied on days when healthcare assistant (HCA) temporary staffing was more than 0.5 hours per patient.

‘This calls into question flexible staffing policies that rely substantially on temporary staff to meet variable patient need’

Chiara Dall'Ora, study lead author

Nursing workforce research fellow and the study's lead author, Chiara Dall'Ora, told Nursing Standard further work was needed to establish what it was about temporary registered nurse staffing that created such a risk.

She said unfamiliarity with wards, teams and hospital procedures could be one of the issues.

Implications for safe-staffing strategies 

Dr Dall'Ora said the fact the use of temporary HCAs increased the patients' risk of death at all was significant given evidence they are being used to fill in for nurses because of the nurse shortage in England. 

'This is the first study to show a substantial increase in risk associated with high levels of temporary staffing independent of overall staffing levels, calling into question flexible staffing policies that rely substantially on temporary staff to meet variable patient need,’ she said.

NHS England and NHS Improvement has been contacted for comment.


Further information

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