Nurse shortages: patient deaths remain raised with temporary staff

Study findings ‘challenge assumption’ that using temporary staff to plug gaps on acute wards is a cost-effective long-term solution to maintaining safety

Using temporary nursing staff to fill gaps in the rota only partially combats the increased risk of patient death linked to staff shortages, according to a new study.

Researchers at the University of Southampton found that the risk of death continues to be elevated when temporary registered nurses and nursing support staff are drafted in to cover shifts, compared with when a ward is fully staffed by permanent nursing staff.

Using temporary staff mitigates patient safety risks, but death rate remains raised

They also found having a higher proportion of band 4 nursing associates among support staff was beneficial, but were clear that the evidence does not support using them as substitutes for registered nurses.

In a large-scale observational study of 600,000 anonymised overnight inpatients across 185 wards at four acute hospitals in England between 2015 and 2020, researchers found that each day that the wards had low staffing of permanent registered nurses with no additional staff brought in to plug the gaps, the risk of patient death increased by 7.9%. When there was a shortage of nursing support staff, the risk increased by 7.2%.

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But when 10% of the registered nurses on the ward were temporary, bank or agency staff, the death rate was 2.3% higher than at baseline staffing levels. The study suggests that the rate increases proportionally as this staffing percentage increases, going up 2.3% for every 10% of temporary registered nurses on shift.

The increased risk of death for patients when agency nursing support staff were used was higher overall, although this was found to be lower for bank assistants (2%) compared to staff from agencies (4%). This also increased when a greater proportion of support staff were temporary, going up 4% for every 10% increase.

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‘Our study shows that addressing low staffing levels by using temporary staff to fill gaps is definitely beneficial in avoiding deaths on wards,’ said lead author Peter Griffiths. ‘The harm associated with low staffing is greater than using temporary staff to rectify shortfalls. However, our findings challenge the assumption that temporary staff are a cost-effective long-term solution to maintaining patient safety.’

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Employing more senior nursing associates in support roles shown to be beneficial

The research also showed some evidence that having more senior staff on shift, in both registered nurse and nursing support roles, had some benefit, although Professor Griffiths said work needed to be done to gather more data on this.

‘Our research showed clear evidence that having more senior skilled workers in the support team was beneficial, including band 4 nursing associates, and this was broadly encouraging. However, this benefit was seen within the support team and the evidence does not support replacing registered nurses with associates or other support staff.’

Findings from the study are due to be published in JAMA Network Open on 19 August.

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