The best way to deal with a shortage of nurses is to have more nurses

Researcher Peter Griffiths says his team’s findings on staffing are clear – but not obvious to all

Researcher Peter Griffiths says his team’s findings on staffing are clear – but not obvious to all

Picture: Alamy

We all know the NHS is desperately short of nurses. The number of nursing vacancies is close to 40,000 – about one in eight posts.

In that context, the latest research on the consequences of low nurse staffing, published by my team and our partners, is either very timely or, some would argue, a rather unnecessary restatement of the obvious.

Fewer registered nurses means greater risk

Our study looked at the records of nearly 140,000 patients over three years in one large general hospital. We linked daily staffing records from an e-roster to the patients' outcomes.

‘For every additional hour of registered nursing care per patient over these five days the risk of death fell by 3%’

Focusing on what happened over the first five days (and therefore most of the hospital stay for the majority of patients), we found that for every day a patient spent on a ward with below-average registered nurse staffing their risk of death was increased by a small but significant amount.

For every additional hour of registered nursing care per patient over these five days the risk of death fell by 3%. A one hour per patient per day increase in registered nurse staffing (about 20%) across the whole hospital would be associated with more than 200 fewer deaths each year.

Few studies have so closely matched staffing at a patient level. This means the method is, in some respects, more robust than large cross-sectional studies like our own well-known RN4CAST study, which shows associations with death rates at the hospital level. But the results are the same.

Where we broke new ground is in considering healthcare assistants, who have often been ignored in past research. We found that low assistant staffing levels were linked to an increased risk of death. However, when patients spent days on wards with above-average assistant staffing the risk of death was also increased.

‘Studies squarely point to the value of having more, and more highly qualified, nurses’

While affirming the vital importance of healthcare assistants, this research also makes it abundantly clear that increasing their numbers is not going to help alleviate the shortage of registered nurses.

The nursing associate role

For some, the answer to the problem is the new nursing associate. None of us can predict the future, and numbers of associates are still relatively small, but studies squarely point to the value of having more, and more highly qualified, nurses.

If nursing associates increase the overall level of skills and knowledge in the care workforce then they may well help to improve patient outcomes. If, as seems likely, associates are used to replace registered nursing posts, the likely outcomes are less clear.

A high standard of proof has been applied to evidence about registered nursing. Each new study is met with new objections and a demand for more evidence. So while I have some sympathy with those who dismiss our studies as statements of the obvious, we must remember that this is not obvious to everyone. Some still believe that ‘a nurse is a nurse is a healthcare assistant’ and all you really need is to be kind, not clever.

These findings should remind us all that we have an evidence-based solution to the shortage of registered nurses. It is an obvious one and I wonder why, for many years, workforce planners, some hospital finance managers and even some members of the profession have chosen to ignore it.

The answer to a shortage of registered nurses is more registered nurses and that is what we need to work towards.

Find out more

2018 nurse staffing studies

RN4CAST 2014

Peter Griffiths is chair of health sciences research, University of Southampton, and senior investigator, National Institute for Health Research

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