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Patients' negative opinion of NHS care linked to insufficient nurse numbers, study states

Increasing nurse numbers could boost patient satisfaction with quality of care, say researchers.

Increasing nurse numbers could boost patient satisfaction with quality of care, say researchers.

  • Findings of 2010 NHS inpatient survey and RN4CAST England survey merged and examined

  • One in ten patients said there were never or rarely enough nurses during their stay

  • Lower workloads associated with better working environments and fewer missed episodes of care

Not satisfied
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A study published in BMJ Open reveals that patients’ negative opinions about hospital care in England are linked to insufficient numbers of nurses on duty.

Researchers from the University of Pennsylvania, University of Southampton and King’s College London looked at the 2010 NHS inpatient survey of more than 66,000 patients who were discharged from 161 acute and specialist NHS trusts.

One in ten patients said there were never or rarely enough nurses during their stay, says the study Patient satisfaction with hospital care and nurses in England: an observational study. 

Patient dissatisfaction

Researchers calculated that the likelihood of patients saying there were always enough nurses was about 40% lower in hospitals where the average nurse to patient ratio was one nurse to ten patients compared with those with an average of one nurse to six patients.

In addition, researchers studied results from the RN4CAST England survey (also covering 2010) of nearly 3,000 registered nurses from general medical and surgical wards at 46 of the 161 trusts.

The survey asked nurses to report on care they were unable to deliver on their last shift because of lack of time. Among these areas of ‘missed’ care, 65% of the nurses said they did not have enough time to comfort or talk to patients. More than half of nurses also felt they did not have enough time to talk to patients and relatives about how to manage care after discharge.

Data for the same 31 trusts from both surveys were merged to estimate if the level of missed nursing care affected patients’ views.

It was found that the lower the patient to nurse ratio, the lower the number of needed, but ‘missed’, episodes of care.

Lack of evidence to support image of 'uncaring' nurses

The researchers also found lower workloads were associated with better working environments and fewer missed episodes of care and this, in turn, improved levels of patient satisfaction.

The report authors include University of Pennsylvania director of the Center for Health Outcomes and Policy Research Linda Aiken and King’s College London professor of nursing policy Anne Marie Rafferty.

They write: 'The narrative that quality deficits in hospitals are due to "uncaring" nurses is not supported by the evidence,' write the researchers.

'On the contrary, our findings suggest that reducing missed nursing care by ensuring adequate numbers of registered nurses at the hospital bedside, and improved hospital clinical care environments are promising strategies for enhancing patient satisfaction with care.'

The researchers also address the creation of the nursing associate role and nurse apprenticeships and warn that ‘adding lesser trained providers to the hospital workforce without adding more registered nurses results in eroding the nursing skill mix that evidence suggests is associated with higher mortality and lower patient satisfaction’.

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