What is it about?
There is a lot of evidence that the number of nurses on a hospital ward / unit can affect the quality of patient care. This includes changing the risk of avoidable negative outcomes, even death. There are very many approaches to deciding the 'right' number of nurses to care for different groups of patients. These approaches usually, but don't always, include some sort of measure (or 'tool') used to guide staffing levels, usually based on the specific care a patient needs or some other way of grouping patients with similar levels of need. Because there are so many approaches and so many different tools this paper set out to explore the evidence that has been published which might help to decide which approaches are 'best'.
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Why is it important?
Getting nurse staffing levels right is important for both patients and hospital managers - nurses are the largest single staff group in most hospitals. The costs of nursing staff are high, but the possible consequences of not having enough are very serious. Although there are many systems and tools available, many promoted by commercial companies, this review shows that the evidence available is very weak and can't be used to select the 'right' or 'best' approach. Different tools give different answers to the number of staff needed but there is little if any evidence of the costs or the effects of taking any given approach. The results of a tool can, at best, be used in tandem with professional judgment, but should never replace it.
Perspectives
Many nurse managers find using a tool to guide staffing decisions helpful and there is an increasing expectation that such tools are used. However, with so little evidence available, there is a danger that a tool can be adopted just because it gives a staffing level that is seen as financially sustainable, with a false assurance that quality of care is maintained. In general, the existing research just hasn't addressed the important questions and we need answers to questions like the costs and outcomes of staffing at the level tools say is necessary. Managers need answers to these important questions and not just the ones that have been offered up in research, which has often been done by those who developed the tools in the first place.
Prof Peter Griffiths
University of Southampton
Read the Original
This page is a summary of: Nursing workload, Nurse Staffing Methodologies & Tools: a systematic scoping review & discussion, International Journal of Nursing Studies, November 2019, Elsevier,
DOI: 10.1016/j.ijnurstu.2019.103487.
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