Hospital nurse staffing and staff–patient interactions: an observational study

What is it about?

There has been recent public concern about nurses' capacity to care compassionately for older people in hospital, and short staffing is often mentioned as an underlying issue. However no research has previously examined if there is a link between low nurse staffing, the skillmix of the nursing team and patient experiences of care. Our research investigated the link between nurse staffing levels and the quality of interaction between staff and patients in two UK hospitals. We analysed data from over 3000 researcher-rated observations of inpatient ward care and information on nurse staffing during the observed sessions. We observed patient interactions with all staff, including registered nurses (RNs), and health care assistants (HCAs), who work in a support role to RNs. We found that interactions with RNs or HCAs were the same quality as each other. The chance of a negative interaction went up significantly when RN staffing levels fell. If RN staffing levels stayed low, adding more HCAs did not improve the quality of interactions. These findings are the first to measure the link between nurse staffing levels and quality of interaction between staff and patients. They tell us that cutting nursing staff numbers and/or substituting RNs with less qualified staff may lead to poorer patient experiences of hospital care.

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