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Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study

Griffths, P, Ball, J, Murrells, T, Jones, S and Rafferty, A-M (2016) Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study BMJ Open, 6, e008751.

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Abstract

Objectives To examine associations between mortality and registered nurse (RN) staffing in English hospital trusts taking account of medical and healthcare support worker (HCSW) staffing. Setting Secondary care provided in acute hospital National Health Service (NHS) trusts in England. Participants Two data sets are examined: Administrative data from 137 NHS acute hospital trusts (staffing measured as beds per staff member). A cross-sectional survey of 2917 registered nurses in a subsample of 31 trusts (measured patients per ward nurse). Outcome measure Risk-adjusted mortality rates for adult patients (administrative data). Results For medical admissions, higher mortality was associated with more occupied beds per RN (RR 1.22, 95% CI 1.04 to 1.43, p=0.02) and per doctor (RR 1.10, 95% CI 1.05 to 1.15, p <0.01) employed by the trust whereas, lower HCSW staffing was associated with lower mortality (RR 0.95, 95% CI 0.91 to 1.00, p=0.04). In multivariable models the relationship was statistically significant for doctors (RR 1.08, 95% CI 1.02 to 1.15, p=0.02) and HCSWs (RR 0.93, 95% CI 0.89 to 0.98, p<01) but not RNs (RR 1.14, 95% CI 0.95 to 1.38, p=0.17). Trusts with an average of ≤6 patients per RN in medical wards had a 20% lower mortality rate compared to trusts with >10 patients per nurse (RR 0.80, 95% CI 0.76 to 0.85, p<0.01). The relationship remained significant in the multivariable model (RR 0.89, 95% CI 0.83 to 0.95, p<0.01). Results for surgical wards/admissions followed a similar pattern but with fewer significant results. Conclusions Ward-based RN staffing is significantly associated with reduced mortality for medical patients. There is little evidence for beneficial associations with HCSW staffing. Higher doctor staffing levels is associated with reduced mortality. The estimated association between RN staffing and mortality changes when medical and HCSW staffing is considered and depending on whether ward or trust wide staffing levels are considered

Item Type: Article
Subjects : Clinical Medicine
Divisions : Faculty of Health and Medical Sciences > School of Biosciences and Medicine > Department of Clinical and Experimental Medicine
Authors :
AuthorsEmailORCID
Griffths, PUNSPECIFIEDUNSPECIFIED
Ball, JUNSPECIFIEDUNSPECIFIED
Murrells, TUNSPECIFIEDUNSPECIFIED
Jones, SUNSPECIFIEDUNSPECIFIED
Rafferty, A-MUNSPECIFIEDUNSPECIFIED
Date : 9 February 2016
Identification Number : 10.1136/bmjopen-2015-008751
Copyright Disclaimer : This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Additional Information : This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/
Depositing User : Symplectic Elements
Date Deposited : 01 Mar 2016 16:41
Last Modified : 01 Mar 2016 16:41
URI: http://epubs.surrey.ac.uk/id/eprint/809972

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