Objectives
The best way to determine nurse staffing requirements on hospital wards is unclear.
This study explores the precision of estimates of nurse staffing requirements made
using the Safer Nursing Care Tool (SNCT) patient classification system for different
sample sizes, and investigates whether recommended staff levels ...
Objectives
The best way to determine nurse staffing requirements on hospital wards is unclear.
This study explores the precision of estimates of nurse staffing requirements made
using the Safer Nursing Care Tool (SNCT) patient classification system for different
sample sizes, and investigates whether recommended staff levels correspond with
professional judgements of adequate staffing.
Design
Observational study linking datasets of staffing requirements (estimated using a tool)
to professional judgements of adequate staffing. Multi-level logistic regression
modelling.
Setting
81 medical/surgical units in 4 acute care hospitals
Participants
22,364 unit days where staffing levels and SNCT ratings were linked to nurse reports
of staffing adequacy
Primary outcome measures
SNCT-estimated staffing requirements and nurses’ assessments of staffing
adequacy.
Results
The recommended minimum sample of 20 days allowed the required number to
employ (the establishment) to be estimated with a mean precision (defined as half
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Performance of the Safer Nursing Care Tool
the width of the confidence interval as a percentage of the mean) of 4.1%. For most
units, much larger samples were required to estimate establishments within +/- 1
whole-time-equivalent staff member. When staffing was lower than that required
according to the SNCT, for each hour per patient day of registered nurse staffing
below the required staffing level, the odds of nurses reporting that there were
enough staff to provide quality care were reduced by 11%. Correspondingly, the
odds of nurses reporting that necessary nursing care was left undone were
increased by 14%. No threshold indicating an optimal staffing level was observed.
Surgical specialty, patient turnover and more single rooms were associated with
lower odds of staffing adequacy.
Conclusions
The SNCT can provide reliable estimates of the number of nurses to employ on a
unit, but larger samples than the recommended minimum are usually required. The
SNCT provides a measure of nursing workload that correlates with professional
judgements, but the recommended staffing levels may not be optimal. Some
important sources of systematic variations in staffing requirements for some units are
not accounted for. SNCT measurements are a potentially useful adjunct to
professional judgement, but cannot replace it.