Inside Banner Featured Research Project 2

Programme of Research into Safe Nurse Staffing and Skill-Mix

Introduction

The relationship between safe nurse staffing and skill-mix and patient, staff and organisational outcomes has been established in a number of studies and reports. Higher levels of staffing and care delivered by a higher proportion of registered nurses is associated with decreased levels of mortality and patients experiencing adverse events such as pressure sores, falls and hospital-acquired infections. Better nurse staffing is also associated with decreased levels of burnout and increased job satisfaction amongst nursing staff as well as reduced levels of missed care and an enhanced clinical environment. Optimal levels of nurse staffing are also associated with enhanced recruitment and reduced staff turnover. The challenge, however, is to identify staffing levels that are safe and effective.

This programme of research, funded by the Health Research Board and the Department of Health, identifies, develops, implements and tests models of safe nurse staffing in a variety of settings. The outputs from this research are impacting on Government policy and leading to changes in how nurse staffing levels are calculated in a variety of healthcare settings.

Project Outline

The collaborative team, led by Professor Jonathan Drennan, consists of partners from University College Cork (Dr Darren Dahly, Dr Aileen Murphy, Dr Vera McCarthy, Dr Ashling Murphy and Ms Ruth Linehan), University of Southampton (Professor Peter Griffiths, Professor Jane Ball, Professor Jackie Bridges) and University of Technology Sydney (Professor Christine Duffield). To date, the safe nurse staffing research team have developed models of safe nurse staffing in medical, surgical and specialist settings in acute hospitals and in emergency settings.

In medical, surgical and specialist settings, the model is based on nursing hours per patient day and was tested in three hospitals over the period of three years. The introduction of the nursing hours per patient day (NHpPD) approach resulted in the adjustment of nurse staffing and skill-mix in a number of wards; as a consequence of these adjustments, a number of patient, staff and organisational outcomes were measured. The introduction of the nursing hours per patient day approach resulted in a reduction in mortality rates and adverse events in in-patients in the three pilot hospitals.

Nurse staffing outcomes also improved with a reduction in burnout, an increase in job satisfaction and a reduction in the number of staff who stated that they intended to leave. The NHpPD approach also resulted in a reduction in missed care and enhancement of the clinical working environment. Following on from the results of the pilot, the Framework for Safe Nurse Staffing and Skill-Mix in Medical, Surgical and Specialist Settings in Ireland was published in 2018. This Framework is now being implemented in all hospitals nationally by the HSE.

Following on from the research in medical and surgical settings, the research team developed and tested a model of safe nurse staffing and skill-mix for emergency settings in Ireland. This was in response to increasing patient demand for emergency services as well as crowding in a number of emergency departments (EDs). In partnership with the Department of Health, the research team developed and tested the Nursing Hours per Patient Presentation (NHpPP) approach to determining safe nurse staffing levels in three pilot EDs. The introduction of this approach to determining safe nurse staffing levels resulted in a number of nurse, patient and organisational outcomes.

Patient outcomes included a reduction in the number of patients who left without being seen, a reduction in time to triage and from triage to be seen and a reduction in the time patients spend in the ED. In addition, there was a reduction in burnout amongst nursing staff as well as an increase in job satisfaction as a consequence of the introduction of the new model to determine nurse staffing levels. The outcomes of the research resulted in the publication of the policy report: A Framework for Safe Nurse Staffing and Skill-Mix in Emergency Settings in Ireland (2022). The recommendations in the Framework to ensure that EDs are safely staffed are currently being implement in model 3 and model 4 emergency settings in Ireland.

The safe nurse staffing research team are currently developing and testing an approach to determining safe nurse staffing and skill-mix in long-term residential settings for older people. This is currently being tested in ten nursing homes. It is proposed that, based on the research, a framework for safe nurse staffing and skill mix in the long-term residential sector will be published early in 2023. This will be the first time a systematic approach to determining safe staffing levels in this sector have been put in place. In 2023, the research team will work on the development of a model of safe nurse staffing in community settings.

Project Outputs

The programme of research on safe nurse on safe nurse staffing and skill-mix has resulted the development of a number of policy documents (outlined below). The recommendations from the research team have been integrated in policy documents by Sláintecare, HIQA, the HSE, the Department of Health and the Expert Review Body on Nursing and Midwifery.