The Correlation between Nursing Workloads and the Quality of Care

A research paper concerning the correlation between nursing workloads and the quality of care being delivered was published in the British Medical Journal last week.

The research involved 2917 registered nurses working in 401 general medical/surgical wards across 46 NHS hospitals in England. The primary aim of the research was to “examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment”.

According to the research an astonishing 87% of the nurses surveyed reported that one or more care activity had been left undone due to lack of time on their last shift. The most frequently omitted activities were comforting and talking to patients (66%), educating patients and family (52%) and developing / updating care pathways (47%). Furthermore, out of those surveyed, 35% said adequate patient surveillance and 33% said adequate documentation of nursing care had been left undone before.

It is very worrying that approximately a third of those registered nurses surveyed said that both adequate surveillance of a patient and documentation of their care had been omitted. Sacrificing these sort of activities due to time constraints could lead to the situation where important issues are missed. For example patient symptoms which could help doctors diagnose and treat serious conditions might be missed or left undocumented i.e. stroke symptoms. It is noted that care which was frequently left undone [such as] adequate patient surveillance has been hypothesised as a key mechanism in explaining the association between low nurse staffing and increased mortality. However, the report also indicates that further research is required to establish the correlation between nursing care quality and patient outcomes.

The paper concludes that the “Register Nurses working in English NHS hospitals report that care is needed but is often not done because of insufficient time. There is a strong relationship between RN staffing levels and the prevalence of care being left undone—and, the better the practice environment the smaller the volume of care that is left undone”.

It will, undoubtedly, be very difficult for the NHS to resolve all of the issues raised in this report. It seems the only way to ensure nurses have sufficient time to dedicate to every patient would involve either increasing staff levels or decreasing inefficiencies. Unfortunately this problem has arisen at a time of unprecedented cuts across all sectors with nurse staffing levels already very stretched. It will be interesting to see how the NHS Trusts approach these difficulties over the coming years.