Patients' unfavorable views of hospital care strongly linked to nurse numbers

January 12, 2018, British Medical Journal

Patients' unfavourable views of hospital care in England are strongly linked to insufficient numbers of nurses on duty, rather than uncaring staff, indicates observational research published in the online journal BMJ Open.

Increasing the registered headcount may boost satisfaction with the quality of care, conclude the researchers, who base their findings on national survey data from and nurses.

The 2010 NHS Survey of Inpatients gathered information from over 66,000 patients who had been discharged from 161 acute and specialist NHS Trusts.

Respondents were asked to rate their care, the confidence they had in their doctors and nurses, and to give their views on whether there were enough nurses to provide the care they needed.

The 2010 nurses' survey (RN4CAST-England study) gathered information from nearly 3000 registered nurses working on general medical and surgical wards from a representative sample of 31 (46 hospitals) of the 161 trusts.

The nurses were asked about their workload during the day and various aspects of their working environment, such as resources, support, interpersonal relationships, leadership.

The data for the same 31 trusts from both surveys were then merged to estimate whether, and to what extent, the level of 'missed' nursing care in the different trusts affected how patients rated their care and their confidence in the clinical staff caring for them.

The level of trust and confidence patients expressed for nurses was of a similar magnitude to that they expressed for doctors.

But while three out of four respondents said they had confidence and trust in the clinicians treating them, only 60 percent felt there were always enough nurses to care for them. And one in 10 said that there were never or rarely enough nurses on duty.

Nurse numbers were strongly linked to how favourably patients viewed their .

This was rated as excellent by over half (57%) of those who felt there were always or nearly always enough nurses on duty, but by only around one in four of those who felt this was 'sometimes' the case, and by only 14 percent of those who never or rarely felt this.

The nurse survey showed that workloads ranged from 5.6 to 11.6 patients each across the 46 hospitals.

After taking account of various influential factors, the researchers calculate that the likelihood of patients always saying there were enough nurses to take care of them were about 40 percent lower in hospitals where the average nurse took care of 10 patients than in hospitals where they took care of six.

The nurses felt that they didn't always have time to provide the necessary care. Some 7 percent felt this about pain management, but over (52%) half felt they didn't have enough time to talk to patients and relatives about how to manage care after discharge. And around two thirds (65%) felt they didn't have enough time to comfort/talk to patients.

The lower the patient:nurse ratio, the lower were the number of needed but 'missed' episodes of care. Lower workloads were also associated with better working environments which, in turn, were associated with fewer missed episodes of care.

And the greater the number of episodes of missed care, the less likely were patients to rate their hospital care favourably.

"The narrative that quality deficits in hospitals are due to 'uncaring' nurses is not supported by the evidence," write the researchers.

"On the contrary, our findings suggest that reducing missed nursing care by ensuring adequate numbers of [registered nurses] at the hospital bedside, and improved clinical care environments are promising strategies for enhancing patient satisfaction with care."

Explore further: Nurses' experience of compassion impacts delivery of care

More information: Linda H Aiken et al. Patient satisfaction with hospital care and nurses in England: an observational study, BMJ Open (2018). DOI: 10.1136/bmjopen-2017-019189

Related Stories

Nurses' experience of compassion impacts delivery of care

January 4, 2018
(HealthDay)—Critical care nurses' experiences of compassion satisfaction and compassion fatigue influence their ability to deliver patient-centered care, according to a study published online Dec. 21 in the Journal of Clinical ...

Missed nursing care due to low nurse staffing increases patient mortality

August 24, 2017
Failure to deliver complete nursing care explains why hospitals with lower registered nursing (RN) staff levels have a higher risk of patient death, a new University of Southampton study has shown.

Most ward nurses say time pressures force them to 'ration' care

July 29, 2013
Most ward nurses say they are forced to ration care, and not do or complete certain aspects of it—including adequate monitoring of patients—because they don't have enough time, indicates research published online in BMJ ...

Pediatric nurses miss care more often in poor work environments, study finds

June 13, 2017
In a new study, researchers at the University of Pennsylvania School of Nursing's Center for Health Outcome and Policy Research and the Children's Hospital of Philadelphia examined the factors influencing the likelihood of ...

Nurses' strike in Portugal cripples public health services

September 11, 2017
Nurses in Portugal began a five-day strike over status, pay and working hours on Monday, crippling services at public hospitals, union leaders said.

Lack of nurses linked to missed care and higher patient mortality

May 5, 2017
There is a clear correlation between the number of registered nurses working at an acute hospital, the amount of nursing care that is left undone and the number of patients who die, a new thesis from Karolinska Institutet ...

Recommended for you

1 in 9 U.S. adults over 45 reports memory problems

July 13, 2018
(HealthDay)—If you're middle-aged and you think you're losing your memory, you're not alone, a new U.S. government report shows.

Antioxidant benefits of sleep

July 12, 2018
Understanding sleep has become increasingly important in modern society, where chronic loss of sleep has become rampant and pervasive. As evidence mounts for a correlation between lack of sleep and negative health effects, ...

Footwear habits influence child and adolescent motor skill development

July 11, 2018
New research finds that children and adolescents who spend most of their time barefoot develop motor skills differently from those who habitually wear shoes. Published in Frontiers in Pediatrics, this is the first study to ...

How a Mediterranean diet could reduce osteoporosis

July 11, 2018
Eating a Mediterranean-type diet could reduce bone loss in people with osteoporosis—according to new research from the University of East Anglia.

Extreme heat and reduced cognitive performance in adults in non-air-conditioned buildings

July 10, 2018
Students who lived in dormitories without air conditioning (AC) during a heat wave performed worse on a series of cognitive tests compared with students who lived in air-conditioned dorms, according to new research led by ...

Suppressing negative emotions during health scare may whip up spiral of fear

July 10, 2018
Trying to suppress worries during a health scare, like the recent Zika outbreak, may lead to an ever-intensifying cycle of emotional suppression and fear, according to a team of researchers.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.