4 Research recommendations

The Safe Staffing Advisory Committee has made the following recommendations for research, based on its review of the evidence, to improve NICE guidelines and patient care in the future.

Relationship between staffing factors and patient outcomes

What is the relationship between the following factors and outcomes related to nursing care, patient safety and patients' and nursing staff satisfaction with the quality of care in the UK?

Why this is important

Insufficient evidence is available about the effects that nursing staff numbers, skill mix and shift patterns have on nursing care, and patient safety and satisfaction-related outcomes. Research is needed to compare outcomes from acute adult inpatient wards that use different staff numbers, skill mix, and shift patterns. Data should be collected on both positive and negative outcomes (such as number of complaints of missed care or satisfaction with quality of nursing care provided), and resource use and costs. Confounding factors (such as patient characteristics) should be controlled. This research would be best done using a cluster randomised controlled trial design.

The evidence from this research would help to establish whether there is an optimum number of nursing staff for different wards, and whether there are types of shift patterns and skill mix that are associated with the best outcomes for patients.

Factors affecting nursing staff requirements at ward level

How do the following factors affect the nursing staff requirement at ward level in the UK?

  • Patient factors

  • Patients' nursing needs (sometimes referred to as acuity and dependency)

  • Time of day

  • Ward layout and size (including the use of single rooms)

  • Ward level team leadership and management

  • Organisational training approaches

  • Organisational policies and procedures (for example, productive ward, Lean)

Why this is important

Insufficient evidence is available about the relationship between staffing, ward-level factors and patient outcomes. Prospective cohort studies should be conducted to examine the relationship between the factors above and both positive and negative outcomes relating to nursing care, patient safety, patients' and nursing staff satisfaction, resource use and costs. The studies should also examine if these factors act as an effect modifier and/or confounder of the relationship between staffing and outcomes. Research should control for other confounding factors (such as patient characteristics).

This research should provide evidence on the ward-level factors that should be included in approaches to determining nursing staff requirements, including decision support toolkits.

Using defined approaches or decision support toolkits

What is the effectiveness of using defined approaches or decision support toolkits to determine nursing staff requirements and skill mix on acute adult inpatient wards in the UK?

Why this is important

Insufficient evidence is available about whether using defined approaches or decision support toolkits for determining nurse staffing requirements has an impact on patient and staff outcomes.

Cluster randomised controlled trials or prospective cohort studies should be designed to compare outcomes relating to nursing care, patient safety, and patients' and nursing staff satisfaction on acute adult inpatient wards that use defined approaches or decision support toolkits to other approaches or professional judgement. Replicate studies should be carried out to provide evidence of reliability and validity.

These comparative studies should help to assess the value of using defined approaches and decision support aids, and to identify those that perform best.