Research examined Government framework across three hospitals
A healthcare study conducted in three of Ireland’s acute hospitals found that targeted staffing interventions can improve work environments and job satisfaction for nurses, and offers a potential solution to the ongoing challenges of nurse turnover and shortages.
The observational study implemented and assessed safe nurse staffing frameworks for six medical and/or surgical wards across three acute hospitals in Ireland – one large acute university hospital (670 beds), one medium-sized acute hospital (235 beds) and a small acute hospital (109 beds).
The findings, outlined in a research paper published by Dr Noeleen Brady from the School of Nursing and Midwifery at University College Cork (UCC), provide a blueprint for improving nurse retention amid increasing healthcare demands and workforce shortages.
The study examined the implementation of the ‘Framework for Safe Staff Nursing and Skill-Mix’. The Government published this framework to determine appropriate nurse staffing levels in medical and surgical wards in acute hospitals. It aims to improve patient care by ensuring hospitals have the right number and mix of nursing staff, both registered nurses and health care assistants.
The framework uses a patient-centred approach, considering factors like patient need, i.e. acuity and dependency, to determine the required nursing hours. This helps hospitals calculate suitable staffing levels.
The results of the study have identified that adjusting nurse staffing through implementing nursing hours per patient day to match patient need, implementing a supernumerary nurse leader, and an 80:20 skill-mix, was associated with staff reporting an improvement in aspects of the work environment, and indicated positive patterns of change in job satisfaction and intention to leave.
“When nurse staffing levels are systematically adjusted to meet patient requirement, there is an improvement in staff perceptions of the working environment and job satisfaction,” said Dr Noeleen Brady.
“These are factors that can result in higher levels of staff retention, which is increasingly important issue, as demand for nursing care in many countries increases and will continue to increase into the future.”
Additional findings from the study include:
- Improved Work Environment: Implementation of the evidence-based Framework for Safe Nurse Staffing and Skill-Mix improved three key aspects of nurses’ working environment: enhanced staffing, improved working relations between nurses and doctors, and allowed nurses to have a greater voice in the governance in the operation of their hospital.
- Increased Job Satisfaction: There was a substantial increase in job satisfaction following the implementation of the evidence-based Framework for Safe Nurse Staffing and Skill-Mix.
- Reduced Intention to Leave: The proportion of staff reporting intention to leave dropped. The most important factor in intention to stay is identified as job satisfaction.
- Systematic Staffing Approach: Implementing a systematic approach to nurse staffing, which ensures that staffing levels are based on patient need, the ward leader is provided with the time to have an oversight of the quality of care delivered on the ward, and the skill-mix matches the complexity of care resulted in a better working environment and increased levels of nurse satisfaction.
The study, led by Prof Jonathan Drennan (UCC, UCD) and Dr Vera McCarthy (UCC) in collaboration with teams at University of Southampton and University of Technology of Sydney, used a pre- and post-design, measuring changes in outcomes following the implementation of new staffing recommendations.
