The association between patient safety outcomes and nurse/healthcare assistant skill mix and staffing levels and factors that may influence staffing requirements

Abstract

Introduction<br/>Identifying safe approaches to nurse staffing in hospital wards is a key challenge for health<br/>service providers. The National Institute for Health and Care Excellence (NICE) has been<br/>asked by the Department of Health and NHS England to develop an evidence-based<br/>guideline on safe and efficient staffing in acute adult inpatient wards.<br/>This review is the first of two reviews to inform the safe staffing guideline. It aims to explore<br/>evidence to inform guidance related to the following three sets of questions, set out in the<br/>scope.<br/>1. What patient safety outcomes are associated with nurse and healthcare<br/>assistant staffing levels and skill mix?<br/>a. What outcomes are associated with tasks undertaken by registered<br/>nurses, healthcare assistants (HCA), and other staff?<br/>b. Which outcomes should be used as indicators of safe staffing?<br/>2. What patient factors affect nurse and healthcare assistant staffing<br/>requirements at different times during the day? These include:<br/>a. Patient dependency and acuity assessment and grading<br/>b. Patient turnover.<br/>3. How does the ward environment, including physical layout and diversity of<br/>clinical disciplines, affect safe staffing requirements?