Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study.

OBJECTIVE: To examine the impact of nursing team size and composition on inpatient hospital mortality. DESIGN: A retrospective longitudinal study using linked nursing staff rostering and patient data. Multilevel conditional logistic regression models with adjustment for patient characteristics, day and time-invariant ward differences estimated the association between inpatient mortality and staffing at the ward-day level. Two staffing measures were constructed: the fraction of target hours worked (fill-rate) and the absolute difference from target hours. SETTING: Three hospitals within a single National Health Service Trust in England. PARTICIPANTS: 19 287 ward-day observations with information on 4498 nurses and 66 923 hospital admissions in 53 inpatient hospital wards for acutely ill adult patients for calendar year 2017. MAIN OUTCOME MEASURE: In-hospital deaths. RESULTS: A statistically significant association between the fill-rate for registered nurses (RNs) and inpatient mortality (OR 0.9883, 95% CI 0.9773 to 0.9996, p=0.0416) was found only for RNs hospital employees. There was no association for healthcare support workers (HCSWs) or agency workers. On average, an extra 12-hour shift by an RN was associated with a reduction in the odds of a patient death of 9.6% (OR 0.9044, 95% CI 0.8219 to 0.9966, p=0.0416). An additional senior RN (in NHS pay band 7 or 8) had 2.2 times the impact of an additional band 5 RN (fill-rate for bands 7 and 8: OR 0.9760, 95% CI 0.9551 to 0.9973, p=0.0275; band 5: OR 0.9893, 95% CI 0.9771 to 1.0017, p=0.0907). CONCLUSIONS: RN staffing and seniority levels were associated with patient mortality. The lack of association for HCSWs and agency nurses indicates they are not effective substitutes for RNs who regularly work on the ward.

Strengthening the role of the ward manager: a review of the literature.

BACKGROUND: The role of the ward manager is integral to service delivery, however, they may lack the necessary authority and autonomy to achieve the organisation and delivery of patient care. AIM: To identify initiatives that have strengthened the ward manager role. METHODS: A review of published literature was undertaken. Data included were drawn from a variety of sources, including policy, professional literature and research studies. FINDINGS: Three policy initiatives were identified along with two innovations from ward managers and two recent professional organisation campaigns. One innovation was identified that could improve the process of care delivery thus empowering ward managers' decision making. The literature identified the need for a review of the role, and adequate administrative support and training for the role. CONCLUSION: The literature reviewed provided little evidence of initiatives to strengthen the role of the ward manager, highlighting the imperative to develop an evidence base. There was consensus on the importance of education and training before and during appointment to the position. IMPLICATIONS FOR NURSING MANAGEMENT: The role of the ward manager remains pivotal in care delivery. The focus should be on how best to support ward managers in achieving their role within health-care systems.

An investigation into the activities of the clinical nurse specialist.

AIM: To assess the activities of clinical nurse specialists (CNSs), examining work patterns, job plans and team structures, especially the balance of patient-facing and non-patient-facing activity. METHOD: A quantitative evaluation was conducted using diary cards at Imperial College Healthcare NHS Trust. CNSs were asked to record their activity for each ten-minute period of the working day over two weeks. RESULTS: Data were received from 236 of 261(90.4%) possible respondents and more than one million minutes of data were submitted. On average, CNSs spent 41% of their time in direct patient-facing activities and an additional 21.5% in patient-related activities. However, there was wide variation in how time was spent between individuals and teams, and across divisions within the trust. CNSs estimated that 16.4% of their clinical activity may have prevented an adverse event or patient attendance at hospital. CONCLUSION: Data generated from this evaluation will be used to develop coherent job plans for individuals and teams of CNSs and to identify which nurse-led activities are being reimbursed by commissioners of services.

Bridging the gap between research and practice.

Health secretary Alan Johnson announced in March the identities of the first five academic health science centres in the UK, one of which is the result of a collaboration between Imperial College London and Imperial College Healthcare NHS Trust. These centres are partnerships between world-class universities and leading NHS organisations, and this article examines the implications of their establishment for nursing and midwifery.

Eliminating mixed sex accommodation in hospital to improve patient experience.

This article outlines the work undertaken by Imperial College Healthcare Trust to eliminate mixed sex accommodation in its hospitals. It gives background information on the issue, and details the trust's policy to tackle it, including monitoring and evaluation.

Congratulations should be in order for academic scheme.

It was with familiar disappointment that I read Julie Scholes's letter 'Drive to meet targets may undermine learning aims' (August 12).

Rewarding efficiency.

SINCE THE new year, and for the first time in the history of the NHS, all eligible patients across England have the right to exercise choice over where and when they receive hospital treatment. They can now choose services that meet their individual needs and preferences.