Perception of Hospital Care Linked to Nursing Roster

A new study shows that a patient’s unfavorable perceptions of hospital care are strongly associated with inadequate professional nurse staffing.

Researchers at the University of Southampton (US; United Kingdom), King’s College London (KCL; United Kingdom), and other institutions reported the results of a cross-sectional study that examined surveys of 66,348 hospital patients discharged in 2010 from 161 National Health Service (NHS) trusts in England. Concomitantly, 2,963 inpatient nurses were surveyed in a sample of 46 hospitals of the same 161 trusts. The main outcome measures were patient ratings of their hospital care, their confidence in nurses and doctors, and other indicators of satisfaction.

The results showed that patients’ perceptions of care were significantly eroded by lack of confidence in either nurses or doctors, and by increases in missed nursing care; 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% felt there were always enough nurses to care for them, and one in 10 said there were never or rarely enough nurses on duty.

The nurse survey showed that workloads ranged from 5.6 to 11.6 patients per nurse each across the 46 hospitals. After taking account of various influential factors, the researchers calculated that the likelihood of patients always saying there were enough nurses to take care of them were about 40% 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 did not always have time to provide the necessary care. Some seven percent felt this about pain management, but 52% felt they did not have enough time to talk to patients and relatives about how to manage care after discharge. The lower the patient-to-nurse ratio, the lower the number of needed but 'missed' episodes of care. But the greater the number of episodes of missed care, the less likely were patients to rate their hospital care favorably. The study was published on January 13, 2018, in BMJ.

“The narrative that quality deficits in hospitals are due to 'uncaring' nurses is not supported by the evidence,” concluded senior author Professor Peter Griffiths, PhD, RN, of US, and colleagues. “On the contrary, our findings suggest that reducing missed nursing care by ensuring adequate numbers of registered nurses at the hospital bedside, and improved hospital clinical care environments, are promising strategies for enhancing patient satisfaction with care.”

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University of Southampton
King’s College London