Temporary nursing staff can partially combat the increased risk of death among patients

A new study led by the University of Southampton has found that the use of temporary nursing staff to fill rosters only partially counteracts the increased risk of patient death caused by staff shortages.

Researchers have found that avoiding understaffing reduces the risk of patient death, particularly when temporary registered nurses are used to maintain staffing levels. However, the risk of death remains higher than in a fully staffed ward with permanent nurses.

The results of the study, which was funded by the National Institute for Health and Care Research (NIHR) and the NIHR Applied Research Collaboration (Wessex), are to be published in the journal JAMA network opened.

The research team conducted an observational study on 185 wards in four acute hospitals in England between 2015 and 2020 – a total of over 600,000 patients were admitted. The anonymized participants were adults staying overnight and nursing staff on inpatient wards.

The study found that for every day that nursing staffing levels were understaffed, a patient's risk of death increased by 7.9 percent over normal levels. For nursing assistants, the figure was similar at 7.2 percent. However, this risk could be partially, although not completely, reduced by hiring temporary staff.

A 10 percent increase in the number of nursing staff on wards was associated with a 2.3 percent increased risk of death – there was no difference between the use of temporary or hospital bank staff. The risk of death was increased by 4 percent for nursing assistants, and temporary staff from this group had a greater negative impact than bank staff.

Commenting on the study, lead author Professor Peter Griffiths from the University of Southampton said: “Our study shows that addressing staff shortages by using temporary staff to fill gaps is definitely beneficial in preventing deaths on wards. The harm caused by staff shortages is greater than using temporary staff to fill gaps. However, our findings challenge the assumption that temporary staff are a cost-effective long-term solution to maintaining patient safety.”

The study also found some evidence that there is benefit in having more experienced staff on duty, both among registered nurses and nursing assistants, although there is some inconsistency within these findings.

“Previous studies have shown that having more experienced staff in a team has a positive effect and our results are consistent with this. This suggests that the relatively new role of the registered nurse, which will increase the proportion of experienced support staff on wards, does indeed have some benefits,” commented Professor Griffiths.

The researchers, who worked with Portsmouth Hospitals University NHS Trust for the study, acknowledge that further work is needed to better understand the role of temporary staff and the impact of different staffing mixes on other patient outcomes and the quality of care.