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

To examine the impact of nursing team size and composition on inpatient hospital mortality. 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. Three hospitals within a single National Health Service Trust in England. 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. In-hospital deaths. 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). 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.

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Déclaration de conflit d'intérêts

Competing interests: All authors have completed the ICMJE uniform disclosure form (available on request from the corresponding author) and declare: EK, CP and BZ had financial support from the Economic and Social Research Council (ESRC) for the submitted work through the Centre for the Microeconomic Analysis of Public Policy (CPP) at IFS (ES/M010147/1) and 'The impact of medical labour on variation in patient outcomes: evidence from English public hospitals' research grant (ES/S003118/1); CP also had support for the submitted work from the European Research Council (ERC) under the Advanced Investigator Grant Healthcare Labour; MW had support for the submitted work from the NIHR Imperial Biomedical Research Centre; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years; no other relationships or activities that could appear to have influenced the submitted work.