Staffing Levels, Not Lack of Caring, Determine Patient Satisfaction

Patients’ level of satisfaction with their stay in hospital is closely linked to registered nurse staffing ratios. This was one of the main conclusions of an extensive study conducted in the United Kingdom. “The narrative that quality deficits in hospitals in England are due to ‘uncaring’ nurses is not supported by the evidence” stated the researchers.

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The aim of the study, “Patient satisfaction with hospital care and nurses in England: an observational study” was to inform health care policy in the UK National Health Service (NHS). The objectives were to determine how patients’ views about their hospital care were influenced by their confidence in nurses and doctors; nurse staffing levels; and hospital work environments.

The team of prominent researchers, from the UK, US and Belgium, analyzed and linked data from two major NHS surveys. These were the 2010 NHS Survey of Inpatients that collected data from 66,000 patients who had been discharged from acute and specialist NHS hospitals, and the 2010 RN4Cast-England study where information was collected from 2,963 registered nurses who were providing direct care in medical and surgical units. Three separate, but related, analyses were done.

In the first analysis, patient ratings were compared to their confidence in nurses and doctors as well as their perception of whether there were enough nurses on duty. Sixty percent of the patients who indicated that they had confidence and trust in both their doctors and nurses rated their care as excellent. These percentages fell down to 17% if they had confidence in only their doctors and to 16% if they had confidence in the nurses and not the doctors. Only 3% of patients who had confidence and trust in neither doctors nor nurses rated their care as excellent.

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Over half of the patients who indicated that there were always enough nurses to care for them rated their hospital care as excellent, compared to only 14% of those patients who felt that there were only sometimes or rarely enough nurses available.


Next, the researchers analyzed the responses by nurses relating to 13 types of nursing care which were reported as being missed due to lack of time, as well as questions concerning their working environment. Workloads were estimated from the respondents’ reports on how many patients they had cared for during the previous shift. Fewer registered nurses to patients were significantly related to more missed care. Furthermore, in better working environments there were fewer instances of missed care. The care which was incomplete most often concerned the types of care that patients would easily recognize as missing – for example, comforting and talking to patients, explaining medications and discharge teaching for patients and their families.

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Finally, the researchers merged the data of the two studies to determine the association between the number and types of missed care and patient’s rating of their hospital stay. It was established that positive ratings by patients decreased as the number of types of missed care increased. “When there aren’t enough professional nurses, things get missed, patients notice, and this affects their confidence in the quality of the hospital and the care they receive,” said Peter Griffiths, one of the co-authors of the study.

“When there aren’t enough professional nurses, things get missed, patients notice, and this affects their confidence in the quality of the hospital and the care they receive…”

The reality of missed nursing care in the NHS is evident from the following extract from an anonymous letter to the press in which a nurse explains why she resigned: “The demand is so much on so few that you are in a position that you are just trying to keep people alive and prevent harm. You have no time to support patients or families because every moment you spend with them you are acutely aware that your other patients who are equally unwell now have no one monitoring them […] You live with a chronic guilt as you cannot provide the care that you want to give […] it pains me to admit that there have been times I have not been able to help someone.”

“The demand is so much on so few that you are in a position that you are just trying to keep people alive and prevent harm.”

The researchers concluded that “Patients express a high level of confidence and trust in nurses, and their satisfaction with hospital care is less favourable when they perceive there are not enough nurses available […] our findings suggest that reducing missed nursing care by ensuring adequate numbers of RNs at the hospital bedside and improved hospital clinical care environments are promising strategies for enhancing patient satisfaction with care.”

Staffing Levels, Not Lack of Caring, Determine Patient Satisfaction

Patients’ level of satisfaction with their stay in hospital is closely linked to registered nurse staffing ratios. This was one of the main conclusions of an extensive study conducted in the United Kingdom. “The narrative that quality deficits in hospitals in England are due to ‘uncaring’ nurses is not supported by the evidence” stated the researchers.

The aim of the study, “Patient satisfaction with hospital care and nurses in England: an observational study” was to inform health care policy in the UK National Health Service (NHS). The objectives were to determine how patients’ views about their hospital care were influenced by their confidence in nurses and doctors; nurse staffing levels; and hospital work environments.

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Staffing Levels, Not Lack of Caring, Determine Patient Satisfaction
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The team of prominent researchers, from the UK, US and Belgium, analyzed and linked data from two major NHS surveys. These were the 2010 NHS Survey of Inpatients that collected data from 66,000 patients who had been discharged from acute and specialist NHS hospitals, and the 2010 RN4Cast-England study where information was collected from 2,963 registered nurses who were providing direct care in medical and surgical units. Three separate, but related, analyses were done.

In the first analysis, patient ratings were compared to their confidence in nurses and doctors as well as their perception of whether there were enough nurses on duty. Sixty percent of the patients who indicated that they had confidence and trust in both their doctors and nurses rated their care as excellent. These percentages fell down to 17% if they had confidence in only their doctors and to 16% if they had confidence in the nurses and not the doctors. Only 3% of patients who had confidence and trust in neither doctors nor nurses rated their care as excellent.

Over half of the patients who indicated that there were always enough nurses to care for them rated their hospital care as excellent, compared to only 14% of those patients who felt that there were only sometimes or rarely enough nurses available.

Next, the researchers analyzed the responses by nurses relating to 13 types of nursing care which were reported as being missed due to lack of time, as well as questions concerning their working environment. Workloads were estimated from the respondents’ reports on how many patients they had cared for during the previous shift. Fewer registered nurses to patients were significantly related to more missed care. Furthermore, in better working environments there were fewer instances of missed care. The care which was incomplete most often concerned the types of care that patients would easily recognize as missing – for example, comforting and talking to patients, explaining medications and discharge teaching for patients and their families.

Finally, the researchers merged the data of the two studies to determine the association between the number and types of missed care and patient’s rating of their hospital stay. It was established that positive ratings by patients decreased as the number of types of missed care increased. “When there aren’t enough professional nurses, things get missed, patients notice, and this affects their confidence in the quality of the hospital and the care they receive,” said Peter Griffiths, one of the co-authors of the study.

“When there aren’t enough professional nurses, things get missed, patients notice, and this affects their confidence in the quality of the hospital and the care they receive…”

The reality of missed nursing care in the NHS is evident from the following extract from an anonymous letter to the press in which a nurse explains why she resigned: “The demand is so much on so few that you are in a position that you are just trying to keep people alive and prevent harm. You have no time to support patients or families because every moment you spend with them you are acutely aware that your other patients who are equally unwell now have no one monitoring them […] You live with a chronic guilt as you cannot provide the care that you want to give […] it pains me to admit that there have been times I have not been able to help someone.”

“The demand is so much on so few that you are in a position that you are just trying to keep people alive and prevent harm.”

The researchers concluded that “Patients express a high level of confidence and trust in nurses, and their satisfaction with hospital care is less favourable when they perceive there are not enough nurses available […] our findings suggest that reducing missed nursing care by ensuring adequate numbers of RNs at the hospital bedside and improved hospital clinical care environments are promising strategies for enhancing patient satisfaction with care.”