Evidence map›Paper›PMID 30918050›Full record

Observational studyBMJ quality & safety2019

Hospital nurse staffing and staff-patient interactions: an observational study.

Jackie Bridges, Peter Griffiths, Emily Oliver, Ruth M Pickering

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ quality & safety, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers.

0numbers the graph read from it
0cells of the map it votes in
36citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

36 citing papers in PubMed.

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  9. Personnel shortages and the provision of long-term care: an empirical analysis of German nursing homes.The European journal of health economics : HEPAC : health economics in prevention and care · 2025
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  16. Exploring the collaborative care of patients with pelvic fractures in Tshwane, South Africa.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors.

Jackie BridgesSchool of Health Sciences, University of Southampton, Southampton, UK jackie.bridges@soton.ac.uk.ORCID 0000-0001-6776-736X
Peter GriffithsSchool of Health Sciences, University of Southampton, Southampton, UK.
Emily OliverSchool of Health Sciences, University of Southampton, Southampton, UK.
Ruth M PickeringPrimary Care and Population Sciences, University of Southampton, Southampton, UK.

Funding

Department of Health HS&DR/13/07/48
6 · The paper itself

Abstract

backgroundExisting evidence indicates that reducing nurse staffing and/or skill mix adversely affects care quality. Nursing shortages may lead managers to dilute nursing team skill mix, substituting assistant personnel for registered nurses (RNs). However, no previous studies have described the relationship between nurse staffing and staff-patient interactions.

settingSix wards at two English National Health Service hospitals.

methodsWe observed 238 hours of care (n=270 patients). Staff-patient interactions were rated using the Quality of Interactions Schedule. RN, healthcare assistant (HCA) and patient numbers were used to calculate patient-to-staff ratios. Multilevel regression models explored the association between staffing levels, skill mix and the chance of an interaction being rated as 'negative' quality, rate at which patients experienced interactions and total amount of time patients spent interacting with staff per observed hour.

results10% of the 3076 observed interactions were rated as negative. The odds of a negative interaction increased significantly as the number of patients per RN increased (p=0.035, OR of 2.82 for ≥8 patients/RN compared with >6 to <8 patients/RN). A similar pattern was observed for HCA staffing but the relationship was not significant (p=0.056). When RN staffing was low, the odds of a negative interaction increased with higher HCA staffing. Rate of interactions per patient hour, but not total amount of interaction time, was related to RN and HCA staffing levels.

conclusionLow RN staffing levels are associated with changes in quality and quantity of staff-patient interactions. When RN staffing is low, increases in assistant staff levels are not associated with improved quality of staff-patient interactions. Beneficial effects from adding assistant staff are likely to be dependent on having sufficient RNs to supervise, limiting the scope for substitution.

Indexed as

Nurse-Patient RelationsPersonnel Staffing and SchedulingAdolescentAdultAgedAged, 80 and overEnglandFemaleHumansMaleMiddle AgedNursing Staff, HospitalState MedicineYoung Adulthealth services researchnursespatient-centred care

Identifiers

PMID30918050
PMCPMC6820291

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.