Evidence map›Paper›PMID 36167797›Full record

ArticleBMJ quality & safety2023

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

Ben Zaranko, Natalie Jean Sanford, Elaine Kelly, Anne Marie Rafferty, James Bird, Luca Mercuri, Janice Sigsworth, Mary Wells, Carol Propper

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ quality & safety, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
30citing papers in PubMed, 1 pooled it
12.2field-weighted citation impact, top 1% of its field
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

30 citing papers in PubMed, 1 synthesis or guideline pooled it, 49 citations in OpenAlex.

  1. Patients and staff perspectives on hospital ward strain and its impacts on patient care and the workforce: a mixed-methods systematic review.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2026
    Pooled it
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  4. Nurse staffing models that rely on employment of temporary nurses: A realist review.International journal of nursing studies advances · 2026
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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

9 authors at 3 institutions in 1 country.

Ben ZarankoInstitute for Fiscal Studies, London, UK.ORCID 0000-0003-4088-8289
Natalie Jean SanfordFlorence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK.ORCID 0000-0003-2650-1818
Elaine KellyInstitute for Fiscal Studies, London, UK.
Anne Marie RaffertyFlorence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK.
James BirdImperial College Healthcare NHS Trust, London, UK.
Luca MercuriResearch Informatics Team, Imperial College Healthcare NHS Trust, London, UK.
Janice SigsworthImperial College Healthcare NHS Trust, London, UK.
Mary WellsImperial College Healthcare NHS Trust, London, UK.ORCID 0000-0001-5789-2773
Carol PropperInstitute for Fiscal Studies, London, UK c.propper@imperial.ac.uk.
Imperial College Healthcare NHS Trust · GBInstitute for Fiscal Studies · GBKing's College London · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo examine the impact of nursing team size and composition on inpatient hospital mortality.

designA 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.

settingThree hospitals within a single National Health Service Trust in England.

participants19 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.

main outcome measureIn-hospital deaths.

resultsA 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).

conclusionsRN 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.

Indexed as

Nursing Staff, HospitalState MedicineAdultHospital MortalityHumansInpatientsLongitudinal StudiesPersonnel Staffing and SchedulingRetrospective StudiesWorkforceduty hours/work hourshealth policynursesteams

Identifiers

PMID36167797
PMCPMC10176371
OpenAlexW4297325230

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

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.