School of Health Sciences, University of Southampton, Southampton, UK.
National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care Wessex, University of Southampton, Southampton, Hampshire, UK.
BMJ Open. 2020 May 15;10(5):e035828. doi: 10.1136/bmjopen-2019-035828.
The best way to determine nurse staffing requirements on hospital wards is unclear. This study explores the precision of estimates of nurse staffing requirements made using the Safer Nursing Care Tool (SNCT) patient classification system for different sample sizes and investigates whether recommended staff levels correspond with professional judgements of adequate staffing.
Observational study linking datasets of staffing requirements (estimated using a tool) to professional judgements of adequate staffing. Multilevel logistic regression modelling.
81 medical/surgical units in four acute care hospitals.
22 364 unit days where staffing levels and SNCT ratings were linked to nurse reports of "enough staff for quality".
SNCT-estimated staffing requirements and nurses' assessments of staffing adequacy.
The recommended minimum sample of 20 days allowed the required number to employ (the establishment) to be estimated with a mean precision (defined as half the width of the CI as a percentage of the mean) of 4.1%. For most units, much larger samples were required to estimate establishments within ±1 whole time equivalent staff member. When staffing was lower than that required according to the SNCT, for each hour per patient day of registered nurse staffing below the required staffing level, the odds of nurses reporting that there were enough staff to provide quality care were reduced by 11%. Correspondingly, the odds of nurses reporting that necessary nursing care was left undone were increased by 14%. No threshold indicating an optimal staffing level was observed. Surgical specialty, patient turnover and more single rooms were associated with lower odds of staffing adequacy.
The SNCT can provide reliable estimates of the number of nurses to employ on a unit, but larger samples than the recommended minimum are usually required. The SNCT provides a measure of nursing workload that correlates with professional judgements, but the recommended staffing levels may not be optimal. Some important sources of systematic variations in staffing requirements for some units are not accounted for. SNCT measurements are a potentially useful adjunct to professional judgement but cannot replace it.
ISRCTN12307968.
确定医院病房护士人员配置需求的最佳方法尚不清楚。本研究旨在探讨使用 Safer Nursing Care Tool（SNCT）患者分类系统进行不同样本量的护士人员配置需求估计的精确性，并调查建议的人员配置水平是否与足够人员配置的专业判断相符。
将人员配置需求（使用工具估计）与足够人员配置的专业判断相关联的观察性研究。多水平逻辑回归模型。
四家急性护理医院的 81 个医疗/外科病房。
22364 个单元日，其中人员配置水平和 SNCT 评分与护士报告的“有足够人员提供高质量护理”相关联。
SNCT 估计的人员配置需求和护士对人员配置充足性的评估。
建议的最小样本量为 20 天，这允许以平均精度（定义为 CI 宽度的一半作为平均值的百分比）为 4.1% 估计所需的人员数量。对于大多数病房，需要更大的样本量才能在 ±1 个全职等效人员内估计人员编制。当人员配备低于 SNCT 要求时，与符合 SNCT 要求的护士配置相比，每小时每患者护理 1 小时，报告有足够人员提供优质护理的护士比例降低 11%。相应地，报告必要的护理工作未完成的护士比例增加了 14%。未观察到表示最佳人员配置水平的阈值。外科专业、患者周转率和更多单人房与人员配置充足的可能性降低相关。
SNCT 可以提供有关单位应雇用护士人数的可靠估计，但通常需要比建议的最小样本量更大的样本量。SNCT 提供了与专业判断相关的护理工作量衡量标准，但建议的人员配置水平可能不是最佳的。一些重要的系统变异来源，如人员配置需求，没有被考虑在内。SNCT 测量是专业判断的有用补充，但不能替代它。
ISRCTN84502116。
