. 2022 Apr 13;22(1):493.

doi: 10.1186/s12913-022-07562-w.

Nurse staffing levels within acute care: results of a national day of care survey

Hannah Hegarty¹, Thomas Knight^{1

2}, Catherine Atkin¹, Tash Kelly³, Chris Subbe⁴, Daniel Lasserson⁵, Mark Holland⁶

Affiliations

¹ Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK.
² Sandwell and West Birmingham NHS Trust, Birmingham, UK.
³ University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.
⁴ School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, LL57 2PW, UK.
⁵ Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
⁶ Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, Bolton, BL3 5AB, UK. M.Holland2@bolton.ac.uk.

PMID: 35418056
PMCID: PMC9008904
DOI: 10.1186/s12913-022-07562-w

Nurse staffing levels within acute care: results of a national day of care survey

Hannah Hegarty et al. BMC Health Serv Res. 2022.

. 2022 Apr 13;22(1):493.

doi: 10.1186/s12913-022-07562-w.

Authors

Hannah Hegarty¹, Thomas Knight^{1

2}, Catherine Atkin¹, Tash Kelly³, Chris Subbe⁴, Daniel Lasserson⁵, Mark Holland⁶

Affiliations

¹ Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University Hospital Birmingham NHS Foundation Trust, University of Birmingham, Edgbaston, Birmingham, B15 2GW, UK.
² Sandwell and West Birmingham NHS Trust, Birmingham, UK.
³ University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK.
⁴ School of Medical Sciences, Bangor University & Consultant Acute, Respiratory & Critical Care Medicine, Ysbyty Gwynedd, Bangor, LL57 2PW, UK.
⁵ Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
⁶ Clinical and Biomedical Sciences, Faculty of Health and Wellbeing, University of Bolton, Bolton, BL3 5AB, UK. M.Holland2@bolton.ac.uk.

PMID: 35418056
PMCID: PMC9008904
DOI: 10.1186/s12913-022-07562-w

Abstract

Introduction: The relationship between nurse staffing levels and patient safety is well recognised. Inadequate provision of nursing staff is associated with increased medical error, as well as higher morbidity and mortality. Defining what constitutes safe nurse staffing levels is complex. A range of guidance and planning tools are available to inform staffing decisions. The Society for Acute Medicine (SAM) recommend a 'nurse-to-bed'ratio of greater than 1:6. Whether this standard accurately reflects the pattern and intensity of work on the Acute Medical Unit (AMU) is unclear.

Methods: Nurse staffing levels in AMUs were explored using the Society for Acute Medicine Benchmarking Audit 2019 (SAMBA19). Data from 122 acute hospitals were analysed. Nurse-to-bed ratios were calculated and compared. Estimates of the total nursing time available within the acute care system were compared to estimates of the time required to perform nursing activities.

Results: The total number of AMU beds across all 122 units was 4997. The mean daytime nurse-to-bed ratio was 1:4.3 and the mean night time nurse-to-bed ratio was 1:5.2. The SAM standard of a nurse to bed ratio of greater than 1:6 was achieved in 99 units (81.9%) during daytime hours and achieved by 74 units (60.6%) at night. The estimated time required to deliver direct clinical care was 35,698 h. A deficit of 4128 h (11.5% of time required) was estimated, representing the time difference between the total number of nursing hours available with current staffing and the estimated time needed for direct clinical care across all participating units.

Conclusion: This UK-wide study suggests a significant proportion of AMUs do not meet the recommenced SAM staffing levels, particularly at night. A difference was observed between the total number of nursing hours within the acute care system and the estimated time required to perform direct nursing activities. This suggests a workforce shortage of nurses within acute care at the system level.

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Conflict of interest statement

The authors declare no competing interests.

Figures

**Fig. 1**
Variation in AMU bed to nurse ratio by country. *hospitals ordered by increasing bed to nurse ratio. Horizonal line represents SAM standard (6:1)

**Fig. 2**
Bar plots demonstrating variation in skill-mix at the hospital level

**Fig. 3**
Boxplots comparing the ratio of non-registered to registered nurses at day and night stratified by achievement of the SAM standard in relation to nurse to bed ratio

See this image and copyright information in PMC

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Nurse staffing levels within acute care: results of a national day of care survey

Affiliations

Nurse staffing levels within acute care: results of a national day of care survey

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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