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Determining acute nurse staffing: a hermeneutic review of an evolving science
  1. Alison Leary1,2,
  2. Geoffrey Punshon1
  1. 1 School of Health and Social Care, London South Bank University, London, UK
  2. 2 School of Health, University of South Eastern Norway, Oslo, Norway
  1. Correspondence to Professor Alison Leary; alisonleary{at}yahoo.com

Abstract

Background Calculating nurse staffing in the acute hospital has become a key issue but solutions appear distant. Community, mental health and areas such as learning disability nursing have attracted less attention and remain intractable. This review aims to examine current approaches to the issue across many disciplines.

Design The approach taken is iterative and in the form of a hermeneutic review. 769 pieces of evidence were reviewed from across disciplines such as nursing, medicine, engineering, statistics, population science, computer science and mathematics where hospital nurse staffing was the subject of the study.

Results A number of themes emerged. The first iteration showed the predominance of unit base approaches (eg, nurse numbers, ratios, activity and workload) and the second was the development of methodologies. Subsequent iterations examined issues such as demand, safety, nurse education, turnover, patient outcomes, patient or staff satisfaction, workload and activity. The majority of studies examined (n=767) demonstrated some association between staffing (units or type/skill) and various factors such as staff or patient satisfaction, working conditions, safety parameters, outcomes complexity of work achieved, work left undone or other factors. Many potential areas such as operational safety research were not utilised.

Conclusion Although the relationship between staffing in acute care and factors such as units, safety or workload is complex, the evidence suggests an interdependent relationship which should only be dismissed with caution. The nature of these relationships should be further examined in order to determine nurse staffing. The body of knowledge appears substantial and complex yet appears to have little impact on policy.

  • staffing
  • safety
  • nursing
  • skillmix
  • education
  • modelling
  • hermeneutics

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Twitter @alisonleary1

  • Contributors AL design, analysis and writing. GP analysis and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval This is a review of the literature. Ethical permission was not sought.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All of the papers reviewed are in the public domain.

  • Patient consent for publication Not required.

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