Availability of qualified nurses in hospitals affects patient satisfaction

Satisfaction with care in hospitals declines when patients believe there are not enough nurses on wards, according to a new study based on the NHS Inpatient Survey published in the BMJ Open.

Only 14 percent of patients who reported there was never or rarely enough nurses on the hospital ward rated their care as excellent, while 57 percent of patients who reported there were usually enough nurses rated their care as excellent.

The study, led by researchers from the University of Pennsylvania, University of Southampton, and King's College London, also showed that only 60 percent of the 66,348 patients responding to the NHS survey reported that there were usually enough nurses available to provide their care. One in 10 patients surveyed said there were never or rarely enough professional nurses during their hospital stay, the study has shown.

The internationally renowned research team say that their findings show that it is the availability of qualified registered nurses in hospitals that affects patient satisfaction most.

"The often repeated narrative suggesting that quality deficits in hospitals are due to 'uncaring' nurses is not supported by evidence from the NHS's own survey," says author Linda Aiken, PhD, RN, Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania. "Patients value nurses so much that when nurses are in short supply, patients' overall ratings of their hospitals decline sharply."

The study shows that missed nursing care that is common when there are too few nurses on duty contributes to patients' low ratings of their hospitals.

Professor Peter Griffiths, from the University of Southampton, said: "The variation in nurse staffing levels between different NHS hospitals is huge. When there aren't enough professional nurses, things get missed, patients notice, and this affects their confidence in the quality of the hospital and the care they receive."

"England has one of the lowest percentages among European countries of professional nurses at the bedside already. We know that 65 percent of nurses in hospitals in England say that high workloads prevent them from spending enough time comforting patients while 52 percent of nurses say they don't have enough time to teach patients and their families how to manage after hospital. But having more staff on the wards, who have limited qualifications is not enough – the NHS needs to focus on achieving safe registered nurse staffing levels as a means to achieve better outcomes including improving patients' satisfaction with their care."

The study shows that patients' confidence in doctors and nurses is equally important in whether they rate the hospital care as excellent.

"Shoring up nurse staffing as well as medical staffing is warranted to improve quality of care," said Professor Anne Marie Rafferty, DPhil (Oxon) RN, from the Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London.

''Patient perception is an important barometer of quality of care and confidence in the NHS. The widening gap between demand and capacity is reflected in missed care, which in turn is associated with poor nurse staffing and poor hospital environments. Improving nurse staffing in NHS hospitals holds promise for improving patient satisfaction''.

This large study is the latest in a series of studies and commissioned reports on uneven quality of care in NHS hospitals in England pointing to the immediate need for increasing the number of funded positions in NHS hospitals for highly qualified professional nurses.