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The University of Southampton

International study highlights nursing workforce issues in England

Published: 21 March 2012
Prof Peter Griffiths
Prof Peter Griffiths

Results of the international RN4CAST study into links between nursing workforce issues and patient outcomes in 13 countries have been published in the British Medical Journal today.

The study of nurses in England, which was led by researchers at the National Nursing Research Unit (NNRU) at King’s College London and the University of Southampton, reveals that the levels of “burnout” and job dissatisfaction experienced by English nurses are some of the worst in Europe.

The worldwide study was led by the University of Pennsylvania School of Nursing in the U.S. and the Catholic University of Leuven, Belgium in Europe. Researchers in England surveyed over 2,900 nurses based at over 40 hospitals across the country and results have been compared with similar samples from 11 other European countries and from the USA. 42% of English nurses surveyed were assessed as being burnt out, second only to Greece, while 44% stated that they intended to leave their job in the next year due to dissatisfaction.

Anne Marie Rafferty, Professor of Nursing Policy at King’s College London, say: “Our study reveals huge variation, both between hospitals and within hospitals, on core workforce issues such as nurse to patient ratios. It is also clear that England’s nurses are working in highly pressurised environments, resulting in lower levels of job satisfaction and greater “burnout” compared to some other European health economies. We now need to analyse this variation in greater depth to assess - are the different staffing levels we found a reflection of different needs, which are being met equally well? Or are they associated with a different level of care provision between and within hospitals?”

The RN4CAST survey asked nurses across Europe and the USA to rate their satisfaction with different aspects of their job, including levels of support, working environment, and whether or not they would recommend their hospital to friends and family.

Linda H. Aiken, PhD, RN, a Professor of Nursing and Sociology at the University of Pennsylvania, and one of the study’s lead authors comments: “Patients in European and U.S. hospitals with better work environments were more likely to rate their hospital highly and to recommend their hospital to others. In contrast, patient safety is a concern in hospitals that have poor work environments and insufficient nurse staffing”

Professor Peter Griffiths, Chair of Health Services Research at the University of Southampton adds: “This study shows that widely reported problems in the quality of nursing are not just a matter of the poor attitudes of some nurses, the working environment also plays an important role and hospital management needs to take these matters seriously. There is a clear link between nurse staffing levels and job satisfaction and their views on overall outcomes for patients. We are now analysing hospital data on death rates and rates of complications to see if high patient to staff ratios impact on these outcomes.”

Jane Ball, Deputy Director of the National Nursing Research Unit at King’s College London, said: “This international study reveals that the same workforce issues are affecting health systems across Europe and the USA. We need to learn from the best performing countries to improve the working environments and support available for our nurses. Otherwise, with high levels of job dissatisfaction and nearly half the nurses we surveyed stating that they are intending to leave their job within the year, we could face substantial nurse shortages in England in the future.”

Martin McKee, Professor of European Health at the London School of Hygiene & Tropical Medicine, said: "These alarming findings must be a major cause of concern for the government as it embarks on a radical change to how we provide health care that is so dependent on the commitment, goodwill and professionalism of those who deliver front line care."

The study, conducted with a 3 million Euro grant from the European Commission, with additional funding from the National Institute of Nursing Research of the National Institutes of Health in the U.S., investigated hospital quality and safety of care in Belgium, England, Finland, Ireland, Germany, Greece, Netherlands, Norway, Poland, Spain, Sweden, Switzerland, and the U.S.

The full article can be found at

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