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Research project

Ward staffing guided by the Safer Nursing Care Tool - a multi-criteria analysis of "fit"

Project overview

Background - It is important to have enough qualified (registered) nurses looking after patients staying on hospital wards, because having too few is associated with worse patient care and more patient deaths. On the other hand, there are extreme shortages of nurses, so having “too many” on a ward could be considered a waste. The Safer Nursing Care Tool is used in many hospital wards in England to work out the number of nursing staff (including nursing assistants) needed. However, a recent study showed that factors not accounted for in the tool, e.g. whether a ward is surgical or medical, and the proportion of single rooms, also affected professional judgement of whether staffing was adequate.

Aims - This study aims to understand which ward characteristics mean that the Safer Nursing Care Tool gives a good estimate of the nursing staff required, and which ward characteristics mean that the number might need to be adjusted or further considered by taking into account the expertise of ward leaders

Collaboration - Nursing workforce leaders at three acute hospital Trusts in southern England were co-Investigators on this project

Methods - We analysed how well the Safer Nursing Care Tool "fit" on different wards, according to multiple criteria. We asked nursing workforce leads to suggest factors associated with poor fit, based on the wards that rated worst.

Outcomes - This project has led to an academic paper published in the Journal of Nursing Management and ongoing work with NHS England/Improvement on safe staffing resources. The key conclusion was that using a staffing tool without applying professional judgement or triangulating against other methods can lead to inaccurate estimates of staffing requirements and unsafe staffing levels.


Lead researcher

Dr Christina Saville MSc, PhD, AFORS

Senior Research Fellow

Research interests

  • Safe staffing
  • Operational research techniques applied to healthcare
  • Health workforce
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Other researchers

Professor Peter Griffiths

Chair in Health Services Research

Research interests

  • Health workforce
  • Epidemiology
  • Nursing
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Collaborating research institutes, centres and groups

Research outputs

Christina Saville, Peter Griffiths, Ann Casey, Rosemary Chable, Hilary Chapman, Mark Radford & Natasha Watts, 2022
Type: other
Christina Saville & Peter Griffiths, 2021, Journal of Nursing Management, 29(7), 2260-2269
Type: article