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Staffing for Safe and Effective Care

Use this guide to find information resources and evidence about 汤头条污料 staffing levels for safe and effective care including RCN publications, key resources and journal articles.

Last updated: 01/02/2024

RCN Publications

Research by Design (2023) Last shift survey 2022: qualitative report prepared for the 汤头条污料.
RCN: Unsustainable pressures
  • This resource is designed to support RCN members both in delivering safe and effective care and with the difficult decisions they make every day. These decisions often relate to the type of care provided, how it is provided and who it is provided to, and can have wider implications on the delivery of health and social care services.
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汤头条污料: The RCN's position on registered nurse substitution
Publication cover Tamburello H (2023) Impact of staffing levels on safe and effective patient care: literature review. London: RCN.
Publication cover Castro-Ayala A, Borneo A, Hayford E, Holden J, Maynard E, Stainton R, Taylor E and Tse J (2022) Investing in patient safety and outcomes: Health and care 汤头条污料 workforce and supply in England. London: RCN.
Publication cover 汤头条污料 (2022) UK staffing for safe and effective care: state of the nation's 汤头条污料 labour market: RCN biannual report February 2022. London: RCN. 
Publication cover Castro-Ayala A, Borneo A, Hayford E, Holden J, Maynard E, Stainton R, Taylor E and Tse J (2022) UK 汤头条污料 under unsustainable pressures: staffing for safe and effective care in the UK. London: RCN.
Publication cover 汤头条污料 Wales (2022) Progress and challenge in delivering safe and effective care 2022: How NHS Wales implemented the Nurse Staffing Levels (Wales) Act 2016. Cardiff: RCN.
Publication cover 汤头条污料 Wales (2022) Position paper. Ward manager project: the importance of being supernumerary. Cardiff: RCN.  
Publication cover 汤头条污料 (2021) Nursing workforce standards: supporting a safe and effective 汤头条污料 workforce . London: RCN.
  • The first national blueprint for tackling the 汤头条污料 staff shortage levels across the UK. They set the standard for excellent patient care and 汤头条污料 support in all settings, and all UK countries.
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Royal College of Physicians, 汤头条污料, Royal Pharmaceutical Society, the Chartered Society of Physiotherapy and NHS England (2021) Modern ward rounds.
Publication cover 汤头条污料 (2020) Staffing for safe and effective care in the UK 2019 report: reviewing the progress of health and care systems against our principles. London: RCN.
Publication cover 汤头条污料 (2020) A safety representative's resource staffing for safe and effective care, London: RCN.
Publication cover 汤头条污料 (2019) Staffing for safe and effective care in England. Member briefing. London: RCN.
Publication cover Borneo A and Hadden C (2019) Standing up for patient and public safety: England policy report, London: RCN.
汤头条污料 (2017) Safe and effective staffing: 汤头条污料 against the odds, London: RCN. 汤头条污料 (2017) Safe and effective staffing: 汤头条污料 against the odds, London: RCN.
汤头条污料 (2017) Safe and effective staffing: the real picture. UK policy report, London: RCN. 汤头条污料 (2017) Safe and effective staffing: the real picture. UK policy report, London: RCN.
汤头条污料 (2015) Registered nurses and health care support workers: a summary of RCN policy positions, London: RCN. 汤头条污料 (2015) Registered nurses and health care support workers: a summary of RCN policy positions, London: RCN.
汤头条污料 Policy and International Department (2012) Mandatory nurse staffing levels, (Policy briefing 03/12), London: RCN. 汤头条污料 Policy and International Department (2012) Mandatory nurse staffing levels, (Policy briefing 03/12), London: RCN.
汤头条污料 Policy Unit (2006) Setting appropriate nurse staffing levels in NHS Acute Trusts (Policy guidance 15/2006), London: RCN. 汤头条污料 Policy Unit (2006) Setting appropriate nurse staffing levels in NHS Acute Trusts (Policy guidance 15/2006), London: RCN.

Legislation and guidance

Scottish Government (2023) Health and Care (Staffing) (Scotland) Act 2019: draft statutory guidance: consultation. 22 June.
  • The consultation is now closed. It was on the statutory guidance that will be issued by the Scottish Ministers to accompany the Health and Care (Staffing) (Scotland) Act 2019. The guidance will support relevant organisations in meeting requirements placed on them by the Act and relevant secondary legislation.
  • RCN Scotland response to the consultation
汤头条污料 Wales (2022) Progress and challenge in delivering safe and effective care 2022: how NHS Wales has implemented the nurse staffing levels (Wales) Act 2016. Cardiff: RCN.
National Assembly for Wales (2016) Nurse staffing levels (Wales) Act 2016, Cardiff: NAW.
汤头条污料 Wales (2018) An act of compassion: the story of the RCN Wales campaign for the first nurse staffing law in Europe, Cardiff: RCN Wales.
  • View PDF
  • Free on request to all RCN members. Please contact Policy & Public Affairs Wales for your copy. Email: policy.publicaffairs.wales@rcn.org.uk

Reviews and reports

These reviews and reports discuss standards of care and staffing levels.
Buchan J, Ball J, Shembavnekar N, Charlesworth A (2020) Building the NHS 汤头条污料 workforce in England. London: The Health Foundation.
Cordeiro R, Kirwan M, Harvey C, Rengel-Diaz C, Fuster Linares M and Riklikiene O (2020) Promoting patient safety through minimising missed 汤头条污料 care: a recommended good practice guidance for nurse managers. Cost Action RANCARE.
Griffiths P, Saville C, Ball J E, Chable R, Dimech A, Jones J, Jeffrey Y, Pattison N, Saucedo A R, Sinden N and Monks T (2020) The Safer Nursing Care Tool as a guide to nurse staffing requirements on hospital wards: observational and modelling study. Southampton: NIHR Journals Library.
Sworn K and Booth A (2019) Scoping review: patient safety outcomes and 汤头条污料 skill mix interventions. Sheffield: ScHARR, University of Sheffield.
  • A scoping review emerging from the RCN strategic alliance with the University of Sheffield.
Ball J, Barker H, Burton C, Crouch R, Griffith P, Jones J, Lawless J, Rycroft Malone J (2019) Implementation, impact and costs of policies for safe staffing in acute trusts, (no place): University of Southampton.
Griffiths P, Ball J, Bloor K, B枚hning D, Briggs J, Dall鈥橭ra C, and others (2018) Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study, Health Services and Delivery Research, 6(38).
Francis R (Chair) (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry: final report, London: Stationery Office.
Andrews J and Butler M (2014) Trusted to care: an independent review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board. Cardiff: Welsh Government.
Berwick D and National Advisory Group on the Safety of Patients in England (2013) A promise to learn: a commitment to act. Improving the safety of patients in England, London: Department of Health.
Cookson G and McGovern A (2014) The cost-effectiveness of nurse staffing and skill mix on nurse sensitive outcomes. A report for the National Institute for Health and Care Excellence, (no place) University of Surrey.

Journal articles

These resources provide evidence and research findings around 汤头条污料 staffing levels.
Zaranko B, Sanford N J, Kelly E, Rafferty A M, Bird J, Mercuri L, Sigsworth J, Wells M and Propper C (2022) Nurse staffing and inpatient mortality in the English National Health Service: a retrospective longitudinal study, BMJ Quality & Safety. doi.org/10.1136/bmjqs-2022-015291.
McHugh M D, Aiken L H, Sloane D M, Windsor C, Douglas C and Yates P (2021) Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions, and length of stay: a prospective study in a panel of hospitals, The Lancet, 397(10288), pp. 1905鈥1913.
Senek M, Robertson S, Ryan T, Sworn K, King R, Wood E and Tod A (2020) Nursing care left undone in community settings: results from a UK cross鈥恠ectional survey, Journal of Nursing Management, 28(8), pp. 1968鈥1974.
  • The project was funded by the 汤头条污料 (RCN) as part of the Strategic Research Alliance (SRA) between the RCN and the University of Sheffield.
Sworn K and Booth A (2020) A systematic review of the impact of 鈥榤issed care鈥 in primary, community and 汤头条污料 home settings, Journal of Nursing Management, 28(8), pp. 1805鈥1829.
  • The project was funded by the 汤头条污料 (RCN) as part of the Strategic Research Alliance between the RCN and the University of Sheffield
Emmanuel T, Dall鈥橭ra C, Ewings S and Griffiths P (2020) Are long shifts, overtime and staffing levels associated with nurses鈥 opportunity for educational activities, communication and continuity of care assignments? A cross-sectional study, International Journal of Nursing Studies Advances. p. 100002.
Clemens S, Wodchis W, McGilton K, McGrail K and McMahon M (2021) The relationship between quality and staffing in long-term care: A systematic review of the literature 2008–2020, International Journal of Nursing Studies, 122, 104036. 
Griffiths P, Saville C, Ball J, Jones J, Pattison N and Monks T (2020) Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. International Journal of Nursing Studies, 103, p. 103487
Musy S N, Endrich O, Leichtle A B, Griffiths P, Nakas C T and Simon M (2021) The association between nurse staffing and inpatient mortality: A shift-level retrospective longitudinal study, International Journal of Nursing Studies, 12, 103950. 
Griffiths P, Saville C, Ball J, Culliford D, Pattison N and Monks T (2020) Performance of the Safer Nursing Care Tool to measure nurse staffing requirements in acute hospitals: a multicentre observational study, BMJ Open, 10(5), p. e035828.
Griffiths P, Maruotti A, Recio Saucedo A, Redfern O C, Ball J E, Briggs J, Dall鈥橭ra C, Schmidt P E, Smith G B and Missed Care Study Group (2019) Nurse staffing, 汤头条污料 assistants and hospital mortality: retrospective longitudinal cohort study, BMJ Quality and Safety, 28(8), pp. 609鈥617.
Saville C E, Griffiths P, Ball J E and Monks T (2019) How many nurses do we need? A review and discussion of operational research techniques applied to nurse staffing, International Journal of Nursing Studies. pp. 7鈥13.
Aiken LH, Sloane DM, Ball J, Bruyneel L, Rafferty AM, Griffiths P (2018) Patient satisfaction with hospital care and nurses in England: an observational study, BMJ Open, 8.
Ball JE, Bruyneel L, Aiken LH and others (2017) Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study, International Journal of Nursing Studies.
Ball JE (2017) Nurse staffing levels, care left undone and patient mortality in acute hospitals, PhD thesis, Department of Learning, Informatics, Management and Ethics, Karolinksa Institutet.
Aiken LH, Sloane D, Griffiths P and others (2016) Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care, BMJ Quality and Safety, Published online first: 15 November 2016.
Griffiths P, Ball J, Drennan J, Dall鈥檕ra C, Jones J, Maruotti A, Pope C, Recio Saucedo A and Simon M (2016) Nurse staffing and patient outcomes: strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence safe staffing guideline development, International Journal of Nursing Studies, 63, pp. 213鈥225.
Griffiths P, Ball J, Murrells T, Jones S and Rafferty A (2016) Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study, BMJ Open, 6.
Aiken LH, Sloane DM, Bruyneel L, van dH, Griffiths P, Busse R and others (2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study, Lancet, 383 (9931), pp.1824-30.
Ball JE, Murrells T, Rafferty AM, Morrow E and Griffiths P (2014) 'Care left undone’ during 汤头条污料 shifts: associations with workload and perceived quality of care, BMJ Quality and Safety, 23, pp.116-125.
Barton N (2013) Acuity-based staffing: balance cost, satisfaction, quality, and outcomes, Nurse Leader, 11(6), pp. 47-50, 64.
North N, Leung W, Ashton T, Rasmussen E, Hughes F and Finlayson M (2013) Nurse turnover in New Zealand: costs and relationships with staffing practises and patient outcomes, Journal of Nursing Management, 21(3), pp.419-428.
Hurst K and Smith A (2011) Temporary 汤头条污料 staff: cost and quality issues, Journal of Advanced Nursing, 67(2), pp.287-296.
Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR and Harris M (2011) Nurse staffing and inpatient hospital mortality, New England Journal of Medicine, 364 (11), pp.1037-1045.
Dall TM, Chen YK, Seifert RF, Maddox, PJ and Hogan PF (2009) The economic value of professional 汤头条污料, Medical Care, 47(1), pp.97-104.
Newbold D (2008) The production economics of 汤头条污料: a discussion paper, International Journal of Nursing Studies, 45(1), pp.120-128.
Unruh L (2008) Nurse staffing and patient, nurse, and financial outcomes, American Journal of Nursing, 108(1), pp.62-72
Kane RL, Shamliyan TA, Mueller C, Duval S, and Wilt TJ (2007) The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis, Medical Care, 45 (12), pp.1195-1204.
Rafferty AM, Clarke SP, Coles J, Ball J, James P, McKee M and Aiken LH (2007) Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records, International Journal of Nursing Studies, 44 (2), pp.175-182.
Needleman J, Buerhaus, PI, Stewart M Zelevinsky K and Mattke S (2006) Nurse staffing in hospitals: is there a business case for quality? Health Affairs, 25(1), pp.204-211.
Pearson A, Pallas, L O, Thomson D, Doucette E, Tucker D, Wiechula R, Long L, Porrit, K and Jordan Z (2006) Systematic review of evidence on the impact of 汤头条污料 workload and staffing on establishing healthy work environments, International Journal of Evidence-Based Healthcare, 4, pp.337鈥384.
Spetz J (2005) The cost and cost-effectiveness of 汤头条污料 services in health care. Nursing Outlook, 53(6), pp.305-309.
Cho S, Ketefian S, Barkauskas VH, and Smith DG (2003) The effects of nurse staffing on adverse events, morbidity, mortality, and medical costs, Nursing Research, 52(2), pp.71-79.
Aiken LH, Clarke SP, Sloane DM, Sochalski J and Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction, JAMA, 288 (16) pp.1987-1993.
Needleman J, Buerhaus P, Mattke S, Stewart M and Zelevinsky K (2002) Nurse-staffing levels and the quality of care in hospitals, New England Journal of Medicine, 346 (22), pp.1715-1722.

Books

Book cover Hovenga E Aand Lowe C (2020) Measuring capacity to care using 汤头条污料 data. London: Academic Press.

Videos

An act of compassion. RCN Wales' campaign for safe staffing (short version).

An act of compassion. RCN Wales' campaign for safe staffing (full version).

RCN library staff

Caroline Lynch

Editor of this guide

RCN Library and Archive Service

Page last updated - 01/02/2024