Using temporary nurses doesn’t mitigate deaths linked with staff shortages

A new study led by the University of Southampton has found that using temporary nursing staff to fill rotas only partially combats an increased risk of patient death associated with staff shortages.

Researchers found that avoiding low nurse staffing levels lowers the risk of death among patients – particularly even when drafting in temporary registered nurses to maintain staffing levels. However, despite this, the risk of death remains elevated compared to when the ward is fully staffed by permanent nurses.

Findings from the study, funded by the National Institute for Health and Care Research (NIHR) and the NIHR Applied Research Collaboration (Wessex), are due to be published in the journal JAMA Network Open.

The research team conducted an observational study on 185 wards across four acute hospital trusts in England between 2015 and 2020 – amounting to a total of over 600, 000 patient admissions. The anonymised participants were adults with an overnight stay, and nursing staff on inpatient wards.

The study found that for each day of low staffing among registered nurses, the risk of patient death increased by 7.9 percent from the norm. The figure for nursing support staff was similar at 7.2 percent. However, this risk was partly, although not completely, mitigated by bringing in temporary staff.

Increasing temporary registered nurses on wards by 10 percent was associated with an increased risk of death of 2.3 percent – with no difference between using agency or hospital bank staff. The figure for nursing support staff saw an increased risk of death of 4 percent and agency staff from this group had a larger adverse impact than bank staff.

Commenting on the study, lead author Professor Peter Griffiths of the University of Southampton said: “Our study shows that addressing low staffing levels by using temporary staff to fill gaps is definitely beneficial in avoiding deaths on wards. The harm associated with low staffing is greater than using temporary staff to rectify shortfalls. However, our findings challenge the assumption that temporary staff are a cost-effective long-term solution to maintaining patient safety.”

The research also showed some evidence that having more senior staff on shift, within both registered nurses and nurse support roles, had some benefit, although there was some inconsistency within these results.

“Previous studies have supported a beneficial effect from using more senior staff within a team and our findings are consistent with this. This suggests the relatively new registered nurse associate role, which will increase the proportion of senior support staff on wards, does have some benefits,” comments Professor Griffiths.

The researchers, who partnered with Portsmouth Hospitals University NHS Trust for the study, acknowledge that further work is needed to understand the role of temporary staff more fully and the effects of different staff mixes on other patient outcomes and quality of care.

Ends
 

Notes to Editors

1. The paper ‘Beyond Numbers – Nursing Team Composition and Mortality Following Acute Hospital Admission’ is due for publication in the journal JAMA Network Open, embargoed until 16.00 UK time, Monday 19 August 2024. It will be available to view after the embargo has lifted here:
    
2. For interviews, please contact Peter Franklin, Media Relations, University of Southampton.  press@soton.ac.uk
    
3. For more about Health Sciences at the University of Southampton visit:
    
4. The University of Southampton drives original thinking, turns knowledge into action and impact, and creates solutions to the world’s challenges. We are among the top 100 institutions globally (QS World University Rankings 2025). Our academics are leaders in their fields, forging links with high-profile international businesses and organisations, and inspiring a 22,000-strong community of exceptional students, from over 135 countries worldwide. Through our high-quality education, the University helps students on a journey of discovery to realise their potential and join our global network of over 200,000 alumni. www.southampton.ac.uk
    
5. The research was funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research Programme and the NIHR Applied Research Collaboration (Wessex).
    
6. About the National Institute for Health and Care Research (NIHR)

   The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. We do this by:

• Funding high quality, timely research that benefits the NHS, public health and social care;
• Investing in world-class expertise, facilities and a skilled delivery workforce to translate discoveries into improved treatments and services;
• Partnering with patients, service users, carers and communities, improving the relevance, quality and impact of our research;
• Attracting, training and supporting the best researchers to tackle complex health and social care challenges;
• Collaborating with other public funders, charities and industry to help shape a cohesive and globally competitive research system;
• Funding applied global health research and training to meet the needs of the poorest people in low and middle income countries.

NIHR is funded by the Department of Health and Social Care. Its work in low-and-middle-income countries is principally funded through UK Aid from the UK government.