Workforce & Health Systems publications

Hope J, Dall'Ora C, Redfern O, Darbyshire JL, Griffiths P

Vital signs monitoring is key to identifying deteriorating hospital patients. However, adherence to monitoring protocols is limited, with observations frequently missed or delayed. Previous studies of interruptions and delays to vital signs observations have been descriptive, with none attempting to conceptualise the types of tasks that are prioritised over vital signs observations.

This paper aims to explore how nursing teams perform vital sign observations on acute hospital wards and conceptualises which types of work delay or interrupt them.

https://doi.org/10.1016/j.ijnurstu.2025.105018

February 2025

Stalpers D, Schoonhoven L, Dall'Ora C, Ball J, Griffiths P

In nursing, achieving adequate staffing levels to ensure high quality of care is a worldwide problem. The existing nursing shortages and the continuously increasing demand for highly skilled nurses lead to higher workloads for the already overburdened nursing workforce (Dall'Ora et al., 2022; Haddad et al., 2023). These challenges in the nursing field have driven a call for rigorous rethinking and redesigning of nursing care delivery (Griffiths and Dall'Ora, 2023; Geltmeyer et al., 2024).

In organising nursing care, currently the leading principle is to primarily consider nursing work a job that consists of a multitude of tasks that can be divided between staff (Sasso et al., 2017). However, this way of thinking partly ignores what nursing work entails; it does not fully acknowledge its multi-layered, holistic and therefore complex character.

In this paper, we aim to explore the potential of a new and less simplistic model for dividing nursing labour. We believe that, to capture the comprehensiveness of nursing work and its corresponding complexity, it is necessary to recognise that care delivery is not only about performing a discrete set of tasks. A defining factor in the daily work of nurses is the ‘entanglement’ of care activities. This refers to the fact that the work does not simply concern a series of tasks occurring in parallel, but that these activities are intertwined and bundled together. These activities are linked and cannot be separated without changing the nature of all activities involved.

https://doi.org/10.1016/j.ijnurstu.2025.104995

January 2025

Campling N, Turnbull J, Richardson A, Voss S, Scott-Green J, Logan S, Latter S

Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this.

 Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics' current practice and experiences providing end-of-life care was undertaken.

https://doi.org/10.1186/s12904-024-01629-7

December 2024

Meredith P, Turner L, Saville C, Griffiths P

Nurses play a crucial role in maintaining the safety of surgical patients. Few nurse staffing studies have looked specifically at surgical patients to examine the impact of exposure to low staffing on patient outcomes.

A longitudinal patient analysis was conducted in four organizations in England using routine data from 213 910 admissions to all surgical specialties. Patients' staffing exposures were modelled as counts of understaffed registered nurse and nurse assistant days in the first 5 inpatient days. Understaffing was identified when staffing per patient-day was below the mean for the ward. Cox models were used to examine mortality within 30 days of admission and readmission within 30 days of discharge. Generalized linear models were used to investigate duration of hospital stay and occurrence of hospital-acquired conditions.

https://doi.org/10.1093/bjs/znae215

August 2024

Griffiths   P, Saville C, Ball J, Culliford D, Jones J, Lambert F, et al

Many studies show the adverse consequences of insufficient nurse staffing in hospitals, but safe and effective staffing is unlikely to be just about staff numbers. There are considerable areas of uncertainty, including whether temporary staff can safely make up shortfalls in permanent staff and whether using experienced staff can mitigate the effect of staff shortages.

The objective of this study is to explore the association of the composition of the nursing team with the risk of patient deaths.

https://doi.org/10.1001/jamanetworkopen.2024.28769

August 2024

Maben J, Taylor C, Jagosh J, Carrieri D, Briscoe S, Klepacz N, Mattick K

Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves.

The aimof this study is to improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions.

https://doi.org/10.3310/twdu4109

April 2024

Klepacz N, Wadey E, Griffiths P, Woodnutt S, Snowden J, Smith C et al

Demand for mental health services is high, but so are vacancy levels for registered nurses in mental health. To effectively address the workforce disparity, we need to engage with nurses to understand better the rewards and challenges of being part of the UK's mental health nursing workforce. The aim of the study set out in this protocol will be to identify modifiable workplace factors impacting nurses' work lives and wellbeing.

https://doi.org/10.12968/bjmh.2023.0037

February 2024

Turner LY, Saville C, Ball J, Culliford D, Dall'Ora C, Jones J et al

Preventing readmission to hospital after giving birth is a key priority, as rates have been rising along with associated costs. There are many contributing factors to readmission, and some are thought to be preventable. Nurse and midwife understaffing has been linked to deficits in care quality. This study explores the relationship between staffing levels and readmission rates in maternity settings.

10.1136/bmjopen-2023-077710

April 2024

Remmington   C, Cameron L, Hanks F, Liang YH, Barrow L, Coxhead R et al

There is good evidence describing pharmacy workforce and service provision in general critical care units. However, no data exist from adult extracorporeal membrane oxygenation (ECMO) centres.

The aim of this study is to describe workforce characteristics, pharmacy service provision, and pharmaceutical care activities in critical care units (CCUs) providing an adult ECMO service in the United Kingdom (UK) and compare to national staffing standards for CCUs.

https://doi.org/10.1007/s11096-024-01719-9

April 2024

Turner  L, Ball J, Meredith P et al.

Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies.

https://doi.org/10.1186/s12913-024-10812-8

March 2024

Andina-Díaz   E, Welch L, Siles-González J, Serrano-Fuentes N, Gutiérrez-García AI,   Solano-Ruiz M

Objective: To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community.

Methods: A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data.

https://doi.org/10.1111/phn.13285

February 2024

Ejebu OZ, Turnbull J, Atherton I, Rafferty AM, Palmer B, Philippou J, Prichard J, Jamieson M, Rolewicz L, Williams M, Ball J

Like many countries, England has a national shortage of registered nurses. Employers strive to retain existing staff, to ease supply pressures. Disproportionate numbers of nurses leave the National Health Services (NHS) both early in their careers, and later, as they near retirement age. Research is needed to understand the job preferences of early-career and late-career nurses working in the NHS, so tailored policies can be developed to better retain these two groups.

https://doi.org/10.1136/bmjopen-2023-075066

February 2024