Unfavourable views of hospital care are strongly to insufficient numbers of nurses on duty, rather than uncaring staff
This may have cues for the Indian health system that is battling a nadir in doctor patient relationship and a general distrust of the private sector. An observational research published in the online journal BMJ Open has found that patients’ unfavourable views of hospital care in England are strongly linked to insufficient numbers of nurses on duty, rather than uncaring staff.
The study correlated findings from two surveys. The 2010 NHS Survey of Inpatients had gathered information from over 66,000 patients who had been discharged from 161 acute and specialist NHS Trusts. Respondents were asked to rate their care, the confidence they had in their doctors and nurses, and to give their views on whether there were enough nurses to provide the care they needed.
The 2010 nurses’ survey (RN4CAST-England study) gathered information from nearly 3000 registered nurses working on general medical and surgical wards from a representative sample of 31 (46 hospitals) of the 161 trusts. The nurses were asked about their workload during the day and various aspects of their working environment, such as resources, support, interpersonal relationships, leadership.
The data for the same 31 trusts from both surveys were then merged to estimate whether, and to what extent, the level of ‘missed’ nursing care in the different trusts affected how patients rated their care and their confidence in the clinical staff caring for them. The level of trust and confidence patients expressed for nurses was of a similar magnitude to that they expressed for doctors.
But while three out of four respondents said they had confidence and trust in the clinicians treating them, only 60 percent felt there were always enough nurses to care for them. And one in 10 said that there were never or rarely enough nurses on duty. Nurse numbers were strongly linked to how favourably patients viewed their hospital care.
For India the findings are significant because there is a huge shortage of nurses in the country. A 2010 bulletin of the World Health Organisation said: “In India, nurse shortages occur at every level of the health-care system. According to Dileep Kumar, chief nursing officer at the Ministry of Health and director of the Indian Nursing Council, 2.4 million nurses will be needed by 2012 to provide a nurse-patient ratio of one nurse per 500 patients.” That ask would have gone up even more now as hospitals face a common issue of shortage in terms of not just numbers but also skills. Nurses are very highly in demand the world over and it is a common phenomenon for trained Indian nurses to seek greener pastures in other countries, especially the middle east.
Increasing the registered nurse headcount may boost satisfaction with the quality of care, conclude the BMJ researchers, who base their findings on national survey data from patients and nurses.
“The narrative that quality deficits in hospitals are due to ‘uncaring’ nurses is not supported by the evidence. On the contrary, our findings suggest that reducing missed nursing care by ensuring adequate numbers of [registered nurses] at the hospital bedside, and improved hospital clinical care environments are promising strategies for enhancing patient satisfaction with care,” write the researchers.
