Staff were happier and care rationing less likely to occur when staffing levels met CCDM criteria during a nursing shift, a research report released last year found.

The SSHW unit study looking at nurse and patient perceptions of care after shifts which were either understaffed or staffed according to the ward’s CCDM “mix and match” staffing methodology.

Six wards at two district health boards took part in the study and data was collected from 734 shifts over six weeks – of which only 24 per cent met the full criteria of a “design-met” or appropriately staffed shift.

On the 75% of shifts that failed to meet the good staffing criteria nurses were nearly twice as likely to report care rationing – like not answering patient bells within five minutes or mobilizing patients. They were also less likely to be happy (45%) after the shift then if the shift was staffed appropriately (58%). But patients reported little to no difference in perception of their care.

The study also found that all six wards “consistently fell short” in responding quickly to sudden surges in patient demand. The study reports that these findings, and the SSHW unit’s experience of working with DHBs “suggests that DHBs cannot expect to have a lean staffing base and a lean buffer, and expect to maintain safe production in the face of predictable and significant variance between demand and capacity”. The study also says “further investigation will be required to determine if the recommended staffing design is ‘good enough’ as opposed to simply ‘better than’ shifts that do not meet the design level.”

A shift was regarded as ‘design met’ when:

  • Actual nursing hours available were within 10% of nursing hours required by patients
  • 80% or more of skill-mix staff were RNs (during day shift)
  • At least 75% of staff were from the home ward.



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