Nurse safety: boosting numbers 'helps protect against aggression or harassment'

Staff safety found to increase when registered nurse numbers are higher than the clinical requirement

The risk of staff experiencing aggression from patients in mental health settings is influenced by how many registered nurses are on shift, a new study has revealed.  

Researchers from Birmingham City University (BCU) reviewed incidents of patient aggression in inpatient settings, recorded between September 2014 and March 2017, by an NHS mental healthcare provider in England that offers acute and community services. The data were culled from 10 locations (totalling 51 wards) and across the early, late and night shifts. 

They found that fewer incidents were reported by all staff groups when nurse numbers were higher than the clinical requirement, which is calculated according to the condition and number of patients admitted to wards.

Over the time period, 6,520 incidents of aggression by patients towards staff members were reported, affecting 12,138 members of staff.   

A total of 1,762 events characterised as ‘inappropriate behaviour’ were logged, affecting 4,058 members of staff.

There were 298 events classed as ‘sexual incidents’ reported, affecting 493 members of staff.

The study authors analysed the data and found that, on aggregate, each additional registered nurse on the early and late shifts led to a 9% decrease in adverse events reported.

More staff reduces rate of adverse events

BCU’s senior research fellow in health and social care, and one of the study’s authors, Sarahjane Jones, said: ‘There is strong evidence that having more registered nurses to, or above, the clinically required levels does reduce the rate of adverse events.

‘However, this is not consistent across all locations and all shifts, so the message would be that we need to understand what goes on in the wards and shifts. It isn’t a one-size-fits-all approach.

‘These findings offer an opportunity for a tightening-up of policy on workforce safety and retention.’

Responding to the findings, a Department of Health and Social Care (DHSC) spokesperson said: ‘No one should have to face the threat of violence or aggression at work.’

They added that the interim NHS People Plan outlines steps to reduce vacancies, and that the department was committed to increasing the nursing workforce.

There are now 36,101 mental health nurses in the NHS, said the DHSC spokesperson, adding that this was more than 750 than in June 2017. 

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World Congress on Nursing and Healthcare 2019

U.S. Nursing Schools Call for Collaborative Action to Raise the Education Level of the Nursing Workforce

WASHINGTON, DC, April 1, 2019 — The American Association of Colleges of Nursing (AACN) and its 825 member schools of nursing have endorsed a new position statement advocating greater engagement among educators, employers, and other stakeholders for preparing more nurses in baccalaureate and graduate degree programs. Titled Academic Progression in Nursing: Moving Together Toward a Highly Educated Nursing Workforce, this new call to action highlights the need for collaborative solutions that enable all nurses to take the next step in their educational development to better serve the health needs of the nation.

"AACN has long been a leading proponent for academic progression in nursing given our core belief that quality patient care hinges on having a well-educated nursing workforce," said Dr. Ann Cary, Chair of the AACN Board of Directors. "With patient care growing more complex, ensuring a sufficient RN workforce is not merely a matter of how many nurses are needed, but rather an issue of preparing an adequate number of nurses with the right level of education to meet healthcare demands."

In 2010, the Institute of Medicine (IOM) called for at least 80% of registered nurses (RNs) in the U.S. to be baccalaureate-prepared by 2020 as well as a doubling of the number of nurses with doctorates. The evidence-based recommendations in the Future of Nursing report recognize that patient needs have grown more complex, and that nurses must attain the competencies needed to deliver high-quality care. Research shows that lower mortality rates, fewer medication errors, and a host of positive outcomes are all linked to nurses with advanced educational preparation. In response to the IOM's recommendation, schools have expanded capacity in RN to baccalaureate degree completion programs. Since fall 2010, enrollment in these programs has increased by 80%, from 77,000 to 139,000 students.

The IOM report has been a catalyst for building new bridges between academic nursing leaders while generating universal support for more highly educated nurses. In 2012, the Joint Statement on Academic Progression for Nursing Students and Graduates was endorsed by AACN, American Association of Community Colleges, Association of Community Colleges Trustees, National League for Nursing, and the Organization for Associate Degree Nursing (OADN). This historic agreement was the first time that leaders from the major national organizations representing community college presidents, boards, and program administrators joined with nursing education associations to promote academic progression in nursing. The need to build stronger ties between associate degree and baccalaureate programs was further advanced by the Academic Progression in Nursing Initiative, which was launched by the Robert Wood Johnson Foundation and is now overseen by OADN as the National Education Progression in Nursing (NEPIN) initiative.

"Recognizing that national organizations may take different positions on matters of entry into practice, OADN advocates for a shared understanding of principles that all stakeholders can embrace to increase the number of nurses holding baccalaureate degrees, as well as other critically important degrees at the master's and doctoral levels," said OADN Chief Executive Officer Donna Meyer. "We concur with AACN that this transformation must be achieved through the collaboration of community colleges, universities, and practice partners.  An unprecedented level of true partnership is needed to meet our common goal of improving academic progression in nursing workforce. OADN stands ready to collaborate with AACN and other stakeholders to meet this shared vision."

AACN's new position statement calls for supporting pathways that will move RNs with associate degrees and diplomas into programs leading to a baccalaureate degree (or entry level master's degree) offered by an accredited four-year college or university. The statement outlines the value of having a more highly educated nursing workforce and the efforts underway to achieve this goal, including statewide models of academic progression, baccalaureate degree completion programs, and articulation agreements between community colleges and university-based programs to facilitate seamless credit transfers between programs. The paper also includes a table profiling more than a dozen studies, which provide evidence of the positive impact that advanced education has on patient care.

Ensuring academic progression beyond entry-level preparation is also essential to meeting the nation's demand for Advanced Practice Registered Nurses, nursing school faculty, nurse researchers, and leaders. AACN's data show that more than 13,000 qualified applicants were turned away from graduate nursing programs in 2018 due to staffing and resource constraints. With an adequate supply of faculty, clinical sites, and teaching space, these students and potentially more could be accommodated in the nation's more than 500 schools that offer graduate nursing programs

"AACN is committed to working with all stakeholders to better prepare nurses to lead and transform care across roles and practice settings by advancing their education to the baccalaureate and graduate degree level," added Dr. Deborah Trautman, AACN's President and Chief Executive Officer. "We strongly believe that encouraging all nurses to continue their education is in the best interest of patients and the communities we serve."

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