Friday, 21 November 2014

Do nurse staffing levels influence patient outcomes?

Roger Watson, Editor-in-Chief

As much as I would like it to be, the relationship between nurse staffing and patient outcomes is not clear. A recent article from an Australian study by Winton et al. (2014) titled ‘The relationship between nurse staffing and inpatient complications’ and published in JAN cites methodological problems as one reason. Of course, this is a difficult area to investigate. It would be hard envisage clinical trials which compared nursing care with no nursing care  — which I imagine would easily demonstrate the value of nursing per se — and the situation is further complicated by definitions of nursing (RNs versus unqualified assistants) and the various levels of skill mix that can be implemented. It is even further complicated by the myriad outcomes and patient complications that could be selected as comparative measures. Nevertheless, this area merits investigation as arguments about staffing levels and skill mix are common, and those who hold healthcare budgets need to know how to spend their money (often it is our money) wisely. Insufficient nursing care may lead to expensive complications but unnecessary spending on nursing staff may waste valuable resources.

The article by Winton et al. (2014) compared 256,984 hospitalizations with and without complications against staffing levels in a retrospective longitudinal study and found that the pattern was not consistent. Specifically, they said: ‘our results did not support the widely held assumption that improved nurse staffing levels are associated with decreased patient complication rates.’ Clearly, further investigation is required.


Winton LW, Bremner AP, Geelhoeld E, Finn J (2014) The relationship between nursestaffing and inpatient complications Journal of Advanced Nursing doi: 10.1111/jan.12572

Thursday, 13 November 2014

Nightingale versus Seacole…round two!

Roger Watson, Editor-in-Chief

You may recall ‘Nightingale versus Seacole…round one!’ which I wrote after we published McDonald’s (2013) less than complimentary piece on Mary Seacole’s contribution to modern nursing. That piece did not go unnoticed and as a result Staring-Derks et al. (2014) have recently published an article titled, ‘MarySeacole: global nurse extraodinaire’. I say as a result, rather than in reaction to, as Staring-Derks et al– while citing McDonald’s article – decided not to confront her arguments ‘head on’ and what results is a very measured, polite and well-referenced piece.

Clearly, by labelling these rounds one and two respectively I am hoping that further correspondence and articles will arise, perhaps not from the original ‘protagonists’ but from others with a view on the relative contributions of Nightingale and Seacole to modern nursing and healthcare.Whatever one’s view – and JAN is neutral in this debate – the influence of Mary Seacole is undeniable. I was in Edgbaston in Birmingham recently, taking a taxi past Birmingham City University, and noticed another Seacole Building; few universities where nursing is taught are without one. The Seacole ‘lobby’ and the move in the UK, for example, to have a statue erected in her honour, are well organised and influential. I am not aware of a similar ‘lobby’ for Florence Nightingale; perhaps her place in the history of nursing is assured.

If you wish to contribute to the debate then please check our author guidelines for how to contribute to JAN interactive.


McDonald L (2013) Florence Nightingale and MarySeacole on nursing and health Journal of Advanced Nursing 70, 1436-1444

Staring-Derks C, Staring J, Anionwu E (2014) MarySeacole: global nurse extrodinaire Journal of Advanced Nursing doi: 10.1111/jan.12559

Monday, 10 November 2014

Nurses' overtime and patient care

Roger Watson, Editor-in-Chief

Nursing work is hard enough with physical and psychological demands and long and often unsocial hours. Nursing shortages and often poor salaries mean that overtime working is often a feature of many nurses' lives. It appears that there is little rigorous research into the extent to which working overtime influences patient care, according to a recent paper from Canada by Lobo et al. (2014) titled Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes.

The paper reports on nine articles related to how nursing overtime affects patient outcomes. As with many such studies, the review showed methodological weaknesses in the area related to defining overtime and working out what effect confounding variables had on the measurement of outcomes. The findings of the studies, therefore, need to be interpreted cautiously. Nevertheless, there was some evidence to show that nurses' overtime was related to such things as infection rates, deaths from pneumonia and medication errors.

If there is any truth in these findings, these phenomena are surely worth investigating further; if upheld, they would certainly strengthen the argument for a better resourced nursing workforce. In the words of the authors: 'additional funding and attention needs to be directed at this topic area to mitigate the negative patient outcomes that may be a result of the use of nursing overtime.'

Lobo v, Fisher A, Peachey G, Ploeg J, Akhtar-Danesh N (2014) Integrative review: an evaluation of the methods used to explore the relationship between overtime and patient outcomes Journal of Advanced Nursing doi: 10.1111/jan.12523

Wednesday, 5 November 2014

Response to Commentary: Is there a spiritual life outside religion?

Katia G. Reinert, PhD, CRNP, FNP-BC, PHCNS-BC

Response to Bert Garssen's Commentary on Reinert K.G. & Koenig H.G. (2013) Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing 69 (12), 2622–2634. doi: 10.1111/jan.12152

Thank you for a thoughtful response to our article (Reinert & Koenig 2013). While we understand the concern voiced in the response, we would like to restate what we proposed and why. We proposed that reducing spirituality to religion (not for clinical practice but for the purposes of research) is critical, since it is difficult if not impossible to measure spirituality as a distinctive construct except by measuring religion.

We agree and fully support the notion that spirituality can be broadened beyond religion to be inclusive for clinical purposes, but for conducting research, there is too much overlap with mental health constructs due to the way spirituality is currently being measured in nursing research, as we described in the article.

Our main point is that the results of research examining spirituality and mental health is virtually impossible to interpret due to the tautology in relationships between constructs being measured. Only by measuring spirituality by religion can we retain the distinctiveness of the concept.

Katia G. Reinert, PhD, CRNP, FNP-BC, PHCNS-BC
Johns Hopkins University School of Nursing
Baltimore, MD


Reinert K.G. & Koenig H.G. (2013) Re-examining definitions of spirituality in nursing research. Journal of Advanced Nursing 69 (12), 2622–2634. doi: 10.1111/jan.12152