Wards with more registered nurses have lower mortality rates

In June 2018, there were 41,000 full-time NHS vacancies for nurses in England alone. 

Ian Snug
30 March 2019
Hospital bed

The relationship between nurse to patient ratios is complex but another study has confirmed it exists.

A study funded by the National Institute for Health Research concluded that having more registered nurse on a ward is associated with lower mortality rates and better clinical outcomes for patients. 


In June 2018, there were 41,000 full-time NHS vacancies for nurses in England alone.

This observational study assessed how staffing levels were linked to patients’ care across 32 adult medical and surgical wards in one hospital in southern England over three years.

The study found that for each day that the registered nurses staffing level was below the average for that ward, the risk of death during the first five days of admission increased by 3%. Similarly, the risk increased by 4% for each day that the healthcare assistant staffing level was below average.

Each additional hour worked by registered nurses per patient each day reduced the risk of death by 3%.


No effect on the risk of death was seen for additional healthcare assistant hours worked per patient each day.

However, when agency workers were used the risk of death increased by 12%.

The study concluded that increasing registered nurse staffing could avoid 50 deaths per year and prevent 4,464 bed-days. Adding that while staffing costs could increase, overall costs would decrease due to fewer bed-days.

Professor Alison Leary, Chair of Healthcare and Workforce Modelling, London South Bank University; said; “This study is useful as it shows how routinely collected data can be used to demonstrate relationships between things like chances of patients surviving and staffing in hospitals.


“It also helps to show that although this relationship is not straightforward, it does exist.

“Although it used data from only one NHS trust, a number of other single centre studies have also shown this complex relationship in different ways.”

There have been several previous studies that support the authors’ conclusion.

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