The association between nurse staffing configurations and sickness absence: longitudinal study

ImportanceNurses work-related stress and sickness absence are high. The consequences of sickness absence are severe for health systems efficiency and productivity. ObjectiveTo measure the association between nurse staffing configurations and sickness absence in hospital ward nursing teams. DesignRetrospective case-control study using hospital routinely collected data SettingFour general acute care hospitals in England Participants3,583,586 shifts worked or missed due to sickness absence by 18,674 registered nurses (RN) and nursing assistant (NA) staff working in 116 hospital units. ExposureNursing team skill-mix; temporary staffing hours; understaffing; proportion of long shifts (12+ hours) worked; full-time/part-time work status in the previous 7 days. Main outcomeEpisodes of sickness absence, defined as a sequence of sickness days with no intervening days of work. ResultsThere were 43,097 sickness episodes. In our reduced parsimonious model, being exposed to a skill mix that was richer in RNs was associated with lower RN sickness absence (OR= 0.98; 95% CI = 0.96-0.99). For each 10% increase in proportion of hours worked as long shifts worked in the previous 7 days odds of sickness were increased by 2% (OR = 1.02; 95% CI = 1.02- 1.03) for RNs. Part-time work for RNs was associated with higher sickness absence (OR = 1.09; 95% CI = 1.04 - 1. 15). When RN staffing over the previous week was below average, the odds of sickness absence for NAs increased by 2% for every 10% increase in understaffing across the period (OR = 1.02; 95% CI = 1.01 - 1.03). For RNs there was a significant interaction between part-time work and RN understaffing, whereby short staffing in the previous week increased sickness absence for full time staff but not among those working part time. NA understaffing was not associated with sickness absence for any staffing group. Conclusions and RelevanceWorking long shifts and working on understaffed wards increases the risk of sickness absence in nursing teams. Adverse working conditions for nurses, already known to pose a risk to patient safety, may also create risks for nurses and the possibility of further exacerbating staff shortages. Key pointsO_ST_ABSQuestionC_ST_ABSWhat is the association between variation in nurse staffing configurations and nurses sickness absence? FindingsRegistered Nurse (RN) understaffing in the preceding 7 days was associated with sickness absence for Nursing Support (NS) staff, but for RNs the association was only seen when working full time. Exposure to shifts with a skill-mix richer in RNs, to higher bank hours and working lower proportions of 12+ h shifts in the preceding 7 days was a protective factor of RN sickness absence. MeaningTo support nurses health and health systems productivity and efficiency, investing in avoiding RN understaffing may be warranted.