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Safe Staffing

Use this guide to find information resources and evidence about safe nursing staffing levels including RCN publications, key resources and journal articles.

Last updated: 02/06/2017

RCN Publications

Royal College of Nursing (2017) Safe and effective staffing: the real picture. UK policy report, London: RCN. Royal College of Nursing (2017) Safe and effective staffing: the real picture. UK policy report, London: RCN.
Royal College of Nursing (2015) Registered nurses and health care support workers: a summary of RCN policy positions, London: RCN. Royal College of Nursing (2015) Registered nurses and health care support workers: a summary of RCN policy positions, London: RCN.
Defining staffing levels for children and young people Royal College of Nursing (2013) Defining staffing levels for children and young people's services: RCN standards for clinical professionals and service managers, London: RCN.
Safe staffing for older people Royal College of Nursing (2012) Safe staffing for older people's wards, London: RCN.
Royal College of Nursing Policy and International Department (2012) Mandatory nurse staffing levels, (Policy briefing 03/12), London: RCN. Royal College of Nursing Policy and International Department (2012) Mandatory nurse staffing levels, (Policy briefing 03/12), London: RCN.
Guidance on safe nurse staffing levels in the UK Royal College of Nursing Policy Unit and Ball J (2010) Guidance on safe nurse staffing levels in the UK, London: RCN.
RCN policy position: evidence-based nurse staffing levels Royal College of Nursing Policy Unit (2010) RCN policy position: evidence-based nurse staffing levels, London: RCN.
Breaking down barriers, driving up standards: the role of the ward sister and charge nurse Royal College of Nursing (2009) Breaking down barriers, driving up standards: the role of the ward sister and charge nurse, London: RCN.
Royal College of Nursing Policy Unit (2006) Setting appropriate nurse staffing levels in NHS Acute Trusts (Policy guidance 15/2006), London: RCN. Royal College of Nursing Policy Unit (2006) Setting appropriate nurse staffing levels in NHS Acute Trusts (Policy guidance 15/2006), London: RCN.

Legislation and guidance

National Assembly for Wales (2016) Nurse staffing levels (Wales) Act 2016, Cardiff: NAW.
NHS Wales 1000 Lives Improvement: National nurse staffing
RCN Wales: Nurse staffing levels (Wales) Act 2016: find out more about this groundbreaking piece of legislation
National Institute for Health and Care Excellence (2014) Safe staffing for nursing in adult inpatient wards in acute hospitals: safe staffing guideline SG1, London: NICE.
  • NICE guidance is officially England only.
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National Institute for Health and Care Excellence (2015) Safe midwifery staffing for maternity settings: NICE guideline NG4, London: NICE.
  • NICE guidance is officially England only.
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Scottish Government: Safe and effective staffing in health and social care consultation.
  • The consultation is now closed but the consultation paper is still available to read.
    View page
NHS Education for Scotland (2013) Nursing and midwifery workload and workforce planning learning toolkit (second edition), Edinburgh: NES.
Northern Ireland Practice and Education Council for Nursing and Midwifery (NIPEC): Delivering care: nurse staffing in NI

Reviews and reports

These reviews and reports discuss standards of care and staffing levels.
Francis R (Chair) (2013) The Mid Staffordshire NHS Foundation Trust Public Inquiry: final report, London: Stationery Office.
Royal College of Nursing (2013) Mid Staffordshire NHS Foundation Trust Public Inquiry Report: response of the Royal College of Nursing. Executive summary, RCN: London.
Andrews J and Butler M (2014) Trusted to care: an independent review of the Princess of Wales Hospital and Neath Port Talbot Hospital at Abertawe Bro Morgannwg University Health Board. Cardiff: Welsh Government.
Berwick D and National Advisory Group on the Safety of Patients in England (2013) A promise to learn: a commitment to act. Improving the safety of patients in England, London: Department of Health.
Keogh B (2013) Review into the quality of care and treatment provided by 14 hospital trusts in England; London: NICE.

Journal articles

These resources provide evidence and research findings around nursing staffing levels.
Ball JE, Bruyneel L, Aiken LH and others (2017) Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study, International Journal of Nursing Studies.
Ball JE (2017) Nurse staffing levels, care left undone and patient mortality in acute hospitals, PhD thesis, Department of Learning, Informatics, Management and Ethics, Karolinksa Institutet.
Aiken LH, Sloane D, Griffiths P and others (2016) Nursing skill mix in European hospitals: cross-sectional study of the association with mortality, patient ratings, and quality of care, BMJ Quality and Safety, Published online first: 15 November 2016.
Griffiths P, Ball J, Murrells T, Jones S and Rafferty A (2016) Registered nurse, healthcare support worker, medical staffing levels and mortality in English hospital trusts: a cross-sectional study, BMJ Open, 6.
Aiken LH, Sloane DM, Bruyneel L, van dH, Griffiths P, Busse R and others (2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study, Lancet, 383 (9931), pp.1824-30.
Ball JE, Murrells T, Rafferty AM, Morrow E and Griffiths P (2014) 'Care left undone’ during nursing shifts: associations with workload and perceived quality of care, BMJ Quality and Safety, 23, pp.116-125.
Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR and Harris M (2011) Nurse staffing and inpatient hospital mortality, New England Journal of Medicine, 364 (11), pp.1037-1045.
Kane RL, Shamliyan TA, Mueller C, Duval S, and Wilt TJ (2007) The association of registered nurse staffing levels and patient outcomes: Systematic review and meta-analysis, Medical Care, 45 (12), pp.1195-1204.
Rafferty AM, Clarke SP, Coles J, Ball J, James P, McKee M and Aiken LH (2007) Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records, International Journal of Nursing Studies, 44 (2), pp.175-182.
Pearson A, Pallas, L O, Thomson D, Doucette E, Tucker D, Wiechula R, Long L, Porrit, K and Jordan Z (2006) Systematic review of evidence on the impact of nursing workload and staffing on establishing healthy work environments, International Journal of Evidence-Based Healthcare, 4, pp.337–384.
Aiken LH, Clarke SP, Sloane DM, Sochalski J and Silber JH (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction, JAMA, 288 (16) pp.1987-1993.
Needleman J, Buerhaus P, Mattke S, Stewart M and Zelevinsky K (2002) Nurse-staffing levels and the quality of care in hospitals, New England Journal of Medicine, 346 (22), pp.1715-1722.

This subject guide relates to:

RCN library staff

Caroline Lynch

Author of this guide

RCN Library and Archives