The Registered Nurse Forecasting (RN4CAST) study shows that improved patient-to-nurse staffing ratios, sound nursing work environments and a better educated nurse workforce are associated with improved nurse wellbeing and better patient outcomes, including higher patient satisfaction and lower patient mortality.
The RN4CAST research consortium brings together researchers from twelve European countries (Belgium, Finland, Germany, Greece, Ireland, Norway, Poland, Spain, Sweden, Switzerland, The Netherlands and England), the US and three international cooperating partner countries from the European Union (Botswana, China, and South Africa).
Findings show that hospital quality, safety, and staff retention problems are common in all countries that participated to this study. These problems are associated with between-organizational features of nursing care. An important finding of the study is that almost every country under study had one or more hospitals that nurses ranked as having good work environments. Agreement between nurses and patients as to which hospitals provided good care is shown repeatedly in all countries. Our findings suggest that it is feasible for policy makers and human resources managers to replicate the success of US initiatives in a larger share of hospitals in every country.
Similar evidence led countries like the US and Australia to take several high-profile initiatives with regard to achieving safe nurse staffing and improved work environments, such as mandated safe nurse staffing ratios and the Magnet Hospital Accreditation Programme for excellence in nurse work environments. In the US, by these measures, nursing has become an attractive career path, and the nursing shortage, which was close to 1 million nurses in 2000, has been reverted.
The RN4CAST consortium to date has published close to 40 articles in international peer-reviewed journals, and through a number of past and future high-profile dissemination activities and continued stakeholder engagement, RN4CAST paves the way for European and national policy-makers and hospital human resources managers to embrace these findings in both evidence-based practices and workforce planning methods.
Our policy synthesis indicates that such well-though out initiatives are necessary to face the European nursing workforce crisis. Significant improvements in work environments are considered a relatively low cost lever and effective approach to achieving the most value for investments in nurse staffing.
Current health workforce planning methods have a poor record of accurately predicting future nursing workforce needs and of informing policy interventions that avoid cyclical shortages. A significant point for improvement is to recognize the need to take into account the dynamics between nursing system delivery strategies and quality and safety of healthcare.
The objective of RN4CAST is to study the dynamics between hospital nurse staffing, skill mix, educational composition, and quality of the nurse work environment on the one hand and hospital mortality, failure to rescue, quality of care, and patient satisfaction with hospital care on the other hand. The project aims to refine current forecasting models based on these nursing workforce dynamics and develop scenarios on how these models affect policy making for making the health workforce attractive and highly performing.
All 12 countries representing differently organized and financed national health care systems have hospital quality, safety, and staff retention problems associated with organizational behaviours related to nursing. The quality of the hospital nurse practice environment and hospital nurse staffing were significantly associated with nurse wellbeing and patient satisfaction. hospital nurse staffing and the proportion of nurses with bachelor’s education are associated with significantly fewer deaths after common surgery.
The RN4CAST project is addressing policymakers at the international, national and organisational level. On the international level, a stakeholder group was established to advise the project team in how RN4CAST could impact policy making on a global European level. This international group includes representatives from OECD, WHO, the European Observation on Health Systems and Policies, the European Hospital and Healthcare Federation (HOPE), the European Health Management Association (EHMA), the European Academy of Nursing Science (EANS), and the European Federation of Nurses (EFN).
Concrete examples in which RN4CAST can give necessary input are the EU-initiative towards a joint action on health workforce planning, resulting from the Belgian Presidency in 2010, and the revision of directive 2005/36/EC on the recognition of professional qualifications, in evaluating the impact of nursing qualification on the quality and safety of patient care.
On the national level, stakeholder groups were established to link the findings to national policy making. In some countries, this has lead to specific actions (on national or regional levels) to promote the nursing profession to young talents or to the reorganisation of nursing care. On the organisational level, all hospitals in the study received feedback in which their performance on nursing and patient outcomes was benchmarked (internationally and nationally).
A set of best-practice hospitals where nurses like to work and patients are satisfied with their hospital stay creates learning opportunities and incentives for other hospitals on successful nursing system delivery strategies.
The RN4CAST project makes a strong significant scientific contribution to nursing workforce planning. It will shift the main focus of nursing workforce planning from rather simple projections in demand and supply of labour to a new focus on patient safety and quality. For this reason, many countries have expressed their interest in replicating the study.