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Failures in fundamental care of patients in hospital can have serious consequences, including patients dying unnecessarily. NHS policy and nursing theory emphasise shared decision making by staff and patients, but do not consider what it is that prevents nurses from providing care as they would wish to, or the difficulties patients can face in alerting staff to missed care. This article summarises research into patients’ experiences of involvement in fundamental care decisions in hospitals, including whether they raised missed care with staff and, if not, why not.

Staffing levels have been implicated in cases of adverse maternity events, near misses and sub-optimal outcomes such as unwell new-borns or still births. Care that is missed due to high workload can affect the detection of deterioration in mothers and babies, and delay appropriate management. A national shortage of midwives has resulted in increased reliance on support workers but the possible effect of skill-mix changes on outcomes has not been assessed.This Evidence Brief describes a systematic scoping review to explore evidence on the association between inpatient midwifery staffing levels, skill mix and outcomes for mothers and babies. Researchers at the University of Southampton aimed to understand the amount and strength of the available evidence, the direction of relationships established, and to highlight gaps for future research.

Many studies of registered nurse staffing in hospitals have shown an association between higher levels and better patient outcomes and care quality. Systems for determining the number of nursing staff needed on wards exist in abundance. However, research evidence is lacking on how well these tools work: how often do they get nurse staffing levels ‘right’, shift by shift? In 2014, the National Institute for Health and Care Excellence (NICE) endorsed using the Safer Nursing Care Tool (SNCT) to help plan nurse staffing levels on adult wards in acute hospitals. The SNCT estimates the nurse staffing needed based on patients’ acuity and their dependence on nursing care. This Evidence Brief describes the results of research that addressed key knowledge gaps about the SNCT.

Cancer is a disease affecting increasing numbers of people. In the UK, the proportion of people affected by cancer is projected to increase from 1 in 3 in 1992, to nearly 1 in 2 by 2020. Health services to tackle cancer can be grouped broadly into prevention, diagnosis, staging and treatment. We review examples of Operational Research (OR) papers addressing decisions encountered in each of these areas.In conclusion we find many examples of OR research on screening strategies, as well as on treatment planning and scheduling. On the other hand, our search strategy uncovered comparatively few examples of OR models applied to reducing cancer risks, optimising diagnostic procedures and staging. Improvements to cancer care services have been made as a result of successful OR modelling. There is potential for closer working with clinicians to enable the impact of other OR studies to be of greater benefit to cancer sufferers.

Failures in fundamental care of hospital patients can have serious consequences, including patients dying unnecessarily. NHS policy and nursing theory emphasise shared decision making by staff and patients. However they do not consider what prevents nurses providing care as they would wish, nor the difficulties patients can face in alerting staff to missed care. Researchers from the University of Southampton interviewed 20 patients and six focus group members about their experiences of involvement in fundamental care decisions in hospitals, including whether they raised missed care with staff and if not, why not. This evidence brief presents our findings, taken from our recent paper [1].

Patients in hospital may be at risk of unexpected deterioration. Monitoring patients’ vital signs, for example blood pressure and heart rate, ensures that any deterioration can be spotted early. This means that monitoring patients’ vital signs is an important part of safe patient care, and, if carried out effectively, has the potential to save many patients’ lives. However, previous studies have been unable to specify the workload this monitoring activity generates for nursing staff. This makes it difficult to plan how many staff are needed to monitor patients.Researchers at the University Of Southampton, University of Portsmouth and University of Oxford have teamed up to measure and estimate the time and workload associated with measuring patients’ vital signs, and this evidence brief reports what they found.

There is a chronic shortage of registered nurses in the UK. Despite efforts to increase nursing numbers, vacancy rates in the NHS remain high, reinforcing the need to retain nurses already in the workforce. What makes some nurses decide to leave their jobs, or the profession altogether, and others stay? Understanding workplace factors that influence these decisions could help employers and policymakers to create the conditions needed to keep nurses in the profession.In this Evidence Brief, we bring together the key findings from a scoping review of reports and research papers to summarise what is known about factors that influence nurse retention, and consider what more needs to be done to develop effective retention strategies.

Recent health workforce crises, exacerbated by the COVID-19 pandemic, have meant that burnout has often become a ‘buzzword’ to represent stress, extreme tiredness, and a willingness to quit one’s job. Several studies in nursing focus on burnout as an indicator of adverse work environments or staff characteristics. Nonetheless, what burnout is - what aspects contribute to its development and what the effect is for nurses, healthcare organisations, or their patients - is often overlooked. This evidence brief describes a review, undertaken by researchers at the University of Southampton, of the research examining relationships between burnout and work-related variables. We sought to determine what is known (and not known) about the causes and consequences of burnout in nursing, and whether these relationships confirm or dispute Maslach’s theory of burnout.

Urgent care typically describes healthcare for non-life threatening conditions requiring prompt attention (‘same day’ or within 24 hours). In England, urgent care services have proliferated partly to divert people from attending overcrowded emergency departments but also to address policy concerns of patient choice and improved access to care. This wider choice of services has led to a complex landscape of urgent and emergency care where boundaries between different services are blurred. Service users are often confused about which service to use. This includes using emergency care for ‘non-emergency’ health problems. Research around this topic has often focused on the ‘inappropriate’ use of emergency services. However, categorisations of ‘appropriate’ or ‘inappropriate’ behaviours are simplistic. This Evidence Brief describes the findings of a two-year study undertaken by the University of Southampton and NHS collaborators at University Hospitals Southampton and South Central Ambulance Service. This research examined the amount and nature of effort (‘work’) service users undertake to make sense of urgent care and seek help from health services.