Nurses' assessments of staffing adequacy in care services for older patients following hospital discharge

Aims: To explore community nurses' assessments of staffing adequacy in care provision for older patients following hospital discharge and analyse the extent to which their assessments are associated with characteristics of the system level of municipality and vertical coordination between hospital and community care services. Design: Nation-wide cross-sectional survey. Methods: Web-based survey conducted in 2017 among 3,461 nurses working with older persons (65+) in homecare services, residential care and nursing homes in Norway. Responses from individual homecare nurses were linked with municipal level register data (age structure, economic flexibility, service profiles). Stratified multilevel analyses were used to analyse the association of staffing adequacy with municipal characteristics and perceived quality of vertical coordination. Results: Almost half of the nurses experienced inadequate staffing in general, whereas a similar share indicated that staffing was adequate. Nursing home nurses showed the least positive ratings of staffing adequacy. Most nurses indicated that there were too many unqualified care workers at their workplace. More positive as sessments of staffing adequacy were associated with better vertical coordination. Average ratings of staffing adequacy were lower in larger municipalities and munici palities with an older population. Conclusion: Healthcare providers, nurse managers and policy makers may benefit from a stronger focus on rebalancing skill-mix and on new models of vertical coordination in addressing current and future nurse staffing shortages in care services for older people following hospital discharge. Impact statement: This study adds to the scarce national and international research literature on nurse staffing in community care services, addressing the pressing challenges of staffing and skill-mix in long-term care provision. Findings support the development of nurse-led models of care coordination for older patients following hospital discharge and stimulate future research on the effects of recruitment and retainment strategies in different municipalities and different models of vertical coordination