title: Nursing staff numbers and their relationship to conflict and containment rates on psychiatric wards-a cross sectional time series poisson regression study.
abstract: BACKGROUND
  The link between positive outcomes and qualified nurse staffing levels is well established for general hospitals. Evidence on staffing levels and outcomes for mental health nursing is more sparse, contradictory and complicated by the day to day allocation of staff resources to wards with more seriously ill patients.
  
  
  OBJECTIVE
  To assess whether rises in staffing numbers precede or follow levels of adverse incidents on the wards of psychiatric hospitals.
  
  
  METHODS
  Time series analysis of the relationship between shift to shift changes over a six month period in total conflict incidents (aggression, self-harm, absconding, drug/alcohol use, medication refusal), total containment incidents (pro re nata medication, special observation, manual restraint, show of force, time out, seclusion, coerced intramuscular medication) and nurse staffing levels.
  
  
  METHODS
  32 acute psychiatric wards in England.
  
  
  METHODS
  At the end of every shift, nurses on the participating wards completed a checklist reporting the numbers of conflict and containment incidents, and the numbers of nursing staff on duty.
  
  
  RESULTS
  Regular qualified nurse staffing levels in the preceding shifts were positively associated with raised conflict and containment levels. Conflict and containment levels in preceding shifts were not associated with nurse staffing levels.
  
  
  CONCLUSIONS
  Results support the interpretation that raised qualified nurse staffing levels lead to small increases in risks of adverse incidents, whereas adverse incidents do not lead to consequent increases in staff. These results may be explicable in terms of the power held and exerted by psychiatric nurses in relation to patients.
authors.affiliation: Institute of Psychiatry, Kings College London, United Kingdom. len.bowers@kcl.ac.uk
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: Martin
authors.initials: M
authors.lastname: Crowder
mesh_terms: D003220:Conflict, Psychological; D003430:Cross-Sectional Studies; D004739:England; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D010561:Personnel Staffing and Scheduling; D016012:Poisson Distribution; D011567:Psychiatric Department, Hospital; D012044:Regression Analysis; D000078329:Workforce