Beyond ratios - flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study.

"Declaration of Competing Interest PG is a member of the National Health Service Improvement (NHSI) safe staffing faculty steering group. The safe staffing faculty programme is intended to ensure that knowledge of the Safer Nursing Care Tool (SNCT), its development and its operational application is consistently applied across the NHS."

"Funding This report presents independent research funded by the UK's National Institute for Health Research (NIHR) Health Services and Delivery Research Programme (award number 14/194/21). The views and opinions expressed in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the Health Services and Delivery Research Programme or the Department of Health and Social Care."

"The study was prospectively registered (ISRCTN 12,307,968), ethical approval was granted by the University of Southampton (ergo ID 18,809) and permission to undertake the research was granted by the Health Research Authority (IRAS ID 190,548). Conclusion: Shift-by-shift measurement of patient demand can guide flexible staff deployment, but the baseline number of staff rostered must be sufficient. Higher baseline rosters are more resilient in the face of variation and appear cost-effective. Staffing plans that minimise the number of nurses rostered in advance are likely to harm patients because temporary staff may not be available at short notice. Such plans, which rely heavily on flexible deployments, do not represent an efficient or effective use of nurses.: Study registration: ISRCTN 12307968: Tweetable abstract: Economic simulation model of hospital units shows low baseline staff levels with high use of flexible staff are not cost-effective and don't solve nursing shortages."