Relationships between healthcare staff characteristics and the conduct of vital signs observations at night: Results of a survey and factor analysis.
Alejandra Recio-Saucedo, Antonello Maruotti, Peter Griffiths and 5 others
PMID 30338108WHAT IT FOUND
Staff beliefs about night-time vital signs varied widely.
Many agreed observations were important, yet nearly half hesitated to wake patients. Experienced nurses relied more on clinical judgement than protocol. Ward culture and staffing issues shaped these decisions, not just workload.
Key findings
01While most staff agreed scheduled observations were important, only 47.9% said they would wake a patient when an Early Warning Score was due.
02Nurses with 16-20 years of experience were more likely to base decisions on clinical judgement rather than the protocol, unlike student nurses who followed the protocol more closely.
03Perceptions of adequate staffing and resources varied by ward specialty, with paediatric wards reporting better capacity to complete observations than other areas.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was conducted in a single hospital trust, limiting the transferability of findings to other organizations. Analysis was restricted to complete surveys (259 of 497 eligible), which may introduce bias if those with incomplete responses differed systematically. The survey measured self-reported attitudes and perceived behaviours, not actual compliance or patient outcomes. The questionnaire's validity was established through factor analysis in this sample, but it has not been tested for generalizability in other contexts.
Declared interests
VitalPAC, the electronic system studied, was developed by The Learning Clinic Ltd and Portsmouth Hospitals NHS Trust. Two authors were employed by Portsmouth Hospitals NHS Trust, and one was a shareholder in The Learning Clinic Ltd. Professor Smith acted as an expert advisor to NICE during the development of relevant guidelines.
The easy way to misread this
Do not interpret these findings as evidence that experienced nurses provide safer care by using clinical judgement. The study reports their attitudes, not outcomes, and the reliance on judgement over protocol was associated with ward-specific factors and resource perceptions, not necessarily better patient safety.