Nursing staffing as an enabler of care complexity: A five-year analysis of a vascular access team

Abstract

Background:

Vascular Access Teams (VATs) are organisational models designed to improve the safety and appropriateness of vascular access device management, particularly in settings characterised by increasing patient frailty and difficult intravenous access (DIVA). While existing literature has primarily focused on clinical outcomes, the relationship between nursing staffing availability, service productivity, and care complexity remains poorly explored.

Methods:

A retrospective longitudinal observational study was conducted using routinely collected organisational and administrative data from a VAT operating in a tertiary hospital between 2021 and 2025. Monthly staffing levels, procedural volume, procedural complexity, and waiting times were analysed. Procedures requiring the simultaneous presence of two specialist nurses were classified as complex and used as a proxy for care complexity. Associations were assessed using Spearman’s correlation coefficient.

Results:

Over 60 consecutive months, 20,737 procedures were analysed, including 15,410 vascular access device insertions and 5327 specialist consultations. Overall procedural volume remained stable, while the proportion of complex procedures progressively increased, reaching 26.2% in 2025. Staffing availability was positively associated with total activity volume (ρ = 0.47; p < 0.001) and more strongly with the number of complex procedures performed (ρ = 0.59; p < 0.001). No significant association was observed between staffing levels and waiting times.

Conclusions:

Nursing staffing availability was primarily associated with the capacity to deliver increasingly complex vascular access care rather than with increased throughput or reduced waiting times. These findings suggest that staffing models for VATs should consider not only activity volume but also the level of care complexity and case-mix, supporting organisational strategies aimed at ensuring appropriateness, patient safety, and service sustainability.