Malawian district hospitals operate under shift staffing rules that specify a maximum number of trauma patients per registered nurse, yet the relationship between the ratio threshold and secondary traumatic stress (STS) symptom burden among ward staff remains unquantified. The sample comprised 162 shift-level observations collected between 1986 and 2025, with a mean STS score of 91.776 (SD = 11.342). The analysis was designed to identify whether shifts that exceeded the staffing threshold produced discontinuously higher STS burden than shifts that did not, and to estimate the size of any such discontinuity. The results indicate that the threshold crossing was associated with a statistically significant increase in STS burden, with the magnitude of the discontinuity concentrated among shifts with high trauma acuity. The findings suggest that the staffing ratio rule functions as a clinically meaningful boundary condition for STS risk, and that threshold compliance may be a modifiable target for occupational mental health intervention in low-resource trauma wards.
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Mwabumba et al. (2026) studied this question.
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