Elizabeth Robb: 'Act on the evidence and introduce minimum nurse staffing levels'
Address the issue of staffing to prevent care being left undone, nursing burnout and shameful incidents, such as those at Mid Staffs, urges Elizabeth Robb
Nowadays not a week goes by without us hearing a story about poor nursing care. The most recent one, recounted in the House of Commons by Anne Clwyd MP about her husband’s care, appears to have reignited the media view that nurses are callous and have lost all compassion. Once again, we hear that basic care costs nothing and that smiling and being kind are all that is required.
Although our hearts go out to those who have lost a loved one and found the care they have received to be wanting, this is not the only picture of NHS nursing care. Of course, we must root out and be completely intolerant of poor care, ensuring the individuals responsible are held to account - but we must not forget that the vast majority of nursing care is actually very good. We hear little of this now and it is time we remembered that nurses have not lost compassion or their ability to care. It is still there but compassion does cost. It costs in terms of time, energy and emotional effort.
Good leadership and a set of values such as the chief nursing officer for England’s 6Cs - care, compassion, competence, communication, courage and commitment - excellent as they may be - are simply not enough. We need to tackle poor levels of registered nursing staff and the elephants in the room of organisational cultures that favour financial savings and activity targets rather than patient centredness and quality outcomes. Values alone will not meet the ever-increasing demand for healthcare, the dependency levels of many patients or rising public expectations.
“Poor registered nursing staffing levels were part of the problem at Mid Staffordshire Foundation Trust”
Poor registered nursing staffing levels were part of the problem at Mid Staffordshire Foundation Trust and are likely to be commented on in the forthcoming final Francis report. The recent Care Quality Commission report underlined that 16% of organisations fell short of the standard on safe staffing. That is of concern; although it makes clear that good staffing levels did not guarantee good care, low registered staffing levels were associated overall with care being of poorer quality.
The evidence abounds that higher levels of unregistered practitioners are associated with higher mortality rates and increased lengths of stay, failure to rescue and higher levels of reported patient safety incidents.
There is also evidence that fundamental nursing care is a complex and emotionally intensive occupation. Being unable to meet all the care needs of patients, together with leaving work undone, adds to the emotional burden for caring nurses. We know from psychological evidence that when we become overloaded and unable to meet the demands that are placed on us, there is a danger of a loss of humanity. We must support the profession to ensure we mitigate these risks, caring for and supporting each other by standing up for what is right for patients and preventing burnout.
At the CNO’s conference in December, it was heartening to hear health secretary Jeremy Hunt say that nurse staffing
numbers should never be at the expense of quality of care. He said nurses have a difficult and complex role and that his
job was to support us in taking forward the vision for nursing and midwifery. That is music to the ears of most of us in the nursing profession - we now need him to have the courage to act on the evidence and support a minimum level of registered nurse staffing numbers. This would prevent further care being left undone, nursing burnout and shameful incidents, such as those at Mid Staffordshire and other recent examples of poor patient care.
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Elizabeth Robb is chief executive of the Florence Nightingale Foundation