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Nurses must act together on staffing concerns, say campaigners

A group campaigning for the introduction of a minimum nurse-to-patient ratio is calling on nurses to set up a network of forums to monitor local staffing issues.

Speaking at a meeting in Brighton on Tuesday, the Four-to-One group said it wanted to “lead” nurses who wished to take action about low staffing levels.

As reported by Nursing Times last June, the group is calling for a minimum of one registered nurse per four patients, which they claim is the minimum needed for safe patient care.

A protest march on the issue is also being planned by the nurses, which they hope will take place in the autumn.

“It’s time to do not what we can afford, or what might be safe, but what patients need,” said campaign founder Mark Boothroyd, a staff nurse at Guy’s and St Thomas’s Hospital in London.

“I’d like nurses to come together, and have their own trust nursing forum to tackle issues of understaffing locally”

Mark Boothroyd

The group claims 4:1 is the ideal mandatory minimum to be able to give 02.48 hours per patient per shift.

It claims the current average – 9:1 on an NHS medical ward according to research from 2009 – means patients only get seen for 01.12 hours per patient per shift. This results in a 20% higher mortality rate, 22% higher job dissatisfaction and 34% higher burnout rate.

But Mr Boothroyd said a ratio of 14:1 was quite frequent in the NHS. This meant 48 minutes per patient per shift, which equates to a 26% higher mortality rate and 71% higher job dissatisfaction and 78% higher burnout rate.

The campaign group consists of eight nurses and student nurses from different unions, who are based predominantly in London. They aim to encourage nurses and trusts to get involved.

“The short term goal is to get some activists meetings going in London and other local activists’ meetings,” Mr Boothroyd told the meeting.

“I’d like nurses to come together, and have their own trust nursing forum to tackle issues of understaffing locally,” he said.

Nurses want to raise concerns, but cannot because they feel “isolated and afraid”, he said, adding that the campaign aimed to “empower” them and “create a movement out of them”.

The group also wants nurses to form nurse forums within their trusts to bring concerns to their managers as a group, instead of as individuals, so they will feel “less intimidated”.

“Nurses feel they don’t have a voice on their ward – so a nursing meeting forum is a safe space to raise issues and take them to management,” said Mr Boothroyd.

He also urged them to keep an audit of all the unpaid overtime nurses did, which could be shown to their managers. “Nurses do a million hours of extra over time a week collectively and only 10% of nurses get reimbursed for this,” he said.                       

Mr Boothroyd dismissed the idea that 4:1 minimum mandatory staffing level was unaffordable. Such claims, he said, were based on “bad math” and that it would be affordable if the government did not “waste” money on maintaining an internal market and private finance initiatives.

The 4:1 campaign is already supported by the union Unite, and the group has submitted a motion to call on the Royal College of Nursing to support it at its congress in June. However, Unison, which held its annual health conference in Brighton last week, has said it cannot “endorse” the campaign at present.

Mr Boothroyd said: “There is so much potential out there for people who want to create an NHS that is better and are not organised and we are going to do it.”

Roger Kline, from whistleblowing group Patients First, also addressed the meeting.

Roger KlineRoger Kline

He told delegates it was part of their code to raise concerns. If you go along with working in under-resourced units or wards, “you are violating duty of care” and “will be seen to be complicit” in the decision, he claimed.

Mr Kline also claimed that both the Nursing and Midwifery Council’s code and duty of care demanded that registrants did not work in conditions that put their patients at risk.

Readers' comments (10)

  • Well done to you and your group Mr Boothroyd. Are you aware of any groups set up in Scotland?

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  • Maybe we are looking at this the wrong way around.If the NHS or any other employer is offering a certain staffing ratio to clients THEY should inform all stake holders what is available....nurses like all other health care workers can"t divide themselves in two.As nurses we should stand back and observe how other health care professionals operate.....It is fascinating to observe for example a physiotherapist in my particular workplace.Mobilising a patient (with the help of a porter or other physio if necessary) then calmly sitting down and writing the notes before taking on another task.Nurses have little or no protected time to complete anything ( I am referring to the general medical or surgical ward nurse...specialists have it twigged!).....the tradition was that the "nurse"did everything at once.Was that ever really possible...I think we know the answer to that.Why can"t we shout it from the rooftops that unless you are unfortunate enough to need critical intensive care YOU GET A SHARE OF A NURSE in most clinical situations.YES A SHARE and unless we work for nothing or tax increases to pay for it that is what is available.That share is made feel guilty and inadequate by so many factors and be mindful that that nurse can lose its registration if it malfunctions.So if a given health care facility is offering x amount of nursing staffing on a given day it should be obliged to tell the clients like a menu in a cafe.For example a notice at the front door..Today we have 2 RGN and 3 HCA on duty...and if the staff numbers are short the reason should be given for this .

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  • Said to me by one midwife. "When I complained that I was breaching my NMC Rules and Code by working in this unsafe way, she told me that she is my boss and the NMC does not employ me"

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  • Elsie Gayle Independent Midwife | 18-Apr-2014 8:33

    a demonstration of pure ignorance from a professional and possible fear of the consequences of her orders where not obeyed. should be reported.

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  • Do the maths, and the numbers quoted equate to a nurse conducting patient care for about 11hrs of their shift. That is without taking into account breaks. Not clear if it is meant to include documentation, answering phone calls, talking to relatives, meal times, medicine rounds, an unforeseen emergency, etc., etc.

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  • michael stone

    Well Jenni, working together on this one, is something of a no-brainer, isn't it !

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  • Elsie Gayle Independent Midwife | 18-Apr-2014 8:33 am -
    A v common response in my experience, and that includes advice from the RCN and NMC!! Probably why things only stand a chance of changing after something catastrophic happens. Puts staff in an indefensible position. Interesting why the Daily Mail isn't howling from the rooftops about this one....but then it wouldn't be stroking the 'right' egos then would it.

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  • It is appreciated that staffing levels within ward clinical areas are under staffed, is this duplicated within other clinical areas e.g. perioperative units and Day dtay areas?
    I agree with the authors comments of recording all overtime with dates and evidence to demonstrate this occurrence. As nurses we all work over our scheduled employed hours which masks the nursing shortages within the areas, so in effect we are doing ourselves a disservice. Not one nurse would walk off duty when patient care is compromised as safety is paramount.

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  • Well done to the group of nurses and student nurses for their campaigning.
    I like the idea of a nursing forum especially to tackle understaffing.
    We need a forum. The unions are not doing a good job, our managers are just comfortable and are not making any significant changes.
    Nurses come on this site to say what is on their minds, I come on this site after a hard days work, wanting to connect with other nurses on how I feel.
    To have a nurses' forum in the trust I work in, will greatly interest me.

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  • How I wish this gets implemented to all NH

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