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EDITOR’S COMMENT

'Listen to what nurses are saying about staffing'

Most nurses believe in setting minimum nurse to patient ratios, according to a recent report by Unison.

The views are at odds with those of the outgoing chief nursing officer for England Dame Christine Beasley, who a few months ago told the Mid Staffs inquiry that she was concerned about introducing minimum ratios because there was a risk that “instead of becoming the floor they become the ceiling”. Other senior healthcare figures have echoed her view - from Dean Royles at NHS Employers to Harry Cayton, the chief executive of the Council for Healthcare Regulatory Excellence, which is carrying out the strategic review of the Nursing and Midwifery Council.

But Unison’s Care in the Balance report, published last week and covered in Nursing Times on 24 April, found their views were not echoed by frontline nurses. Its 24-hour survey carried out on 6 March asked members to take a snapshot of nurse to patient ratios and to divulge how that affected the care they were able to provide.

More than 90% of nurses who responded to the survey were in favour of legislation to set minimum nurse to patient ratios.

And now, interim results from the RN4CAST study provide evidence that inadequate staffing directly influences nurses’ ability to carry out and complete core nursing tasks.

It’s a complicated issue - minimum staffing levels cannot be implemented as a one-size-fits-all across all areas, or it would indeed become, as many have commented, a blunt tool. However, Unison’s report makes it clear that organisations’ self-policing of staffing levels is not making nurses feel able to provide safe care.

The worrying thing about the survey is that respondents felt that when things went wrong, albeit in a multidisciplinary team, it was nurses who carried the can. And yet it is those nurses who are not being listened to when they raise concerns about that very issue.

In fact, at the Unison health conference last week, many nurses stated that their senior managers were concerned about them even filling in the union’s survey or distributing it to their colleagues.

It is shocking to think that this is still happening after all the reports and concerns raised about nursing recently and in the wake of Mid Staffs. Managers who care about patients should want to hear from frontline staff about what is going on in their organisations, and be open to suggestions for improvement.

It is time for managers to listen to evidence about standards of care and work with their nursing teams to find a solution, rather than branding those who raise concerns as troublemakers.

Readers' comments (5)

  • michael stone

    'she was concerned about introducing minimum ratios because there was a risk that “instead of becoming the floor they become the ceiling”.'

    That is almost invariably what happens, when cash-strapped managers 'look at things'.

    But clearly there do need to be enough nurses, to enable them to do all of the required nursing tasks - and, it does seem that 'nurses often end up carrying the can' when things go wrong.

    'Managers who care about patients should want to hear from frontline staff about what is going on in their organisations, and be open to suggestions for improvement.

    It is time for managers to listen to evidence about standards of care and work with their nursing teams to find a solution, rather than branding those who raise concerns as troublemakers.'

    Yes - how is that to be achieved ?

    Suggestions for improvement, should be properly considered, whatever the source of the suggestion. And we all know about the problems of 'being branded as a troublemaker for raising a concern', don't we ?

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  • DH Agent - as if ! | 4-May-2012 3:51 pm

    yes, dear. we know all this already but in many cases it is not happening is it?

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  • I think you’ve hit the nail on the head again Jenni, thank you.
    It made me think about the scrutiny of managers’ work. When have managers been under the microscope? When have they had time and motion studies carried out about the value of their work?
    How much time do they spend on the front line? How well do they know their staff? What financial value do they add to the care of patients?
    When will MPs or anyone in the Department of Health start to be concerned about managers who don’t want staff completing union surveys to prevent anyone knowing how bad the situation has become?
    So the silencing of staff in a most brutal way by false allegations and suspension, continues. Desperate.
    Julie Fagan founder member , CAUSE
    (Campaign Against Unnecessary Suspensions and Exclusions in the NHS UK)

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  • I work in a busy ED and when we have a low number of staff then the patient care suffers, when we have adequate numbers of nurses then the care is massively improved. It is simple numbers game but the NHS seems to feel that managers are more important than those of us directly engaged in patient care. I for one would definately be behind a ratio of staffing as it seems to improve things in the patient's favour,even if it may prove troublesome for the trust to implement.

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  • Staffing levels are already at the floor most of the time. Management need to pushed to see how adequate care/staffing can so easily become poor care .just one more emergency or one more demented patient and the damage is done. To a patient ,a family and a nurse.

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