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Nurses warn of dangerous dips in safe staffing levels

Most nurses believe that staffing levels have regularly dipped below safe levels over the last year and want mandatory ratios for the number of staff per patient introduced, according to a Nursing Times survey.

Asked whether staffing had regularly fallen below safe levels on their ward over the past 12 months, 72% of respondents said that it had.

The findings reinforce concerns about staff cuts made by NHS trusts desperate to save money, which have consistently been highlighted by the Royal College of Nursing in its ongoing Frontline First campaign.

One respondent said: “The ethos of quality care is paid lip service to by managers and government who are determined that care will be delivered by the lowest cost workforce. Nurses no longer have a voice – the governments drive to claw back millions is having a huge detrimental effect on patient care.”

Another said: “Staff are taken advantage of as they continue to soak up the extra work at their own expense – whether they work extra hours, are increasingly suffering from stress, or the extra workload takes its toll physically.”

In addition, 72% of respondents said they were in favour of mandatory patient to nurse ratios. A similar percentage, 70%, said they were also in favour of introducing mandatory ratios for nursing skillmix between registered nurses and healthcare assistants.  

One respondent said registered nurse to HCA ratios were a “minimum move toward greater patient safety at a time of fewer resources”.

Another said: “I have in the past cared for 28 patients alone due to night shift ratio and one other nurse of sick. This is not good enough.”

However, others noted it would be a complex undertaking. One respondent said: “There are so many variables to consider when deciding on a minimum nurse:patient ratio that this could only really be done on a ward by ward basis or by setting the nurse numbers high which would be expensive.”

Another added: “The danger with suggesting mandatory ratios is that it’s not necessarily how many patients you have, but rather it’s their acuity, their level of dependence and need.”

Despite long standing and repeated calls for the introduction of minimum staffing and skillmix ratios from unions and others, the government has so far resisted their introduction.

It is expected to come under further pressure to act on the issue when the report of the Mid Staffordshire Foundation Trust public inquiry is published later this year. Research published by Nursing Times in 2009 showed the more trusts a trust employed per bed the fewer of its patients were likely to die or experience long stays.

The survey also asked respondents which if any workforce issue currently facing the profession would lead them to consider taking some form of industrial action.

Three quarters cited staffing cuts that in their view endangered patient safety – also the most popular reason given by nurses for considering industrial action in a Nursing Times poll in October.  

In addition, around half of respondents said they would consider industrial action over attempts by trusts to reband nursing staff to a lower pay level, government proposals to change NHS pension scheme and retirement age, and staffing cuts that significantly increased your workload.

A third also said they would consider taking action over attempts by government or trusts to dismantle Agenda for Change and move to local pay setting, and a quarter over the possibility of being transferred to a social enterprise scheme or other body outside of the NHS.

The poll findings released today are the third instalment of results to come from an online survey of around 400 nurses carried out by Nursing Times over the past week.

The poll has asked nurses about the “big issues” currently facing the profession. As well as workforce, it has looked at other key areas including the health bill and the current review of the Nursing and Midwifery Council.    

Readers' comments (12)

  • wonder how these tory idiots would feel if their loved ones were being cared for on a ward with under staffed nurse's

    oh sorry...forgot they go private as they can afford it!!!!!

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  • Wont be long before there is only one nurse working a 24hr shifts, 7 days a week, until (s)he reaches the age of 70, and then retires suffering from severe mental stress.

    The whole NHS system has gone crazy... ever since they policy makers used a business management model on which to run the failing service.

    I have always maintained you can't operate a 'people service' in the same manner in which you can run a factory or shop.

    So far I've been proven right in every aspect.

    Why doesn't the secretary of statefor health get real, and 'LISTEN' to the nurses and the patients pleas?

    Oh, I know the true answer really... it's because (s)he's a conservative, whose only purpose in government, it to run the NHS down so they can make it privatised organisation - a bit like the olden days in Dicken's times.

    Nurses... for goodness sake, do something positive to stop this rapid decline, by taking effective action, otherwise you too will be out of your job!

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  • Anonymous | 15-Feb-2012 11:21 am

    "So far I've been proven right in every aspect."
    More than one billion per cent right. this management model exists in other countries as well and does not work where sentient human beings with individual differences need healthcare services. It is not possible to process people through a system in the same way as manufactured goods.
    Management should have learnt this by now when they repeatedly experience the 'difficult' patient who does not have an expected outcome to treatment, comes out with an infection and blocks the bed for extra days when it has been booked for somebody else, or the 'awkward' staff who express their concerns about shortages and insufficient numbers to carry out adequate or safe care, or mention their working conditions are not those to which they are entitled, even though they often work for free to prevent harm to their patients. It s just too bad if anybody dares to upset the status quo of management during their meeting/coffee break or puts their highly paid job on the line (with a salary sufficient to employ more than one HCA or RN).

    Regarding Lansley and others involved, how can people be made to listen to others if they do not want to? Force seems to be the only answer but then effective ways would need to be found to apply that force.

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  • George Kuchanny

    In my view this article clearly illustrates one problem and one problem only.

    Mangement in our NHS is very poor. It matters not a jot in the end about funding when this is the case. What so many Trusts do is this.

    They hire a 'legal services manager' (LCM) at the same cost as 3 or 4 HCA's when problems start. This LCM in plain english is a minor clerk who sits in at meetings, is patronised by senoir staff into thinking that their view helps to form policy and so on, but in fact simply does whatever they are told to do and farms out work to local solicitors at extortionate rates to write rubbish in response to serious complaints.

    Hands up all those who think the assistance of 3 or 4 HCA's on your ward to help with patients is of less use than a twit in suit who does nothing.

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  • George Kuchanny

    Sorry about the typo in my previous comment. I meant senior management staff not senoir - or did I mean senile?

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  • George Kuchanny | 15-Feb-2012 12:29 pm

    In addition to the LCM how many more different types of managers are there in the NHS? Has anyone ever counted? I have heard of press officer ones, public relations ones, and just wonder what other types of ones there are, and especially those ones not directly related to patient care?

    Are all of these ones more important, in someone's opinion, to patient care and to the organisation than HCAs and nurses?

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  • tinkerbell

    Anonymous | 15-Feb-2012 10:03 am
    Anonymous | 15-Feb-2012 11:21 am
    George Kuchanny | 15-Feb-2012 12:29 pm
    George not we're not the slightest bit worried about typos or spelling mistakes. Get if off your chest regardless.

    Way to go! Let's tell it like it is. Let's stop pussy footing, we are not hand servants/maids/butlers. We have a voice and now is the time to use it. Let's give it to em - lock and load.

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  • tinkerbell

    7 March TUC NHS London Rally please join

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  • I volunteer at my local hospital and they are always short staffed. One day, just after giving patients their lunch there was just myself and one other nurse on a ward with 26 beds, it was a nightmare. I was not allowed to help patients due to insurance purposes and the other nurse was rushed off her feet. I start my nursing degree September and just hope that it's like that everywhere. Nurses really are taken for granted!

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  • Ment to say hope that it is NOT like that when I start university September.

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  • Anonymous | 18-Feb-2012 7:13 pm

    I understood what you meant from the rest of your comments. I am quite sure others would have done as well.

    I can just about picture the scenario with one nurse on a busy ward responsible for so many patients and you doing the best you can but being excluded from doing many things because of insurance. It is a dreadful and dangerous situation not only for the patients but for the staff as well with all the serious consequences such a situation could implicate. I admire you for volunteering and hope you get some gratitude for your help.

    Good luck with your training. At least you have some insight into what nursing could be like although it is not that bad on some wards, and dare I say maybe worse on others. It is a real mixed bag but great experience but do think about it carefully - working conditions, attitudes, salary, etc.

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  • I worked with a Care Assistant in Devon, it recently came to my notice that she has a warning marker on her CRB Check for giving a patient an injection of insulin, she was reported to her employer by the district nurse and sacked for gross misconduct, this dose could have been fatal to the patient if the district nurse had given her a further dose, i have worked with this girl and similer things have happened and she is still working in care homes, she should be blacklisted before she causes more harm, her name is Sherina Cornish, and she works in the Devon area Exeter and Okehampton, Be Warned Check her CRB.

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