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Exclusive: Trusts will need to find more nurses


Many trusts will need to increase their nurse numbers to comply with new national guidance on setting safe staffing levels in England, Nursing Times has been told. Meanwhile, latest workforce data shows huge variation between hospitals.

Guidance from the chief nursing officer for England and the NHS National Quality Board was announced last week as part of the government’s full response to the Francis report.

It said, from April, all hospitals would have to publish staffing levels on a ward-by-ward basis together with the percentage of shifts meeting safe staffing guidelines. This would be mandatory and done on a monthly basis.

By the end of next year this will be done using models approved independently by the National Institute for Health and Care Excellence, it added.

It is widely expected to lead to trusts identifying shortfalls in their staffing establishments.

There is no official estimate of how many extra nurses might be needed to meet requirements such as cover for unplanned leave among staff.

However, the Royal College of Nursing recently estimated there were at least 20,000 vacancies for registered nurses, while the Centre for Workforce Intelligence has predicted a shortfall of 47,500 nurses by 2016.

Meanwhile, Nursing Times has obtained data suggesting a big variation in nursing ratios between hospitals which gives further indication that the shortfall will be significant.

Data from June, compiled by analytics company Methods and shared with Nursing Times, shows the ratio of available nurse staff days to occupied bed days for every NHS acute hospital.

The ratio among acute trusts varies from 1.33 at Tameside Hospital Foundation Trust to 2.59 at University College London Hospitals Trust. Among trusts that provide both acute and community services, the ratio ranges from 1.52 at Croydon Health Services Trust to 3.34 at Guys and St Thomas’ Foundation Trust.

Even when the varying size of organisations is taken in account, some organisations currently appear to have one and half times more nursing availability than others.

The data must be treated with caution as it includes nurses who are not in patient facing roles and excludes day cases.  

Both Croydon and Tameside have been subject to much public scrutiny due to concerns about quality and staffing levels, and are planning to increase their numbers of registered nurses. In total, seven of the 10 acute trusts with the lowest ratios are among those that the CQC has highlighted concerns about. 

Ruth May, NHS England’s director of nursing for Midlands and the East, led the development of the new guidance for boards on staffing.

Ruth May

Ruth May

She told Nursing Times the first step for boards was to make sure they knew what their establishment should be.

“To begin with people will be surprised to see they have got a shortfall, but as the weeks and months go on, organisations will get better at aligning their staffing levels,” she said. “It’s likely we will see trusts increasing establishments as well as more focus on rostering correctly to maximise staff they have got.”

Dr May said the idea was for staffing levels to be reported in a similar manner to how wards report how many days they have been free of a pressure ulcer or an MRSA infection.

She stressed the guidance applied to community and mental health providers just as much as acute trusts.

Although additional nursing recruitment is likely to be welcomed by the profession, there is widespread concern among hospital managers about whether it is affordable in the long term. An additional 8,000 band 5 nurses would cost the NHS about £320m.

A Nursing Times investigation earlier this year found 73 acute trusts had increased their nursing establishment in 2012-13 by a total of 4,321. Last week Health Education England revealed trusts are planning to employ an additional 3,700 nurses during the current financial year.

Royal College of Nursing head of policy Howard Catton told Nursing Times it was encouraging that the government seemed to be finally recognizing the existence of a nursing shortage.

“There is a question mark about what the extent of that shortage would be. The work that’s going to flow from this new guidance will put us in a much better place.”


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Readers' comments (28)

  • Most hospital Trusts have an abundance of qualified staff: visit any critical care, theatre or endoscopy suite and you will find large concentrations of nurses not necessarily making best use of their registrations. This isn't a dig at these particular specialities, it is just an observation and in these austere times, it makes sense to redeploy this untapped resource.

    I think many Trusts will be revisiting their vastly swelled ranks of 'specialist nurses' and looking to reassigning them - even for just one shift a week - to a ward-based setting.

    I welcome this new thinking as I believe ward-based staff have become very deskilled in a number of key areas as virtually every process now has some specialist nurse attached to it. I think having specialists working on wards will help with staff training and the promotion of best practice.

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  • Skills4nurses a Scottish organisation have been over to Portugal, Spain, Greece and Italy in the past recent months and have recruited over 300 nurses for UK NHS Trusts. I know that are returning in January again on behalf of a northern NHS Trust, it seems that the shortage of nurses is not only confined to down south.

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  • michael stone

    How do we know - as opposed to suspect - that there are note nough nurses, when the 'metric' has not yet been settled ?

    Personally, I still see this working in a cause-and-effect fashion. If different hospitals publish staffing numbers AND 'patient outcomes', then it should soon become clear both:

    1) if there is a 'critical ratio' below which bad things happen, and

    2) if some places have got 'bad things happening' even if they apparently have got enough staff.

    So if you properly collect and publish the ratios and outcomes, you can then work out from the figures 'what is needed as a minimum level' (from 1) and also 'which operational set-ups seem to work well and which badly' (from 2).

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  • michael stone

    'not enough nurses' !

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  • Currently to plug gaps, recruitment drives are being done from other countries. Though this should only be a short term fix, and will not solve long term shortages of nurses in this country.
    The emphasis on nurturing home grown staff and the improvement of retention of staff is very much lacking from what I've heard.

    It seems there is only retention premia for the most difficult to fill vacancies, where staff don't stay for long.

    Nurses work bank shifts for extra money to make ends meet; paid at similar rates to normal rates. However as they are meeting service requirements, they should really be paid overtime rates (especially if there is lack of staff or increased numbers of patients or complexity of care).

    Due to lack of retention, staff leave more readily, either to work elsewhere or to leave the profession entirely. This then adds to the cost of employers of advertising and recruiting new staff, time and costs to cover senior staffs for interviewing, training costs of new staff, allied costs associated with recruitment - DBS checks, references, occupational health screening.

    Staff and resources are directed towards specialist areas such as Emergency Departments, Intensive Care, Hyper-Acute Stroke Units, etc; as they are high profile areas; however this then leaves massive gaps in care of the Elderly and those with long-term conditions, as resources aren't being put into those areas.

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  • Anonymous | 27-Nov-2013 10:46 am

    I don't know anywhere with an "abundance of qualified staff" or "vastly swelled ranks of "specialist nurses"".

    The specialist nurses in my hospital work throughout the breadth of their specialties. (In wards, clinics, patients' homes, etc). They are also required to work ward shifts, not "to help with staff training and the promotion of best practice.", but to make up the numbers and avoid recruiting adequate levels of staff. Their patient caseloads (which ward based nurses don't carry) do not decrease whilst they are working in the wards and their teaching and research duties need to be fulfilled in addition to their main role.

    Most patients are not found in bed, yet 'nurses at the bedside' is peddled endlessly as the answer to all problems. Neither is any consideration given to career choices and ambitions of individuals. The ignorance and lack of aspiration in this type of thinking is damaging. It isn't the solution to chronic understaffing and should never be punted as such.

    I think you will also find that the vast majority of ward-based staff are well educated, trained and skilled individuals who might take exception to being portrayed as "deskilled". In an increasingly complex patient environment, they are required to possess many more skills than ever before.

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  • Where are these nurses going to come from? we know that there is a nurse shortage, what happens if they can't find extra staff?

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  • Does this mean the end to supernumerary ward managers - will they be out on the wards helping patients, same with the senior nurse managers, bed managers etc. etc. - is this the end of these jobs being given to nurses.

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  • Not all patients are on the ward. Most are not.

    Regardless, the organisation of a ward can't be done by nurses if every nurse is carrying out 'bedside care' for every minute of every shift. Those who constantly argue for ward managers to spend all their time 'out in the ward', are completely unaware of the requirements of the job, (and never seem to put themselves up for these jobs).

    If all nurses regardless of training, experience, qualifications, specialist interest and ambition are to be placed 'at the bedside', how can nursing ever progress? We might as well just let everyone walk over us and do as we are told. Mind you that is pretty much what goes on at the moment.

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  • Anonymous | 28-Nov-2013 12:05 pm

    All of your specialist nurses may well be filling in and covering shifts on wards, but that certainly isn't the case in my patch, indeed there are droves of very qualified people in non-jobs wandering the corridors and populating the coffee shops and restaurants of hospitals.

    We have so many 'teams' involving themselves - viscerally - in patient care that it is almost impossible to admit, correct and discharge a patient without some team or specialist having to be informed or involving themselves. It's crazy, the NHS is effectively bust, we need to make changes!

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