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Senior nurses restate call for ratio of one nurse for eight patients

Campaigners from the Safe Staffing Alliance have emphasised that a nurse-patient ratio of more than one-to-eight should be a warning signal that a ward may be struggling.

Wards with higher ratios should automatically raise safety concerns, according to alliance member Pippa Hart, director of nursing at Epsom and St Helier University Hospitals Trust.

“If you have more than one-to-eight that should be a smoke signal”

Pippa Hart

“If you have more than eight patients to care for then the risk of harm significantly increases,” she told delegates at a nursing conference at the end of last week.

“If you have more than one-to-eight that should be a smoke signal, something that tells us that patients are at risk on that ward,” she warned.

She said this simple rule of thumb should be used to encourage nurses and colleagues to raise concerns about staffing levels. However, other factors

Epsom and St Helier director of nursing

Epsom and St Helier director of nursing Pippa Hart

Ms Hart was speaking to an audience of senior nurses and nurse managers at a session on safe staffing in acute settings, as part of the Florence Nightingale Foundation’s annual conference.

She said there was mounting evidence that “numbers matter” in nursing.

“There is a huge body of evidence coming through that supports what we all know as nurses, which is the lower the ratio, the better the standard of care,” she said. “And with lower ratios you see improvements in mortality.”

She highlighted research findings that suggested hospitals with ratios of 10 to 12 patients per nurse were likely to have at least one incident where care was compromised every shift.

Meanwhile, Elaine Inglesby, nurse director at the Salford Royal Foundation Trust and another member of the alliance, said the reality of staffing levels in hospitals “can be quite scary sometimes”.

But she said staffing boards displayed on wards showing how many nurses should be on duty and how many there actually were, had helped her trust keep safe staffing at the forefront of managers’ minds.

“Staff who trialled it were very anxious about what would happen when we hadn’t got enough staff and what patients and families would say,” she told the session.

However, what they found was that patients and families praised the trust’s honesty while the boards meant safe staffing was discussed much more often.

She said nurses were used to taking a “make do and mend approach” to cope with staffing shortages, but they needed to get used to the idea “that if there is not safe staffing then actually that’s not good enough”.

Elaine Inglesby-Burke

Elaine Inglesby-Burke

The alliance was formed in summer 2012 and is supported by a range of nursing organisations and senior nurses, including Professor Elizabeth Robb, chief executive of the Florence Nightingale Foundation. It cites a number of studies as evidence in favour of its favoured 1:8 ratio.

Earlier in the day, England’s chief nursing officer Jane Cummings told the conference she did not think it was possible to provide compassionate care without appropriate staffing levels.

Jane Cummings

Jane Cummings

“You can’t provide good, compassionate care without appropriate safe staffing, although there is more to it than that,” she said. “It’s not just numbers that make a difference.”

Northern Ireland’s chief nursing officer Charlotte McArdle added that, without the right staffing, “you end up with moments of compassion rather than a culture of compassion”.

Readers' comments (14)

  • We need a minimum of 1 to 8 with the right skills, plus one to co-ordinate the shift, one to discharge plan and a supernumerary ward sister - we also need this 1-8 on the late shifts and at weekends and need to increase the night ratio, currently 1-14 on many large wards.
    We also need more community nurses.
    In fact we need more nurses, more doctors, more 24/7 services.
    There's no point in a 1-8 if only one nurse is fully trained up and competent to care for sick people.
    We also need to have more HCA on the ward who feel supported and are also fully competent and trained up in the job they do.

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  • poor patient looks worried and not in the least reassured with staff discussing him/her at the foot of their bed. it would be better if he/she was shown they cared and included him/her in their conversation. no six 'C' displayed there but just another step in the 'processing ' of patients and their care.

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  • How would this translate to nursing homes? We currently have a ratio of 25 residents to 2 nurses

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  • 1 in 8 ratio is too much unless you have an RN and a HCA caring for the 8. I left the NHS 6 years after 20 years service and work in UAE where we have a qualified only workforce and a 1 in 5 or 6 ratio plus CN plus manager with discharge planners supporting and are trying to get to a 1 in 4 to improve levels of care and satisfaction. Sad to see NHS declining in front of our eyes.

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  • So at least some of these "nurse leaders" are beginning to see some sense.

    Each one of these clowns should attempt to manage an acute ward with a 1 to 8 nurse patient ratio!

    They should be able to cope ! They are "leaders" who know everything about the profession.

    Will they do it ?

    Not a chance in he**

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  • We have been having 1 nurse to 8 patients, with the help of 1 HCA, and we have been strugging. The 8 patients comprised of at lease two mental health patients, one of them at risk of falling and the other at risk of being lost, also wandering and interfering with other patients and their property and causing distress to some patients.
    Of the other 6, one End of life, this involves care that is not rushed, the next of kin is also on hand and wanting some of your time and comfort.
    Two for discharge planning.
    For the discharge, this involves telephone calls to next of kin, social worker, transport, pharmacy, district nurse. Faxing transfer letter to district nurse, liasing with ward doctor for letters and prescription. Being pressured by Site manager to send the patients to discharge lounge, speaking to discharge lounge staff to arrange collection of patients. Ensuring patients leave safely check that venflons are removed they have eaten washed and dressed etc. Once beds empty site manager on your back to fill the bed, and she don't care a damm if you are now helping with lunch or still washing the patients, or trying to get the blood sugar test done, just drop every thing, clean and make the beds to fill the bed from A&E.
    I have not mention what care are involved for the other 5 patients and I have not even touched on medicine management.
    I have never worked so hard in my life and I have done a lot of jobs besides nursing.
    These nurse managers could never ever do the work I am doing and keep their patients safe.
    So 1:8 is nonsense.

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  • There are so many variables that simply stating a ratio of nurses to patients in nonsense. It depends on the acuity, risks and on other staff available (HCA's, Dr's, ward clerk, physio, OT, Orderly, Dietitian, cleaning, catering and volunteer. Hope I haven't left anybody. If these are not available or only have limited availability, more work for the Nurses. Intensive care must have a higher ratio, acute mental health must have a higher ratio. We also need to be careful that a set ratio doesn't become a maximum staffing ratio. As soon as the variables change such as acuity or lack of other staff, the nursing ratio must be reviewed.

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  • I am a third year student and I am certainly worried about being qualified, with such a high patient nurse ratio. I often seen 1:15 and at best 1:9 on a very demanding ward. I am worried I will not be able to give best patient centred care or i will make a mistake through busy wards. I have always wanted to be a nurse and have worked so hard to get this far. However I make a note of patient nurse ratio's when considering job offers.

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  • i am so angry !!! what do they mean we are used to making do........ there is no choice if there is only 4 nurses in shift on an acute care of the elderly ward what are we meant to do?? down tools. go home??? we dont have the energy to make statements etc

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  • "Scarey" is an understatement!!! what is the matter with these so called senior nurses??
    if there is an incident e.g a fall all they do is issue more forms to fill in instead of understanding that how ever wonderfully muti talented and skilled we nurses are 1:6 upwards on a busy ward is not SAFE . YOU DO NOT NEED TO CARRY OUT STUDIES TO PROVE THIS............. just speak to a few of us at grass root level.

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  • 1-8 should be absolute minimun eg nightshift only & not include the nurse incharge. I trained in victoria, australia were it's 1:4 in a public hospital ward (obviously it still differs depending on which area you work in), and though I worked in the private sector, which doesn't have to abide by it, they usually come close ie 1-5 (or 6) on the acute wards & 1-7 in rehab.

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  • And it's terrifying sometimes seeing what goes on on the wards in the UK & how stretched the nursing staff is, yet still trying to do their best by their patients and colleagues. We can't keep having to do more with less yet not let let standards of care slip, it doesn't work that way & the sooner the politicians & other powers that be realise that the better!!! But I wouldn't hold my breathe unfortunately because the sense of apathy and lack of confidence I've seen in nurses & nursing over here is also scary!

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  • Steve Holland 4-4 14

    Well done oyou on brining in a professional voice to these discussions and your commentss were refelcted in Mark Drayford's repsonse to a polititions' bill to have legal minimum staffing levels. it is not just a number becasue minimum will soon become the norm.
    it is only by interpretign the data from a whole host of indicators over a period of time and include professional judgement that we can come up with safe staffing numbers . Giving a number / minimum levels will leave nuress vulnerable

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  • All you need is for one of your 8 patients to become unwell, fall, go for a procedure etc. and you will have to handover the rest of your 8 to another member of staff, leaving them with 15 patients.
    Why are staffing levels so bad?
    Why can't we just have enough staff, appropriately trained, to look after patients properly like we used to.
    If there are not enough staff then close beds (like we used to).

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