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”
“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
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”.
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.
“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”.