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'Staffing guidance falls short for patient safety'

Wards are seriously understaffed. That’s the message Nursing Times readers gave loud and clear over a year ago, responding to a survey just before the
publication of the Francis report into care failings at Mid Staffordshire Foundation Trust. And when we repeated the survey this year the situation was little improved.

What happened at Mid Staffs was inexcusable and not solely the result of understaffing, but resourcing decisions do leave some hospitals just as likely to fail to provide their patients with safe care.

The point of our surveys was to show the crisis in resourcing. The government may say there are more NHS nurses than ever before, but the frontline view is different - and patient needs are more demanding, and we are playing catch-up as staffing levels have been so desperately low.

So it was with great expectation that the profession awaited the regulations on staffing level data. Part of the government’s response to Francis, this was meant to make transparent what safe staffing looked like in the best trusts and spur others to follow their example.

But it seems this is not to be the holy grail many had hoped for. It appears publication of the number of nurses that should be on a ward and the number actually on shift can be interpreted and displayed differently. It won’t be standardised (for that read could be fudged) and the public (and staff for that matter) will have no greater understanding of whether the ward is safe on any given day.

It appears publication of the number of nurses that should be on a ward and the number actually on shift can be interpreted differently. It won’t be standardised

Don’t get me wrong, there is much to be praised here - it is a step in the right direction - but it falls short of being the patient safety bulwark originally promised. Many reports from organisations such as the National Nursing Research Unit and the Safe Staffing Alliance have shown that cutting nurse numbers puts patients at risk.

I understand all the hyperbole around not wanting to mandate numbers because it becomes “the ceiling and not the floor”, but the facts are this: if you ask a nurse to care for 28 patients on a ward (and this is something we have heard of ), those patients will receive poor care - or worse - no care, with potentially tragic consequences.

Many trusts provide excellent care and ensure teams are well resourced. The only reason the government won’t use those models as an exemplar to other trusts is money. It can’t afford it. Why can’t the politicians be honest about that instead of dressing it up? They want falls prevention, pressure ulcer prevention and A&E targets met, but won’t give nursing directors enough staff to do it. But what they will do is burden them with paperwork that doesn’t keep patients safer.

We’re notching this one up as yet another opportunity missed.

Jenni Middleton, editor jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (6)

  • Maybe instead of making hospitals pay huge "fines" if targets are not met, there should be a requirement to pay the penalty by funding additional front line staff?

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  • Anonymous | 8-Apr-2014 3:20 pm

    Good idea!

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  • Absolutely shocking that major decisions on ward staffing are being solely based on the national acuity tool. We are fighting to be heard where I work so management will look at the wider risks of not having enough staff on the wards. Staff wellbeing and value is being pushed aside - time to support, educate, appraise, team build, manage capability, and actually provide good care are the casualties.



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  • michael stone

    'It won’t be standardised (for that read could be fudged) and the public (and staff for that matter) will have no greater understanding of whether the ward is safe on any given day.'

    Oh Jenni - as a fellow [it seems] cynic, I'm wondering if that 'could be fudged' was a slip-of-the-hand and should have read 'would be fudged [by at least some people]' !

    Your 'no greater understanding' point, puts me in mind of the recent NT piece suggesting that nobody actually understands the Family & Friends 'test' (something else that is supposed to improve improve service performance and patient safety).

    I think - I'm 'analysing this as I type' so I've not really thought about it - that the problem with all of these types of 'measure', is the positioning of them somewhere between 'very simple' and 'very comprehensive'.

    For staffing, 'very simple' would be to just collect hard patient outcome data, ranking wards in comparison to other clinically-similar wards, and letting the poorer performers get on with improving their performance: presumably, if 'adding more staff' had not been tried and other measures had not improved performance, it would perforce be tried. 'Very comprehensive' would entail full details of staffing numbers/categories 24/7 for every ward in the country, and 'patient outcome data', and then looking at that data set.

    Somewhere inbetween - 'some counting of staffing numbers, but not standardised and not 'comprehensive' - leaves plenty of room to 'argue over what the data means'.

    Many (or most) 'data sets' are of the 'somewhere inbetween' variety. Puts me in mind of that old saying about 'A little knowledge is ...'.

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  • It is interesting to observe from Saudi Arabia this debate over minimum staffing levels and the various arguments as to why setting minimum staffing levels will not work. In our hospital we set our staffing levels on the Nursing Hours Per Patient Day (NHPPD) required to provide safe patient care and a safe working environment for Nurses. This is what drives our staffing establishments. We do not always meet those levels every single day but we know what safe staffing levels look like and can take action to ensure that risks are managed at the unit level. Nobody I know would argue against patient safety and a safe environment for care delivery so it seems to me that setting minimum staffing levels is a necessity rather than a choice.

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  • Anonymous | 12-Apr-2014 10:28 am

    we did this by a series of complex calculations which took up precious bedside nursing hours each day. we submitted our figures to inform staffing levels for the next day for 24 hours. however, on a busy medical ward accurate staffing needs were never totally predictable and if we found ourselves with any extra hands the following day allowing us to catch up with any backlog of routine work they were immediately whisked off to replace elsewhere. when we were short it was more a huge favour than a rule that the numbers would be made up and mostly we just had to buckle to and share out the extra work of the missing colleague, which eventually became two and then even three. not easy during those hours of the shift when you are alone and have not only your own work but that of two others as well!

    the hospital purchased this redundant points system based on calculating the level of dependency of each patient and the amount of nursing required at great expense from Canada who had thrown it out after proving it did not work for them! :<(

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