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Doctor urges limit on number of patients per nurse


Laws should be changed to limit the number of patients a nurse should care for in hospitals, according to a doctor in Greater Manchester.

Orthopaedic consultant Dr Milton Pena said nurses across England have too heavy a workload and that the quality of care deteriorates when nurses are stretched.

And he added hospitals are running “false economies” if they choose to go with a low nurse-to-patient ratio.

Earlier this year, Dr Pena criticised patient safety at Tameside General Hospital. He told BBC’s Panorama programme that out of every 100 deaths at the hospital, one or two could be prevented by having a greater nurse-to-patient ratio.

He wants new legislation to be passed in England to dictate to hospitals how many patients a nurse or midwife can tend to. Wales and Scotland have different legal systems, he said.

The consultant said: “One problem in my hospital is that there’s no rule determining the minimum number of nurses. They don’t break any law and they get away with it.”

Dr Pena said Canada and Australia already had laws similar to the one he proposed.

California also has a quota on the number of patients a nurse should treat, he said, and several other states are considering the scheme.

He suggested that on surgical wards there should be a minimum of one qualified nurse for every six patients plus one auxiliary nurse, and on medical wards, one nurse for every seven patients, with an auxiliary.

The surgeon explained: “It is a false economy to have fewer qualified nurses.”


Readers' comments (59)

  • It's refreshing to have a consultant physician coming out in support for what we have known to be a fact for years.

    Unfortunately in the frenetic and demented Westminster led drive for fiscal prudence Dr Pens's voice will likely remain like ours in the wilderness and unheard, unheard that is, until a tragic disaster brought about by a poor Nurse to patient ratio occurrs.

    The outcome of which could be forecast now: Nursing staff will be disciplined, the CEO promoted sideways with a huge bonus.... No change.

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  • Hallelujah! what a pity this doesn't happen in the real world. Where I work in the private sector management have stated they want a 30/70 split between qualified and support staff. The only saving grace is that when we have fully dependent patients our manager ensures we have adequate staff. Generally it is the norm for one qualified and one HCA to have10-14 patients.

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  • I am so glad that at last somebody has recognised how overstretched nursing staff can be. We regularly work with one trained nurse to 14 acute post operative orthopaedic patients. The workload is heavy and difficult and many of our team often leave work feeling as if they have under achieved and that they have not given adequate care to their patients. Maybe these people who HAVE recognised that there is a problem may be able to convince the budget holders that there is a serious problem in some of the UK hospitals with nurse/patient ratios...

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  • This is quite refreshing. At least someone is paying attention. Hope the big guns in the NHS are reading this. Thanks Dr. Pena

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  • Nurses have known this for a long time. Managers have ignored it. In the past I have looked for staffing ratios but only been able to obtain "guidelines" (which are always ignored by managers). A law is desperately needed here. Take note all you vote seeking politicians! More indians and less chiefs please.

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  • the only way people is swap places management wouldnt no were to start give them a week without us frontliners anyway where are our unions in all this we pay enough i work in trauma orthopedic and know where mr pena is coming from? this article needs to grow and be more voiceful keep the comments coming in this is the way ahead somebody may feel we are a worthy cause?

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  • Congratulations on this review. I moved to Oz because the ratio of nursing for patients was better and more support is provided for the nurses i.e clinical nurse educators and clinical support to help out not only are we teaching we are lifting the workload off the nurses by teaching student nurses. The ratio is 5/6 - 1 nurse working in teams either with an EEN/RN and 8 patients are allocated to the AIN's (similar to HCA's) and they attend to the personal hygiene needs and basic care mainly heavy patients who require the assistance of 2.
    we don't organise discharges as each ward has their own discharge planner. We basically attend to the nursing needs.
    Hope this goes further.

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  • i was often working with a nurse to every 10 patients on a surgical ward - it was crazy even with my help...

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  • DR Pena for health minister. anyone else to second my motion? get rid of all the sycophants and appoint people who know what they are talking about.

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  • Thank goodness a member of the medical profession is speaking out - they might have more clout than nurses have. We (acute sector med, surg, orth) often have 28 patients - 3 non reg and 1 max 2 Registered nurses - that is a good day!!!

    Staff have been told not to submit incident forms on staffing levels - incident forms have taken up valuable time, they never get acknowledged and now it apparent why - they are 'not relevant' if they refer to staffing levels!

    Er, I thought patient safety was the latest wonder morale is so poor.

    Nurses have always put the patient first, that includes safety - but the fact that staffing levels are not being considered relevant to patient safety says it all........lets hope other medics support Dr Penna.

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  • My ward is regularly short of both nurses & HCA's - with both day & night shifts having one nurse & one HCA for 16 pts many of whom are often "All Care". We try to complain & fill in incident forms; state that it's our registrations at risk NOT that of the managers who tell us to take the patients, but does anyone listen - do they hell. As said on a previous entry - it would be nice if the RCN & Unison fought to protect us - but do they listen - do they hell - woe betied we upset the Management!!

    Thank you Dr Pena for stating something that most nurses & HCA's have known for some time - maybe with more people like him the powers that be may actually listen!

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  • Bravo Bravo Dr Pena!!!
    Where are the other Dr Pena's of the nursing world in England and the UK? The RCN and NMC seem to be an extension of the political machinery and do not serve the interest of nursing at all nor that of the public. They are a copy-cat of "Yes Minister" saying yeh in tune with senior NHS managers and Whitehall. Nurses may be seen as cheap and replaceable but what about the lives of the public- the patients'?
    I urge the National Patient Safety Agency (NPSA) to come on board with nursing as Dr Pena has, at this crutial stage when nurses jobs will be ear-marked for cuts in this difficult economic climate and challenge the status-quo on this very issue. Which deserves a great deal of urgency to save more untimely preventable deaths of patients within the UK especially London's healthcare system. Till date in some London hospitals, surgical wards may have one qualified nurse and two healthcare support workers looking after up to 28 patients at any one time. Health Secretary, would you like to be nursed on such a ward before and after an exploratory laparotomy? I geuss the answer is a no. Why then should anyone be nursed on a ward like that with a similar condition?
    Its time nurses learn to face up squarely to reality with a unified voice for the sanity and dignity of the profession. The nurse-to-patient quota will stop many nurses from being suspended, intimidated, threatened, harrassed, bullied, cajoled or even being struck off from the NMC register through no fault of theirs but through what is glaringly employer autonomy and dictatorship. Forgive my ignorance, but I don't think that animal hospitals work with similar nurse-to-patient ratios as the NHS curently does across the UK.

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  • The Trust I work for actually has a policy on staffing/patient ratio...... seems this is another Trust policy that is used when it suits. The phrases "but there's a bed crisis" and "you have to see the bigger picture" seems to be the standard excuse when we state were short staffed!!

    Well done Dr Pena for supporting something many of us know already.

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  • I work on an acute medical admissions ward. We have 33 beds and fully staffed means 3 qualified and 3 healthcare's. With 2 of the trained taking 12 pts each, and the remaining trained taking 9 pts, sometimes cordinating the ward as well. More and more paperwork is required weekly, no back up from senior staff, pt care is compromised often and all the while you have got the bed coordinator bullying you to take even more inappropriate pts. I love nursing, but pray every day that I could find something else.

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  • I thank Dr Penna for his supportive, truthful & common sense approach but this really is nothing new. I do believe that we've been shouting out for an appropriate skill mix review for years. Where is the support from the highest realms of our nursing profession?

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  • Martin Gray

    Well all I can do is add my support to the positive comments above and thank this clinician for having the 'cojhones' to put pen to paper. Bet he has come under critism for it though, but at least he can rest assurred that he has the support of the nursing staff.

    Now, if the leaders of the political parties were to take the time to read some of the threads on NTthey could pick up a lot of good tips on what is affecting our profession, and how we feel about it all. There must be some votes to be gained by doing a bit of real research rather than relying on what their staff tell them. At least there is the real possibility of a reduction in managers, and their over sized salaries being put to far better use in terms of front line staff.

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  • I have worked in 4 countries before coming to uk,the number of patients a nurse is responsible for,did surprise me here.All managers said to me is'' you know- you are accountable for your allocated patients''.
    I thank Dr.Penna for the support to nurses,because they are the one know what we do.Managers are in the office busy in papperwork and cheking on sickness and absence of staff.

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  • Just a shame that our leaders are too busy feathering their nests to contribute themselves.
    Of course these tragic mummy bears want to impress people so they make stupid promisessuch as being able to continually deliver more forless wahtever thecost because it boosts their own personal prestige whichis based on years of sservice not merit in nursing.

    I hate that doctors have todo the talking for us


    At lunch withthe girlsfromteh RCN and NMC i guess. '
    more cucumber and bitter lemon sandwiches dear?'

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  • Lets hope someone listens but I doubt it. In private care homes there is a minimum of how many nurses/HCA's there must be to a certain number of residents and the Inspectors check this out.

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  • We need ratio that are enforced by law.
    acute COTE wards in my hospital are chronically understaffed compared with the needs of this group of patient. Every nurse knowns what care they should be receiving however tptb just see patients as money and getting them through the system as quickly as possible is the aim of the game.
    i did a 15 hour shift to cover sickness yet still short a hca, and to try to give my pt the best care i could.

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