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Nurse leaders divided over minimum staffing levels


Three of the most senior nurses in the NHS have warned the government against introducing minimum staffing levels, as the profession becomes increasingly divided over the issue ahead of the government’s response to the Francis report.

In a letter published in the Times today the three hospital directors of nursing say they “do not support Whitehall second-guessing what nursing levels should be for each hospital”.

The letter is signed by Eileen Sills of Guys and St Thomas’ Foundation Trust, Katherine Fenton of University College London Hospitals and Flo Panel Coates from Barking Havering and Redbridge University Hospitals Trust.

It comes in response to calls from the Prime Minister’s Forum on Nursing and Care Quality for the government to introduce a minimum ratio immediately to “bridge the gap” while more detailed guidance is developed by the National Institute for Health and Care Excellence.

As revealed by Nursing Times on Saturday, the forum has urged the government to “take account” of the existing “evidence that a ratio of more than eight patients per registered nurse significantly increases the risk of harm and constitutes a breach in patient safety”.

The letter in the Times states: “On the eve of the government’s response to Robert Francis’s inquiry into Mid Staffordshire NHS Foundation Trust, we want to urge caution when it comes to mandating minimum staffing numbers and ratios.

“The right numbers of staff will vary depending on the sickness and dependency of the patients and the skill of the staff. It is not something that can be mandated for a whole country.”

The government is expected to publish its full response to the Francis report tomorrow. As revealed at the weekend, it will introduce a new criminal offence for healthcare staff found guilty of wilful neglect.

It is also expected to include new guidance on setting safe staffing levels – seen by Nursing Times – which says boards should review staffing levels at least twice a year.


Readers' comments (29)

  • I can't say I'm surprised by the attitude of these three senior nurses. The one simple measure that the government could introduce that would benefit patients and staff equally would be to introduce minimum staffing levels. These three are thinking more about budgets than the welfare of their staff and patients.

    I'm now even more clear that the government needs to introduce the offence of wilful neglect to curb behaviours of managers with attitudes akin to these three.

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  • Unfortunately minimum staffing levels are not a simple measure to introduce and I don't support them either.
    One of the risks is that some organisations will see these as "maximum" instead of minimum staffing staff and we will have very little leverage in arguing for more when we have essentially said we can manage with a defined number. Clinical judgement in a live environment must prevail in my view.

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  • Anonymous | 18-Nov-2013 12:06 pm

    Reluctantly, I too find myself agreeing with three directors. That's a first.

    Unfortunately, the debate about staffing levels and skill mixes is a complete dog's dinner in this country. All led by a clueless government pandering to what it thinks the public wants to hear. Another disaster in the making.

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  • I pray every day that clinical areas and community teams could have the minimum number of nurses their establishments say they should have. Every night patients are being put at risk where there is 1 nurse instead of 2. Every day that there's one less nurse people have to wait longer, go without or suffer. We have establishments (even though they merge and disestablish to kid us we've got enough)
    If these 3 nurse leaders are confident they always have enough nurses in every area they are responsible for to give patients the time and care they need then I am a monkey's aunt.
    I'm sure Victorian cotton mill owners said the same thing about their staff. Shame on them for not living the reality to which they consign others.

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  • Anonymous | 18-Nov-2013 12:45 pm

    Couldn't agree more: it is easy for the three senior nurses to make statements like that from the safety of the boardroom, safe in the knowledge that they're not the ones that are going to have to face irate patients and their relatives on the wards and departments where staff can't appropriately care for them due to poor staffing levels.

    Minimum staff/patient ratios are not the whole answer but I think they would act similarly to the NEWS scores in that staff could use it as a 'trigger' to escalate concerns re staffing - it would give staff something concrete in which to base an argument on e.g. Why are there only 2 RGNs on duty when the minimum number for this many patients is 3!

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  • Anonymous | 18-Nov-2013 12:06 pm
    mags | 18-Nov-2013 12:14 pm

    I concur. Minimum staffing levels will become the maximum regardless of dependency. The variety of acuity tools are barely fit for purpose.

    Anonymous | 18-Nov-2013 12:45 pm

    "If these 3 nurse leaders are confident they always have enough nurses in every area they are responsible for to give patients the time and care they need then I am a monkey's aunt."

    I have sympathy with what you say. The motives of these people is always suspect. But on the subject of setting minimum staffing, these 3 nurse directors are actually correct. Appropriate and adequate staffing levels are not the same as minimum staffing levels.

    "“The right numbers of staff will vary depending on the sickness and dependency of the patients and the skill of the staff. It is not something that can be mandated for a whole country.”"

    For example, if the minimum mandated staffing level is set by the government at 1:8, then no further discussions will take place on whether or not that is appropriate. Anywhere working with levels of 1:6 or 1:7, no matter the dependency, will immediately lose staff. We all know that 1:8 is nowhere near adequate, so why let the government legislate on this and leave with no room to be flexible. Be careful what you wish for, you might not actually like it when you get it. Minimum staffing levels isn't what everyone hopes it will be.

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  • i tend to agree that minimum staffing levels will become a maximum- but i had been working as the only registered nurse with 24 patients! yes i had three other staff but as a registered nurse i would be pulled in all directions- meds were late while managing a patients physical needs, constantly being called away to the phone- so yes there should be minimum introduced but to bridge the gap whilst honest assessments of individual areas are made to ensure the skill mix and registered to unregistered are assessed accurrately for the individual needs of the wards

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  • when are people going to realise that minimum staffing levels won't be set at a number that is anywhere near enough nurses to do the job?! really, they will use it as an excuse to pull the numbers out of the air and serve out redundancies to those excess to new requirements. has nobody learned anything from this government's record? they will not use evidence based research to conjure up the figures. they will simply look at the nhs wage bill, decide on the number of staff they can afford and hey presto, there will be your ratios. honestly folks, wake up. i don't know anything about these 'nurse leaders', or their motives, but they are right about this particular point.

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  • Anonymous | 18-Nov-2013 2:10 pm

    That's true and what people also need to be aware of is that many nurse directors will be very keen to adhere to any government mandated staffing levels. So those disagreeing with these 3 will be agreeing with the majority of nurse directors, who are looking closely at staff wage bills and rubbing their hands with glee as they tote up the P45s.
    I think everyone here is in agreement that we need better staffing levels. Australia is doing better than us because the fight (and therefore the staffing levels) was initiated by the unions and their proactive membership. They said, "We want these ratios!" and then went out on marches and on strike to get them.
    Here, it is the government doing all the deciding. The person who was complaining that he/she was the only trained nurse working with 3 other staff would probably find her/himself working with only 2 other staff. 1:8 doesn't mean 1 'trained' nurse to every 8 patients. Like people have said, "Be careful what you wish for..." Minimum WILL be the new maximum.

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  • I think people on here are on a different planet. The government is proposing a minimum qualified nurse to patient ratio. That might be 1:12 on a general ward on nights and 1:8 on days. Anything is better than what many of us who actually work on wards currently find themselves working with now.

    Like my colleague who regularly works 1 qualified to 24 patients, I think she'd rather replace two or even three of those HCAs for 1 RGN - I know I would.

    I think you may find that the number of qualified staff in theatres and ITU might be up for discussion and people may be transferred within Trusts, but overall qualified staff levels wouldn't reduce.

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