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Plea on 'unsafe' nurse staff levels


Nurse staffing levels on many English hospital wards are dangerously unsafe, a group of senior nurses have said in an unprecedented warning.

The Safe Staffing Alliance (SSA) says one nurse should look after an absolute maximum of eight patients - but often nurses have to look after more, jeopardising patient care.

The alliance, which was formed last summer, and comprising senior expert nurses, says the 1:8 figure is based on hard evidence and it has issued new recommendations that “under no circumstances” should staffing be allowed to fall below that level.

A study by researchers at Southampton University found that hospitals with more than eight patients per registered nurse (during the day time on general acute wards) would see around 20 more deaths a year than better staffed hospitals.

Those units with worse staffing levels could expect more “excess” deaths.

A national nursing survey found that wards are run with one registered nurse to eight patients or more approximately 40% of the time.

An SSA statement said: “For the sake of clarity, more than eight patients per registered nurse is the level considered to be unsafe and putting patients at risk. It is not a recommended minimum.

“For nurses to provide compassionate care which treats patients with dignity and respect, higher levels will be needed and these should be determined by every health care provider.”

Katherine Murphy, chief executive of The Patients Association, pointed out that staffing levels were a key issue raised by patients in the latest Care Quality Commission inpatient survey.

She said: “Patients said they thought all staff, and in particular nurses, were overworked.

“A frequent comment was that staff were caring but that they ‘did not have enough time for you’. The fact is without adequate staffing levels, overstretched nurses are not able to give patients the care they need.”

The group includes the Royal College of Nursing, Unison, the Patients Association and a range of other stakeholder organisations.

Speaking on behalf of the alliance, Professor Elizabeth Robb, chief executive of the Florence Nightingale Foundation, said: “For the first time ever, nursing’s leadership is united on this. We are coming together to stand up for patient safety and for the profession.

“We are saying that, with a ratio of one registered nurse to more than eight patients, there is a significantly increased risk of harm. We hope that by coming up with a figure we will give directors of nursing the evidence they need to argue for the staffing levels necessary to provide good care,” she added.

“If government are saying that staffing levels are a local decision, then it is more important than ever to set out clear guidance.”

Elaine Inglesby, Salford Royal Foundation Trust nursing director and a member of the Prime Minister’s Nursing and Care Quality Forum, said: “This is a great opportunity for hospitals to address safe staffing levels in the interests of both patients and staff.

“It is agreed guidance for boards and the public to understand that this is a fundamental standard for staffing that should not be compromised.”

The government has previously rejected introducing a mandatory minimum ratio for qualified nurses to patients or skill mix among registered and non-registered staff.

Ministers have argued that setting a minimum could lead to a “drive to the bottom” and, instead, have favoured leaving it to local decision makers - in-line with policies to give NHS organisations, especially foundation trusts, more autonomy.

However, in its response to the Mid Staffordshire Foundation Trust Public Inquiry report, the government said the Care Quality Commission would be specifically checking that staff levels were safe during inspections in future.

The Francis report itself recommended that the National Institute for Health and Care Excellence (NICE) should establish minimum safe staffing levels for different clinical settings, which it would be for trusts to use locally.

The national nursing strategy for England, Compassion in Practice, is working on a similar approach, with tools for calculating appropriate staffing levels being developed and refined for use by local nursing directors.


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Readers' comments (10)

  • Staff levels are worryingly low in many hospitals, and I really feel that it should be a priority to increase the number of nurses to prevent unneccessary fatalities on our wards.

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  • Minimum staffing levels won't be set because the government and the trusts don't want to pay for them.

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  • nurses regularly look after 14 patients, no-one cares, we report it over and over again. why is it no-one publishes any concerns unless it involves a 'senior' person? don't staff nurses have any credibility or any respect any more?

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  • Nurses are the largest part of the workforce, relatively poorly paid vs levels of responsibilities (people's lives + well-being), mostly likely to soldier on regardless of challenges faced, least likely to make loud official complaints / concerns usually for fear of own position. Reducing nurses has made short term savings but costing more long-term due to complications and readmissions, ultimately costs in mortality rates. Elaine Inglesby-Burke has it spot on in that nurses are too stressed + laboured, basically too burned out to give compassionate care and not that nurses lack compassion.
    If you're on the receiving end of care would you prefer less stressed and more nurses around to meet your healthcare needs even if it costs more. Or will it be survival of the fittest for both patients + staff.

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  • "If you're on the receiving end of care would you prefer less stressed and more nurses around to meet your healthcare needs even if it costs more. Or will it be survival of the fittest for both patients + staff."

    I don't think you need to ask any hc profis that question but rather those who manage it.

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  • why does it just contain day shift in this? My trust works with 2 qualified per duty to 16 patients so meets the 1:8 ratio. however night shift is only 1 qualified staff member and at times the night shifts are much busier than the day time

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  • The same subjects keep rearing their heads time and again. We know the wards are an unsafe environment, the management know, our government knows, and I would even imagine the more cognitive patients know, but those with the power to bring about change are prepared to maintain a large litigation budget rather than do the right thing and employ more Nursing Staff.

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  • I work in Australia where ratios are one nurse to four patients during the day. it is so much safer for the patient and nurse and feel when you go home you have done a good job, instead of being physically and mentally exhausted.

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  • Pauline Beldon

    A concern which I have raised regulalry in my Trust is that its the acuity of the patients which needs to be considered, not just numbers.

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  • we had a very time consuming and costly tool, PRN purchased from Canada who had abandoned it as a failure, to work out how much care each patient needed for each 24h period. each procedure and even talking to the patients was assigned a number of points all listed to guide us on a very large chart. the total number of points were then converted to a percentage for each patient which gave us their degree of dependence - thus from fully dependent, highly dependent, semi-dependent and independent. this was supposed to inform staffing levels the next day and nurses and/or HCAs could be moved from other wards to help teams which were short staffed, although the system often fell down as there were not always enough staff to move around. the points were also designed to bill private patients at some future date if the system required it.

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