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Elizabeth Robb: 'Act on the evidence and introduce minimum nurse staffing levels'


Address the issue of staffing to prevent care being left undone, nursing burnout and shameful incidents, such as those at Mid Staffs, urges Elizabeth Robb

Nowadays not a week goes by without us hearing a story about poor nursing care. The most recent one, recounted in the House of Commons by Anne Clwyd MP about her husband’s care, appears to have reignited the media view that nurses are callous and have lost all compassion. Once again, we hear that basic care costs nothing and that smiling and being kind are all that is required.

Although our hearts go out to those who have lost a loved one and found the care they have received to be wanting, this is not the only picture of NHS nursing care. Of course, we must root out and be completely intolerant of poor care, ensuring the individuals responsible are held to account - but we must not forget that the vast majority of nursing care is actually very good. We hear little of this now and it is time we remembered that nurses have not lost compassion or their ability to care. It is still there but compassion does cost. It costs in terms of time, energy and emotional effort.

Good leadership and a set of values such as the chief nursing officer for England’s 6Cs - care, compassion, competence, communication, courage and commitment - excellent as they may be - are simply not enough. We need to tackle poor levels of registered nursing staff and the elephants in the room of organisational cultures that favour financial savings and activity targets rather than patient centredness and quality outcomes. Values alone will not meet the ever-increasing demand for healthcare, the dependency levels of many patients or rising public expectations.

“Poor registered nursing staffing levels were part of the problem at Mid Staffordshire Foundation Trust”

Poor registered nursing staffing levels were part of the problem at Mid Staffordshire Foundation Trust and are likely to be commented on in the forthcoming final Francis report. The recent Care Quality Commission report underlined that 16% of organisations fell short of the standard on safe staffing. That is of concern; although it makes clear that good staffing levels did not guarantee good care, low registered staffing levels were associated overall with care being of poorer quality.
The evidence abounds that higher levels of unregistered practitioners are associated with higher mortality rates and increased lengths of stay, failure to rescue and higher levels of reported patient safety incidents.

There is also evidence that fundamental nursing care is a complex and emotionally intensive occupation. Being unable to meet all the care needs of patients, together with leaving work undone, adds to the emotional burden for caring nurses. We know from psychological evidence that when we become overloaded and unable to meet the demands that are placed on us, there is a danger of a loss of humanity. We must support the profession to ensure we mitigate these risks, caring for and supporting each other by standing up for what is right for patients and preventing burnout.

At the CNO’s conference in December, it was heartening to hear health secretary Jeremy Hunt say that nurse staffing
numbers should never be at the expense of quality of care. He said nurses have a difficult and complex role and that his
job was to support us in taking forward the vision for nursing and midwifery. That is music to the ears of most of us in the nursing profession - we now need him to have the courage to act on the evidence and support a minimum level of registered nurse staffing numbers. This would prevent further care being left undone, nursing burnout and shameful incidents, such as those at Mid Staffordshire and other recent examples of poor patient care.

Do you want to keep up to date with the latest from the Francis Report into the Mid Staffordshire Foundation Trust? Visit our tailored Francis Report channel with the latest rolling news and analysis

Elizabeth Robb is chief executive of the Florence Nightingale Foundation


Readers' comments (46)

  • All we need now then is a competent Chief Nurse (England) who will push an agenda based on real issues (like inadequate staffing and poor skill mix) instead of wasting time and effort on "fluffy" topics like the ridiculous "C" project which provides ammunition for the tabloid press and will produce no improvement in care for patients!

    Thanks for the report Elizabeth ! You come closer to the real issues than the discredited so called "Leader" !

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  • is this the same jeremy hunt who now wants families to wash and feed patients as there is not enough money to employ staff?

    why does it take something like the Francis report until something might actually get done about staffing levels and skill mix. nurses have been complaining for years about this and no-one listened to us. now that we might actually be getting chief nurses on our side do you think the media might just leave us alone to get on with doing our jobs.

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  • A recent 200m pound Study, commissioned by McStuddies at the University of Studdiness, studied the effect of studying in the study against studying in the library. Our colleagues at The Institute of Studying, In Studyville USA, recently concluded that environment plays a significant role in the effectiveness of studying. However, further studies are now required and we will publish our Study 'The Effect of Studying In The Study' when we have studied how long the average study takes to study.

    Chief Nurse Stu Dy, realising that his brain was in danger of imploding, resigned from his voluntary position on the Board of Studdyers, claiming that he did not enter nursing to study studies but to look after patients.

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  • As a now burnt out nurse all i can say is i enjoyed my job giving the best i could to my patients on a daily basis as did the majority of the people i worked with whatever their role. Now i have had to walk away from the NHS as my mental and physical health was deteriorating rapidly what did my matron say? just hang in there a bit longer it will get better - 4months later i walked away. I feel exhausted, sad, angry that i cant do the job i enjoyed so much not to mention my pension being sacrificed but when it comes down to it no one cares about me or others like me, i am very lucky to have a supportive husband. I still cant help but miss the job, patients, colleagues and not using all my skills every day. Somehow the government must realise hospitals cant run like businesses because we are dealing with humans not robots so it is impossible for good care to be given on current staffing levels as usual we need more indians and less chiefs. Good luck to you all and look after yourselves as no one else will.

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  • Anonymous | 29-Jan-2013 11:17 am

    I take it you don't like studies then?

    I don't mind them. In fact, I like having evidence to prove what I know to be true. What I don't like is the fact the we don't use the evidence as a stick to beat the government over the head, preferring instead, to criticise those who gather rhe evidence on our behalf. I also know that it is a phenomenon peculiar to the nursing profession. I wonder, is it a lack in our education and/or intelligence? Because no other profession is this stupid and self destructive.

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  • Yes But

    We need to tackle poor levels of registered nursing staff and the elephants in the room of organisational cultures that favour financial savings and activity targets rather than patient centredness and quality outcomes. Values alone will not meet the ever-increasing demand for healthcare, the dependency levels of many patients or rising public expectations.


    Elizabeth is, of course, right - but didn't people already know that ? It has been pointed oput many times, on this website.

    christine ranson | 29-Jan-2013 2:09 pm

    Many nurses, are now saying much the same as you do there - who is listening ?

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  • Anonymous | 29-Jan-2013 2:52 pm

    I heard on the radio only yesterday that scientific studies are designed to prove that things are not true! Presumably this is the 'nul hypothesis' and presumably this refers to all types of research!

    I like the post of Anonymous | 29-Jan-2013 11:17 am but I am not quite sure whether it is true or false! A further study is obviously required to thoroughly investigate this with another (? conclusive ?) report to file for posterity in the dust gathering archives! I say this as I am not sure whether any of the other millions of reports already filed have ever been conclusive! I would think not otherwise there would be no need to carry out any further studies!
    No worries about financing any further studies, I am sure there unlimited millions still available to play with and waste for such ongoing projects.

    Well done both for your comments and vivid imaginations. It is good to still find a few nuggets of good humour here and there in these austere times.

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  • Anonymous | 29-Jan-2013 3:30 pm


    Anonymous | 29-Jan-2013 2:52 pm

    I guess when I'm on here, I'm neglecting the null hypothesis! Poor practice I know, but what the hey, I'm on my own time.

    Nothing wrong with a null hypothesis to be rejected, disproved or long as we also realise that accepting the null hypothesis does not mean that it is true and rejecting the null does not prove the alternative. It is still a hypothesis which must conform to the principle of falsifiability. Fisher has a lot to answer for!

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  • Just out of interest. Can anyone tell me where the funding for research comes from? There seems to be a line taken on quite a few threads, that money is being 'wasted' on research and studies.

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  • Money spent on research and development and all those sorts of things is well spent when someone takes notice of it and acts on it. Where the money comes from we don't know but there seems to be an awful lot of it around. Is spending money on management consultants telling us what we already know really 'research money". What I think nurses are all getting fed up with are the numerous and seemingly endless initiatives and studies that keep happening in nursing which cost an awful lot of money but don't seem to have any positive effect on either patient care, staffing levels, skill mix or nurses welfare.

    Surely there is enough evidence now to prove that health-care in whatever form doesn't have enough staff, enough money, enough beds, - the list just goes on and on but nothing seems to change.

    Every single shift, in every single setting, nurses go on duty knowing that work will be left undone,it's not work that is okay to hand over to the next shift but work that we cannot physically get through on our own shifts. It's not being able to care for our patients properly, not being able to make them comfortable, not being able to take any break ourselves which research also shows is not healthy.

    When we see millions of pounds spent on another initiative we groan and just want money spent on getting more staff to look after patients to the high standard that we all expect. We do not want to leave patients uncomfortable - whatever the media like to say we know what the now infamous 6c's are all about.

    The comment I posted about 'studies' is just tongue in cheek although I have my doubts.

    All we want is enough staff to look after patients, is that really too much to ask?

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