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Exclusive: Third of nursing directors concerned about staffing levels


A third of nursing directors worry they regularly do not have enough nurses to ensure safe staffing levels on their wards, a Nursing Times survey of some of England’s most senior nurses suggests.

A fifth also have concerns about skill mix, while 17% said they had been put under pressure to sign off savings plans that included reductions in nursing staff.

The survey of 47 directors of nursing – equivalent to around 30% of English acute and specialist hospitals – canvassed the profession’s leaders on a range of key issues affecting workforce, training and leadership.  

Though 69% felt they had enough nurses “most of the time”, 27% said they often struggled and 4% said they “hardly ever” had enough staff. Not one nursing director said they were confident they had enough nurses to deliver high quality care “all the time”.

However, respondents were split over the need for a minimum nurse staffing levels. In total 48% were in favour, 37% against and 15% were unsure.

Those against – who were also more likely as a group to say they had enough nurses “most of the time” – worried a minimum level would become the norm and could not account properly for the huge variation in patient acuity and staff skills and competencies.

Those in favour said it would give weight to their arguments with the board about staffing levels and “protect nursing from being the easy target for cost improvements”.

The vast majority of nursing directors felt nursing concerns were taken seriously by their trust’s  board. However, 15% would like more influence over decisions not directly related to nursing and 40% wanted more control over the nursing budget. Many commented they had had to fight to get their voice heard at board level.

One said: “Directors of nursing usually have to prove their worth more than other executive roles in terms of being the authoritative voice on patient safety and patient experience issues. For new directors of Nursing this can be a trial by fire.”

The survey also sought views on the wide range of policies and initiatives announced in the wake of this year’s Francis report into care failings at Mid Staffordshire Foundation Trust.

Nearly three-quarters of respondents (73%) said they did not support health secretary Jeremy Hunt’s proposal to make aspiring nurses work as healthcare assistants for up to a year in order to qualify for a place on a funded undergraduate nursing course.

Commenting on the government’s controversial proposal, one nursing director warned that “12 months as an HCA in the wrong culture” could “cause more damage” and “create the wrong values in the individual”.

Respondents were also virtually unanimous in their support for HCAs to be regulated, a move recommended by Robert Francis QC’s report in February but which the government continues to oppose.

In total 80% were in favour of HCA regulation, while 17% were opposed and the remainder unsure.

More than two thirds thought the government’s proposal to introduce standardised training and a code of conduct for HCAs was insufficient to ensure patients receive safe and good quality nursing care.

While 40% of respondents were fully responsible for the recruitment and training of HCAs, 27% worked in organisations where this was the responsibility of the human resources department and 33% reported that responsibility was split.

A review of healthcare assistant training, carried out by the journalist Camilla Cavendish earlier this year, recommended full responsibility be given to nursing directors.

Most directors also backed the Francis report’s call for the Royal College of Nursing to split its union and royal college functions.

Asked whether nursing would benefit from having a royal college that did not also act as a union, 85% said “yes” and 13% were “unsure”.

One respondent said: “The RCN can simply not continue in its current format. It has to separate to give credibility to nursing voice. Too often it forgets which hat it has on.”

Another said the RCN’s arguments on safe staffing were undermined as the college was regarded as acting in its members’ interests rather than the interests of patients.

Responding to the findings, RCN chief executive and general secretary Peter Carter said the college had “carefully considered” Francis’ suggestion the organisations split its functions.

“However, we consulted with our members and at RCN Congress 99% of members told us that the two functions complement rather than conflict with one another,” he said.

Nursing directors were also critical about the lack of a powerful voice on the national stage during the past year, when the profession has faced widespread criticism in the national media following a succession of negative reports.

A few respondents said they felt the government’s splitting of the former chief nursing officer for England’s role into two – with a chief nurse at NHS England and director of nursing based in the Department of Health – had further weakened the national voice of the profession.

“With all the criticism of nursing from Francis and an ‘NHS-hostile’ media, there has been a deafening silence from any national leaders about all the brilliant care nurses give every day,” one respondent claimed.


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Readers' comments (35)

  • So now these "leaders" are condemning themselves.

    The vast majority are no more than sycophants who are anxious to protect their "Bonus!

    Very few have the welfare of patients or nursing staff at heart when devising wicked plans to reduce staffing and dilute skill mix.

    These people claim to be "nurses" they are not they are demented bean counters.

    Whenever there is a reduction of staff without a reduction of service the responsible "nursing director" should be referred to the NMC for investigation.

    These "nurses" are clearly failing to meet the standards required by the Code of Practice and are deliberately placing patients at risk.

    I look forward to a comments on what I have said from a "directors of nursing".

    Guess I will just join the queue as these people dont answer "hard" questions

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  • What's the next step now, does this mean we will get more staff or close beds until our NHS is safe?

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  • Whether it is teaching assistants, Community Support Officers or HCA's there is constant pressure to de-skill and cheapen the provision of professional services in the public sector by the government and their underlings. Nurses need both a strong union and an effective professional body and this unlikely in a single organisation.

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  • tinkerbell

    Jenny Jones | 6-Nov-2013 5:49 am
    'Very few have the welfare of patients or nursing staff at heart when devising wicked plans to reduce staffing and dilute skill mix'

    Total agreement with Jenny, 'wicked plans'.

    This ideology is programmed to destroy 'us'.

    We are in a moral crisis, being led it seems by a majority of amoral corporate parasites, with metallic hearts, who quite possibly, if asked, would sell their granny to make a fast buck. Total contempt for any consequences to peoples lives being placed in harms way.

    Continually expressing their concerns but not taking any action. They know the price of a nurse but not their value. We are now a financial burden along with the patients that needs to be squashed.

    'for evil to triumph it is only necessary that good men do nothing'.

    Anonymous | 6-Nov-2013 9:18 am

    The next step is more of the same, sadly until the NHS is completely broken.

    For the future, unless this ideology is stopped, where care is profit driven for private stakeholders, we will need to be wealthy to be healthy.

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  • tinkerbell

    food for thought. Made me smile to see some honest passion:)

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  • Tinkerbell you are on form !

    Hover over the names and it exposes the salaries of those who are overseeing the NHS and this is just one of the bodies who has such a role. What in heavens name do they do other than spout platitudes, acronyms and jargon.

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  • More empty oratory from the gods....

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  • Flawed acuity tools allow wicked accountants to freeze or axe posts through natural wastage at a time when front line nurses are at breaking point.
    No one least of all senior management wants to hear what we say, they are simply chasing RTT and foundation status. Why real nurses doing the actual job of caring on the wards are not being listened to is because they are perhaps not as articulate as the accountant or are stating unpalatable truths.
    Instead we are battered by the press, by the Matrons and patient groups for not being caring, compassionate, courageous etc but we are humans too.....

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  • Never one to miss an opportunity to join a debate with fellow nurses, as a participant in this survey I wanted to respond to a few of the comments.

    I am a new Chief Nurse, I should add that first and foremost I am a registered nurse and like every other registered nurse I have a professional responsibility to ensure that I do all I can to protect patients and support my nurses, midwives and care staff in delivering high quality care.

    I would also say, I am not perfect – whilst I strive for excellence in care, care that my family would be proud of and care that I would be happy to receive myself - sometimes it doesn't go the way I would have expected and I learn for the next time so that we can continually improve. As a Chief Nurse I surround myself with the best nurses, midwives and care staff so that together we can deliver great care to patients. The ‘together’ bit is important, whilst I would like to do more hands on delivery of care, I do ensure that I spend time with our patients and with my team – I am proud to wear my uniform and I am a nurse first and foremost.

    As for ‘wicked’ plans to reduce staffing and skill mix, this year my organisation is investing over £2million in more registered nurses and midwives and I am committed to increasing our skill mix so that our patients have the full benefit of being cared for by RNs and RMs as part of the broader ‘team around the patient’. Even with this additional investment I know that we need more, as Chief Nurse it is my responsibility to ensure that we have plans for additional investment – if this is what is referred to as ‘bean counting’ then I need to do more, because the more beans I get to invest in the delivery of patient care the better.

    As a junior nurse I always went home after a long shift worried about the welfare of patients who I cared for – every great nurse gives a little bit of themselves using their head, hands and heart, this same level of concern has never left me. Each night I go home I have over 450 patients and over 1,300 nurses and midwives to think about, each one individually and collectively delivering care to our patients.

    It may seem strange, but I have always wanted to be a Chief Nurse. From a very early stage in my career as a nurse I was inspired by the most amazing Directors of Nursing – I knew that the role could make a tangible difference to the care experienced by patients and it was a role that could loudly and proudly demonstrate the value of nursing and midwifery, both professions have a proud and long history and it is my role to protect both patients and the profession I am proud to be part of.

    I am one of ‘these people’ who fail to answer the ‘hard’ question – to be honest they are not hard questions – they are sensible questions we should be asking of one another. Being brave and courageous to offer high support and high challenge is what keeps our profession moving and our patients protected.

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  • If only one third are concerned about staffing levels, does this mean that two thirds think we are 'just fine'? Time to get the heads out of the sand...

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