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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