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CNO: Cultural change key to safe staffing and raising concerns


Nurses need a “culture of using hard evidence and local professional judgment” to determine safe staffing levels and a “culture of support to speak out when something isn’t right”, the chief nursing officer for England has said.

Jane Cummings set out these aims in a wide ranging statement published to coincide with International Nurses’ Day.

She started by discussing the overall challenges currently facing nursing and the health service, noting that nursing had “changed dramatically” and “undoubtedly for the better” in the 150 years since Florence Nightingale founded the first nursing school in London.

“Each of us and every organisation needs to step up to the plate and be accountable”

Jane Cummings

But she said: “The modern nursing challenge is to deliver consistent and improving high quality care despite this growing demand.

“In the face of these pressures, it is clear that we need to change and transform the service. We need to up the pace of radical change if we are to truly respond to the lessons of Mid Staffordshire, Winterbourne View and the needs of our increasingly older population.”

Ms Cummings said that “key to this” was widespread cultural change in nurses’ approach to healthcare. 

“We need to think and do things differently right across the health and care sector – each of us and every organisation needs to step up to the plate and be accountable,” she said.

The CNO highlighted the high profile issue of safe staffing, which and once again dominated the headlines over the weekend.

She noted NHS England guidelines requiring trusts to increase transparency over ward staffing by June and new draft guidance on nurse staffing from the National Institute for Health and Care Excellence, which were widely trailed in the media on Saturday.

“The public debate around staffing levels quite rightly continues,” she said. “This is a priority in the nursing and care strategy Compassion in Practice and more recently, at the end of last year, I published guidance on nurse staffing with the National Quality Board.

“With the Department of Health, we have also commissioned NICE to look at the evidence available about adult hospital wards and make recommendations on determining nurse staffing.”

“We need a culture of using hard evidence and local professional judgment to determine the right team of staff with the right experience in each situation”

Jane Cummings

The NICE recommendations were published in draft form for consultation today, to coincide by International Nurses’ Day.

Ms Cummings said: “This is part of the sophisticated, evolving approach to staffing that we need.

“Each ward in each hospital around the country is different in size, number of patients, the type of patients and acuity of condition. Likewise, each community is different,” she said.

“We need a culture of using hard evidence and local professional judgment to determine the right team of staff with the right experience in each situation and a culture of support to speak out when something isn’t right,” she added, before turning the NHS England guidance.  

“Public accountability will intensify –more trusts are publishing actual versus planned nurse staffing levels shift by shift and are being publicly held to account. Together with the Care Quality Commission we have asked all trusts to ensure they are doing this by June,” she said.

The CNO ended by discussing the changing cultural make-up of communities over time and how this affected the NHS workforce itself, especially the need for more health service leaders from more diverse ethical backgrounds.

Ms Cummings said: “Society is now more multi-layered and multicultural. Yet the NHS seriously lags behind in its black minority ethnic representation, particularly in the most senior positions.

“There is increasing evidence that diverse teams make better and safer decisions which leads to better patient outcomes and better staff experience, because they are more representative of the communities they serve when making decisions,” she said.

“We need an NHS that truly embraces equality and diversity and represents all demographics, she added.”


Readers' comments (5)

  • My question to Jane Cummings is: is there ever a day, on any acute ward in England, when you think that 8 patients per registered nurse would be sufficient? No matter what the specific acuity, or how experienced your staff - its simply not enough nurses to give patients the time they deserve (and to get complete care delivered in a compassionate way). That's why in my view we need to not only improve HOW Trusts plan their nurse staffing (and hold them to account), but we should use the existing 'hard evidence' to stop known high-risk staffing levels from being common place. In our research, 45% of acute medical/surgical wards had an average of 8 patients or more per RN on a day shift (excluding nurse in charge).

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  • 1:8 is going to become the maximum staffing levels from now on - it's not enough!

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  • So much for support for nurses, compassion and good value for taxpayers' money in state employees!

    "Jane Cummings, NHS chief nursing officer, spent more than £27,000 in total, including £8,000 on hotels and dining, the records show."

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  • It's a sad day when I write this to say I am shattered by this whole mess. Total chaos has been allowed to ensue and I am frustrated that no one would listen when we first had this problem. Well problem we had and now still have!! How to solve it?
    Start by treating your staff well. A loved staff is a happy and forgiving staff. If you treat people like slaves, a riot will ensue!!
    Start with a bit of respect, a bit of fair and adequate rostering, only ask overtime from those who want to do it, start communication at all levels, don't just walk away from a problem, deal with it!!
    Most important of all. IF YOU HAVE NO ROOM FOR PATIENTS, JUST SAY NO! No, we can't take anymore, No, we won't accept any patients except the dying, NO,G.P. try and treat them at the surgery first!!
    Finally, NO, I am not prepared to work in dangerous situations and put myself in danger or harms way!! What good is that to anyone!! I will just be the next patient in the next bed!!
    Thank You for my rant, but it does make me MAD!!

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  • It is refreshing to have a framework that ensures transparency. I am dismayed at the negative response. Of course everyone is entitled to have their opinion and be cross but what about supporting our chief nurse. Who would actually want her job and the responsibility, no matter how much it is paid. Not many of us could or would do the job. All I can say is that it comes through that we have a chief nurse who is supportive of good quality nursing care who puts patients first. What more can we ask for?
    The NHS is never going to be perfect but rather than moan we can work to make our area of responsibility world class.

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