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Many managers ignorant of nursing levels on wards, says NHS chief


NHS chief executive Sir David Nicholson has told managers they must do more to ensure nursing levels on wards are safe.

Speaking at the NHS Employers conference in Liverpool this week, he told human resources managers: “You’d be amazed how many people simply don’t know how many nurses they have, never mind how many nurses they have on an individual ward or an individual shift.”

He told managers to check which tools they were using to “satisfy” themselves that staffing levels on wards were appropriate.

Nursing levels were found to be particularly low at Mid Staffordshire Foundation Trust during a high profile period of poor care standards which has sparked two inquiries.

Sir David said some “very simple practices” could be implemented to prevent the problems being repeated in other trusts. For example, some trusts are bringing in systems to ensure nurses check on patients every hour – a practice known as “hourly rounding”.

As reported by Nursing Times in March, this has already been implemented by trusts in the East Midlands.

Sir David also highlighted its use at Nuffield Orthopaedic Centre, part of Oxford University Hospitals Trust. He said nurses there had found “it reduced the amount of work they did”, despite initially raising concerns they would be too busy to do it.

He also told managers to ask themselves about the quality of leadership support offered by the trusts, including the training for ward sisters.

Mid Staffordshire had demonstrated how “the quality of first line leadership is the thing that sets the tone for that individual ward”, he said.

He added: “It’s worth asking these questions because I think you will be surprised in your organisation.”

Health secretary Andrew Lansley also discussed nursing standards when he addressed the conference.

He said: “There are an immense number of excellent nurses, and healthcare assistants, across the NHS, proving their patients with exemplary care on a daily basis. [And] often providing that service in difficult and trying circumstances. But we have to admit that’s not the whole story.”

However, he said the compulsory registration of HCAs was not the solution. He officially announced plans to set minimum training standards for HCAs, as reported in Nursing Times last week.

He said: “Some see the compulsory registration of HCAs…as part of the solution. I don’t believe the case is strong enough to extend statutory regulation to a further 1.2m relatively low paid workers, requiring them by law to pay registration fees in order to pursue their livelihoods.”


Readers' comments (11)

  • Yes, the hourly implemented rounds, another piece of paper to accidentally be forgotten about when a patient becomes critically ill and you fail another audit because of it. A ridiculous, patronising piece of paper which forces you to, hourly, ask a patient "how they are, if they're comfortable and if they'd like a drink", which having been a recent patient in an East Midlands hospital as well as working in one, is the most annoying set of questions after about 2 hours, and as a staff member means I spend 10 minutes every hour making cup after cup of tea because the Trust has said that it is only the Nurse who can complete the form and the outcomes of it. It's ridiculous because I nip to my patients every so often, generally quite frequently, to ask if they're ok and if I can do anything for them, it's just wasting time filling in a piece of paper to prove you're doing something you were already doing, and all that happens is it gets missed and forgotten and then it either gets backdated or left completely.

    As to managers not knowing staff numbers, I am appalled but not surprised that they don't know. Maybe they'd like to come and sit on a ward for a few days and see what their ignorance is doing to patient care.

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  • managers do know how many staff they have and in all honesty they would like to have more nursing staff if they could.although they have a budget to keep within they dont have the extra when patient acuity changes which is regularly in the acute setting. they are not the ones holding the purse strings at the end of the day.its the chief execs looking at their losses each week when managers have to attend bloody meetings to be told theyre spending too much and need to cut back. our ward manager had to come out of her office last week and couldn't cope with the 4 patients she was given.lucky she only had 4!

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  • “You’d be amazed how many people simply don’t know how many nurses they have, never mind how many nurses they have on an individual ward or an individual shift.”

    Why is there never a firing squad about when you need one?

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  • michael stone

    I think that headline should have read 'DELIBERATELY do not know' - it isn't hard to physically visit a ward, and notice how many staff are there, is it !

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    FYI :)

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  • Managers, like nurses & doctors, owe a duty of care and are accountable for their Omissions as well as their comissions under civil and statutory legislation.

    Simply avoiding the issue (the equivilant of sticking one's fingers in one's ears and Lalalaling) will not get them off the hook legally or morally.

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  • Managers are aware how many staff are on duty but chose to ignore the fact there is not enough of them.

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  • Forget about "managers" how about the focus on nursing managers - the clinical managers: matrons, heads of nursing etc - surely they know who is on the wards for redeployment if needed, surely they know what temporary staff have been booked and where....?

    Isn't this about nurse leadership - visible leadership? Walking the floor daily is a good start.

    By the way, there are tools available which can inform on staff numbers and where they are and skill set but organisations do have to buy them and then, most importantly, use them to actually do workforce planning.

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  • Anon at 11.43 you sum it up brilliantly. More industrialisation of care. Knowing how many nurses there are is irrelevant if this is what we end up getting people to spend their time doing. Goodness happens in spite of the system not because of it As a system, from what I have studied, I don't think we like people very much either

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  • Well said mags, well said. Let me get the rifles and we can bloody well start one!

    Michael I absolutely agree about the deliberate part. They 'know' because we frequently tell them, yet we are also frequently ignored.

    Anonymous | 20-Nov-2011 1:40 pm I agree, but they also frequently get away with it, don't they, both legally and morally.

    We NEED a LEGALISED Nurse/patient ratio now, so that managers and executives can stop sticking their heads in the bloody stand and stop forcing us to work with dangerous staffing levels that seriously affects patient care.

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