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Doctor urges limit on number of patients per nurse

  • 59 Comments

Laws should be changed to limit the number of patients a nurse should care for in hospitals, according to a doctor in Greater Manchester.

Orthopaedic consultant Dr Milton Pena said nurses across England have too heavy a workload and that the quality of care deteriorates when nurses are stretched.

And he added hospitals are running “false economies” if they choose to go with a low nurse-to-patient ratio.

Earlier this year, Dr Pena criticised patient safety at Tameside General Hospital. He told BBC’s Panorama programme that out of every 100 deaths at the hospital, one or two could be prevented by having a greater nurse-to-patient ratio.

He wants new legislation to be passed in England to dictate to hospitals how many patients a nurse or midwife can tend to. Wales and Scotland have different legal systems, he said.

The consultant said: “One problem in my hospital is that there’s no rule determining the minimum number of nurses. They don’t break any law and they get away with it.”

Dr Pena said Canada and Australia already had laws similar to the one he proposed.

California also has a quota on the number of patients a nurse should treat, he said, and several other states are considering the scheme.

He suggested that on surgical wards there should be a minimum of one qualified nurse for every six patients plus one auxiliary nurse, and on medical wards, one nurse for every seven patients, with an auxiliary.

The surgeon explained: “It is a false economy to have fewer qualified nurses.”

  • 59 Comments

Readers' comments (59)

  • When I worked in NewZealand on an Abdominal Surgical Ward there were two qualified nurses between nine patients. They did not have clinical support workers at that time. And the Renal Medical ward you were allocated patients on the medical problem. You would only have one fully dependent patient, the others would have some independence. The nurse would have up to a maximum of five patients to look after. Here in the UK on the medical wards you would have two qualified nurses between 18-20 patients and two clinical support workers. I guess this is a small ward compared to others in the UK but it was still hard work!!!!!!

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  • Good to hear it Dr Pena, thanks at last somebody from the medical world is taking an interest in the fact that medical outcomes often depend on good quality nursing care. Pity nobody from the RCN or UNISON has been making the same noises. I've not worked on med /surgical wards for years for precisely this reason. Workhouses.

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  • I wonder if CHC checks the ratio when visited the NHS trust.With great respect clinical areas thoroughly checked and trust policicies. What about a report on nurse patient ratio. Thanks Dr. Pena, now the management can listen to nurses if they not coping with workload. Nurses working like machines running the material to meet the production required by the Boss.

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  • I completely agree with Pena. Nurses are under an enormous amount of pressure and patient care suffers. I have experienced this recently, my mother deteriorated and died and I am sure that the understaffing was a major factor that contributed in the lack of care provided. Thank God some body is prepared to stand up and speak on our behalf. I hope the government and individual trusts take notice.

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  • Not before time someone speaking out in favour of what is effectively patient safety. I work on an acute surgical ward with 34 patients and we frequently have to work without our full quota of 5 qualified nurses. On a good day we get 3 HCAs (which inevitably includes bank staff) but frequently we're down to 1. When on the very rare occasions we're 'fully staffed', our staff are pulled to work on another ward!!

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  • AT LAST!!!! I have been saying this for years! Unfortunately due to infighting, lack of backbone, leadership and lack of cohesion, Nursing simply does not have the voice to demand this basic common sense rule, so it is nice to hear others start to do it for us.

    1 trained staff Nurse plus 1 HCA for every 6 patients!!! This would be ideal! Do this and I guarantee that the majority of other problems that patients complain about (such as Nurses seeming stressed/tired/not happy or smiling, lack of compassion, not enough staff to feed/treat/chat to patients/ etc etc etc etc) will disappear overnight.

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  • Thank you Dr. Pena for pointing out what is obvious in the NHS in UK/England. I worked in the West Mid-lands for five years and the nurse-patient ratio was 1RN to 12 patients with 1 auxilliary/HCA. The work was really heavy...not just on nurses but to other members of the health care team. Now, I compare the work load here in South Australia ratio is 1 nurse to 4 patients in public sector and 1 nurse to 6 patients in private sector. And not to mention the better pay I receive here in Oz. I hope that my colleagues in England will be going in the same status of patient care as soon as possible/applicable.

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  • I also would like to thank Dr Pena for highlighting this very obvious problem. I think nurses and nursing representative bodies ie nmc, rcn need to support nurses more by issuing guidelines as to how many patient nurses can look after. I've worked on a busy surgical ward where there has been one RN and one HCA to look after nine patients. This just cant be right especially as nurses are expected to take on more responsibility ie taking bloods, iv's etc. It is not fair on patients or staff!!!!

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  • I'm so happy this is getting some media attention. I now work in the community for this very reason. Nurses are reaching burn out and the good ones are leaving the acute sector in droves. Well done and thank you Dr Pena.

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  • Can the Nursing Times PLEASE make sure that the couragous Dr. Pena gets all of the comments on this site. Maybe then he will be spurred on further to get this tragic state of affairs dealt with. As an RN (Child) I often ask "is there really no legal ratio of patient to nurse? If there is in teaching, how can there not be in nursing?" No one seems to be able to give me an answer. I know that child nursing is sometimes seen as an easier type of nursing but please believe me, it is not! Unaccompanied, frightened children are an enormous challenge to nurse, and crying babies, that you don't have time to cuddle is heartbreaking. However, you are told "no we won't close beds because you are shortstaffed, get on with it". Who loses their job when something goes wrong? The nurse! Please, please Dr. Pena, you have clout, use it!!!

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