Registered nurses must not be substituted with less qualified workers, according to the International Council of Nurses’ first ever position statement on safe staffing.
Real-time assessment of patients’ needs and sufficient funding to ensure the right staffing levels are also vital when it comes to the safety and wellbeing of patients and nurses, says the body, which brings together more than 130 national nursing associations.
“Patient safety and the health of the nursing workforce are two sides of the same coin”
The position statement, which was drawn up by international experts and in consultation with member organisations, sets out the principles and practicalities of safe staffing.
It highlights research evidence that shows a direct link between nurse staffing levels and outcomes for patients and spells out the impact of inadequate staffing, including the increased risk of burnout and high turnover rates.
The ICN said it was intended to help all those involved in determining staffing levels as well as ensuring “clear nursing leadership on this vital issue”.
“The primacy of registered nurse professional judgement must be respected”
Howard Catton, director of nursing and health policy at ICN, said the body recognised safe staffing was a key priority and a major concern for many of its members and the millions of nurses they represent worldwide.
“There is clear evidence of the importance of safe nurse staffing in relation to patient safety in all healthcare sectors,” said Mr Catton.
“Inadequate or insufficient nurse staffing levels increase the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient death in hospitals and poorer patient experience of care,” he said.
The document – titled Evidence-based safe nurse staffing – goes on to make a series of recommendations for national nurses’ associations, healthcare employers and individual nurses.
In particular, it warned against trying to replace registered nurses with “less qualified cadres of workers” – a criticism that has been levelled at the nursing associate programme in England.
It called on national nursing associations – alongside their respective governments across the globe – to “cease the creation of substitute roles for registered nurses”.
It said: “Substituting with higher numbers of less highly qualified/educated nursing and support staff is associated with higher hospital mortality rates, lower cost-effectiveness, an increase in the occurrence of adverse events such as medication errors and falls, and poorer patient outcomes.”
“Inadequate or insufficient nurse staffing levels increase the risk of care being compromised”
The document advocates the use of robust, evidence-based staffing tools and said safety thresholds must be identified for nurse staff in different settings. However, it also emphasised the importance of professional judgement.
“The primacy of registered nurse professional judgement must be respected in determining the required number and ratio of staffing,” said the position statement.
It emphasises the need to involve frontline staff and nursing managers at all stages when designing and implementing safe staffing systems and policies.
All organisations should have a nurse at executive level with authority over nursing budgets in order to “safeguard safe staffing”, said the document.
Meanwhile, it called on individual nurses to formally report unsafe nurse staffing situations and stated that nurses’ associations should support those who raise concerns.
As well as stressing the importance of safe staffing when it comes to patient welfare, the ICN statement highlighted the need for healthy and supportive working environments for staff.
“Patient safety and the health of the nursing workforce are two sides of the same coin,” said Mr Catton.
“Many nursing associations are concerned that staffing decisions are being driven by financial considerations, rather than improved patient outcomes and practice environments,” he said.
He added: “In order to deliver quality, patient-centred care, there is a real need for positive practice environments with an adequate number of staff, manageable workloads, managerial support, high quality leadership and the ability of nurses to work at their full scope of practice.”