Nurse staffing numbers are in the news again following publication of a study suggesting that the worse patient outcomes associated with lower nurse staffing levels result from the omission of necessary nursing care. Put simply, short-staffed nursing teams don’t have the time to do everything their patients need them to do.
So no surprise there – but at last there seems to be a head of steam building to ensure decisions on nurse staffing are based on more than the fact that nurses are the biggest staff group and can therefore take a bit of trimming in hard times. The Prime Minister’s Forum on Nursing and Care Quality has called for the Care Quality Commission to monitor nurse staffing levels as an early warning of where poor care is likely to happen.
We had a lively #NTTwitchat about the issue, in which some people suggested that nurses should never allow instances of missed care. They felt it was breaching both their code of conduct and the spirit of the role.
No nurse wants to leave patients in need of care – unfortunately too many employers rely on this. But if missed care results from low staff numbers, should nurses plug the gaps by undertaking yet more free overtime – on top of what most already seem to do? That’s a perverse incentive for trusts to maintain the low-staffed status quo – or cut even further. It’s also a safety risk for patients and a health risk for overworked nurses.
One of the arguments against minimum staffing ratios is that they are blunt tools that take no account of local needs and patient acuity. That’s a fair point, but the NHS needs a method of assessing how many nursing staff it needs, and the appropriate skill mix. And nurse managers need a formula they can use to demonstrate they need more staff or cannot afford to lose existing staff.
So news that the Shelford Group of leading trusts in England have not only adopted a tool enabling them to determine their staffing needs is welcome. It’s even more welcome that the tool was developed by nurses. Here’s hoping the tool will prove what we already know – more nurses not only mean safer and better care, but also lower costs.