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Nurses don’t grow on trees: will NICE’s new safe staffing guidelines improve safety?

  • Comments (5)

The second I walked onto the ward I knew something was wrong.

I’d been qualified seven months, one of those incredibly keen, yet still incredibly unsure, nurses.

“Hi Fran,” Rachel smiled at me as I walked into handover, ready for the late shift to start. “So… err… Ann and Michelle are both sick. You’re the only qualified on this afternoon.”

She went from being my best friend, who’d just signed off my preceptorship paperwork, to my worst enemy.

I was 22 years old, how could I run a busy acute mental health ward? I wasn’t old enough to make decisions!

Yet for some reason, the trust was happy to let me take full responsibility of the keys and keep 20 patients alive for the next 7 hours and 23 minutes.

A nurse-to-patient ratio of 1:20 is not unusual in mental health, it should be, but it’s not. I survived the shift, as did all my patients, and I got through it the next time it happened, and the next. But the care that I and the three HCAs working with me gave was not what service users should expect.

No-one could use their escorted section 17 leave as the HCAs were permanently on special obs and I wasn’t able to leave the ward in case there was an emergency. I had to cancel the one-to-one sessions I’d planned with my named patients to prioritise giving everyone their medication and when a doctor arrived on the ward and wanted a chaperone while he saw a patient I had to say no, I needed to discuss prn with a service user who was clearly escalating.

In theory, when NICE’s new safe staffing guidelines come into force, this sort of experience will be a thing of the past. Fewer than two registered nurses on a ward during any shift, day or night, will be deemed a “red-flag”. This will “prompt an immediate escalation response”, such as allocating additional nursing staff to the ward.

Some of you reading this will be asking “but where from?” Nurses don’t grow on trees, if one ward is short-staffed, it’s unlikely that another has an abundance of nurses sat around twiddling their thumbs.

But the guidance makes it clear that it is unacceptable for acute wards to be run with fewer than two registered nurses. That acknowledgment is a huge step towards safer wards and safer patients. The red-flag events will still happen, but maybe if they keep being pointed out, trusts will be forced to do something.

Please report your red-flag events. Let your trust know the guidance isn’t being followed. It’s five minutes that you can’t afford to spend on paperwork but if it puts pressure on your trust to make wards safer then it’s worth it every second.

  • Comments (5)

Readers' comments (5)

  • michael stone

    Fran, nobody has so far explained - or if they have, I've missed it - where the necessary extra money to pay for these extra nurses, is going to come from: even if nurses did grow on trees, there is still a cost to this.

    I still have this perhaps-overly-cynical suspicion, that one way or another the goverment's response to 'these extra nurses cost a lot' will be to try and use that as another 'lever' to use for dismantling the 'paid for from general taxation NHS', which is the model I support.

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  • tinkerbell

    Coping is not the same as caring but that is what nurses have to do on a daily basis and then deal with allegations that they don't care. Rock and a hard place.

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  • Anonymous

    The first time a similar thing happened to me when newly qualified, whilst sobbing and thinking 'this sort of' nursing is not for me, the person who was comforting me said, "well, no one died"! I am still here, 5 years on, but nothing has changed. Coping is normal, being appropriately staffed is abnormal and classed as over staffed, this will lose you bodies before you can turn around. I ache to give up but hold on to the thought that, one day, I will need a nurse too!

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  • Kathy Aldis

    I agree with tinkerbell coping can never be the same as caring... I left the NHS 8yrs ago after 20+ yrs as staffing levels we're increasingly becoming, in my personal opinion, dangerous not to mention stressful for the staff concerned..
    Seems like not much has happened to address this..

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  • Anonymous

    It is a pity the safe staffing ratios only apply to the NHS! I am a nurse working in a 60 bedded nursing home Each shift there are 3 nurses on duty so it is the norm that each of us take about 20 residents each with only 3 health care workers to assist. There are the usual 3 medication rounds to do, plus the usual dressings (which being elderly there are many-skin tears, pressure ulcer), doctors visits, chasing up prescriptions, organising transport for visits, covering of staffing, (no ward clerk as in hospital), continual update of care plans and handwriting of new ones, plus help of everyday care. In hospital many patients are independent in feeding - many in the home are 1;1 and take between 10 to 15 minutes each to have a meal! If an unexpected event occurs such as a resident having a fall or becoming unwell (quite common in elderly people) and needs hospitalisation it is the staff nurse who needs to sort everything out. No Doctor available on hand and the general workload falls behind. What a pity no minimum nurse:patient ratio applies in nursing homes. They are just as busy as hospital wards but without the extra support staff. Why do i feel that peoples view of nursing homes is that the nursing is not so demanding as in hosptals and that they are slightly inferior in skills as to those that work in the NHS??

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