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‘Blanket comments about staffing levels risk causing a knee-jerk reaction’


Tony Stein argues that focusing on a 1:8 nursing ratio diminishes the true value of properly qualified nurses

Recent comments made by NICE (National Institute of Care and Excellence) regarding the need for more nurses are somewhat misleading and not helpful to nurses, organisations providing care or to patients.

Professor Gillian Leng of NICE has been quoted saying: “nurses in hospitals should not have to look after more than eight patients at any one time” and the organisation has warned that going above this number would put patients at risk.

The Safe Staffing Alliance compounds this issue, stating: “A 1:8 ratio still means that the nurse only has seven and a half minutes per patient per hour, which is too little” and “if it’s more than eight, then patients won’t get fed, care plans won’t get written, and nurses can’t sit and talk to patients and reassure them about their condition”.

It seems difficult to believe that either organisation would seriously argue that helping patients to eat and sitting and talking to them requires the services of a nurse with several years university training.

It would be interesting to monitor a cross section of patients and find out exactly how many patient interventions take place every hour that actually require qualified nursing skills, and how many would be better delivered by a properly trained carer.

Tony Stein

Tony Stein

The danger of these blanket comments is that patients will be concerned that the ‘nurse shortage’ is putting them at risk of poor care in today’s hospitals and homes.

The other danger is that it knee-jerks huge competition to recruit nurses that cannot be met through the number exiting nurse training. This is leading to the mass employment of overseas nurses, many of whom will be capable of delivering excellent care, but some of whom may have language issues that increase risks of mis-reading and mis-interpreting medications records and care plans or, result in difficulty in communicating clearly and effectively with patients.

Finally, and very importantly, it diminishes the true value of properly qualified nurses.

Pre 2000 we had enrolled nurses (ENs). ENs took a vocational route to a nursing qualification with on-the-job training underpinning their experience. The move to graduate-only nurse qualifications has effectively shut the door on those with a true vocation for care, who want to become a nurse, but who struggle to find the time, money or academic ability to undertake a degree level, university based course.

In order to have a more useful and productive debate we need to identify exactly what staffing shortages there are in our care system, and look to develop the appropriately skilled labour force to meet this demand.

To simply state there aren’t enough nurses doesn’t do the debate justice.


Tony Stein is Managing Director, Healthcare Management Solutions


Readers' comments (5)

  • "patients will be concerned that Nurse shortage is putting them at risk of poor care in Hospitals and homes"

    Errr.. well yes it is Tony, and they would be right to be concerned.

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  • what are "properly qualified nurses"?

    how is Tony Stein is Managing Director, Healthcare Management Solutions "properly qualified" to pronounce on the nursing needs in clinical areas of NHS hospitals?

    as for foreign nurses, this is more a discriminaory attitude and the fact they are not welcome in the UK where everything is made exceedingly and unnecessarily complicated. other European countries where the workforce is usually multilingual in large and university hospitals is not a problem for staff or patients, but perhaps they just have a better level of general education, training cultural background and are just more used to it and with getting on with what really matters instead of wasting their time nitpicking things which don't!

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  • It is obvious from his comments that Tony Stein hasn't got a clue. He states "It seems difficult to believe that either organisation would seriously argue that helping patients to eat and sitting and talking to them requires the services of a nurse with several years university training". These are the thoughts of an ignoramus who doesn't understand that the nursing value of these tasks. The nurse can be doing a raft of different observations and assessments whist carrying out these task which a carer is unqualified to do. This is the type of management speak which has so undermined the role of nurses over the years. I well remember the time and motion managers who came round the wards during the "skill mix" operation with their clipboards and pens, and rated every nursing activity purely in terms of tasks. They, like Mr Stein, only saw what they wanted to see and this was purely about how to reduce costs, not about what would be be best for the patient, and who was best to carry out the care.

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  • 'Managing Director, Healthcare Management Solutions'

    excellent comment above which generally agrees with my first comment in the first paragraph above yours. but doesn't the title say it all. in the job to gain credit merely by what one says and in it to make money out of the health services. those non-clinicians with position power, or self-promotion, such as a company director linked to healthcare, believing they can manage nurses and nursing seem to think it is all so simple and in reality have absolutely no clue what nurses actually do or what their role is in patient care and recovery.

    before making such simplistic pronouncements, perhaps all of these people should not only spend extended time visiting the wards and having some of these roles explained to them in detail but should also sit in in a wide variety of university lectures and practical teaching sessions so that they get the full picture instead of smugly believing and convincing the public that they have all the answers. (maybe they should also be put through the qualifying examinations!).

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  • The true value of "qualified nurses" is in direct patient care i.e. anything that requires interaction with patients, including feeding and talking with (not to) patients. It is direct patient care where the real skill is required because this is where there are subtleties and unpredictabilities. Caring for patients well requires building a therapeutic relationship and that requires time with patients to listen, understand, care for, enable, teach. Instead qualified nurses are being used for all sorts of things for which their skills and qualifications are not needed e.g. administration, audit, form filling, cleaning, etc etc - ticking boxes for all and sundry instead of doing what they are qualified to do which is look after patients - plan, deliver and evaluate care. (Note that in saying this I do not consider cleaning beneath nurses just that it is not what they are best qualified to do.) Incidentally I do not understand what a "properly qualified nurse" is - either a nurse is a qualified nurse or they are not a nurse! Furthermore nurses are carers - that is our role, to care! Delivering nursing care is a highly skilled activity requiring art and science - in the 21st century this requires a considerable depth of knowledge and understanding and the ability to apply that in personalised care of individuals. There are many like Tony Stein who still do not understand any of this. Please Tony let nurses care for patients and have non-nurses do all the other things that do not require the skills of nurses.

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