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.
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