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‘There is more to safe and effective staffing than numbers’

Fiona McQueen
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The Scottish Parliament saying yes – unanimously – to the Health and Care (Staffing) (Scotland) Bill at the start of May was a major milestone in the quest for safe and effective nurse staffing in Scotland. 

Our first minister used the platform of the RCN Congress in 2016 to announce that the workload tools we have in Scotland would be enshrined in law; and the passing of this legislation has done just that.

Growing evidence tells us that with the right number and mix of nursing staff, mortality and morbidity reduces. So while I believe numbers are essential, there are other factors that we must consider.

I think of the other factors as preconditions, essentially if they are not there, care will not be safe no matter how many staff are on duty. So what more is needed than just numbers?  

Having a culture where all staff can raise concerns is imperative and their health and wellbeing must be at the centre of everything an organisation does.

Staff need to feel confident that they are being listened to and that they are given the ability to contribute to improving services and care. Florence Nightingale herself said “how very little can be done under the spirit of fear”. 

Staff need to feel like they are being given the tools to deliver the best care to their patients. Continuing professional development is not a luxury – but essential for staff to be up-to-date with practice. 

The rhythm of working as a nurse can be complex – variable shifts, balancing personal and professional responsibilities alongside the emotionally challenging and intellectually demanding work that we do, can at times feel overwhelming.  “Who am I on with?” as well as “How many am I on with?” are important questions for nurses. 

But as the “Who am I on with?” question reiterates, there is more to safe and effective staffing than numbers. So while the staffing bill in Scotland enshrines the nursing and midwifery workload tools in law, so too does it cover wellbeing of staff alongside accountability and escalation.

That’s why in Scotland – I see the legislation as a staging post – a wonderful foundation that I am incredibly proud of. However, creating the conditions for nurses to flourish and have time to care for their patients and loved ones is a journey we are still on.

We need to ensure that nursing teams continue to be able to personalise care, be prepared for the future, and be supported in their workplace.  We also need to encourage more people to join this great profession and we already have the building blocks in place in Scotland. We are increasing the number of student nurse places and also increasing the bursary available to students. 

Of course, looking to the future – like the rest of the UK – we are busily preparing for the implementation of the new future nurse and midwife standards. This also feels like a huge step change in the evolution of nursing education and one that I am thrilled to lead in Scotland.

We have agreed that our higher education institutions will start their new programmes at the same time in Scotland, this allows our practice placement areas to be as prepared as they can be to support our new undergraduates. We know that the graduate nursing workforce improves outcomes for patients, so this is a very important piece of work and will support the implementation of our staffing legislation.  

The challenge now is to make the legislation work for both staff and patients – and I am relishing that challenge.

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