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'When we compromise nurse staffing, we compromise patient safety'

Jane Ball
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When the care negligence at Mid Staffordshire came to light, the initial reaction of many was how could they? How could those nurses have daily compromised patient care and put patients’ lives at risk?

The public outrage led to inquiries, and in response the government launched new national policies. ‘Never again’ – from here patients and their safety would be put ‘first and foremost’.

The second Francis inquiry unpicked the system-wide failings that had led to the compromised care delivery at Mid Staffs. Within the complex interwoven set of factors revealed, was a unifying theme: decisions had been taken without assessing the risks to patients.

We know from our research, that lower nurse staffing is linked to care being left undone, with potentially fatal consequences. To ‘balance the books’ the trust had reduced registered nurse (RN) staffing levels. There were no checks and balances in the system to prevent hospitals from running with dangerously low RN staffing – either at Mid Staffs or elsewhere.

The Francis Inquiry motivated the introduction of policy and in 2014 NICE guidelines were introduced to safeguard patients from such compromises.

As an academic, I’m often speaking at conferences about nurse staffing. I present the research on the risks associated with lower RN staffing levels. Yet despite the volume of evidence, I’m often met with a polite, world-weary push back.

Off the podium, or behind closed doors, a senior nurse will take me to one side, to explain “It’s no good me talking about safe staffing – we haven’t the nurses for it” or “We need to get real. We can’t just knit more nurses Jane”.

No. We can’t. But if in 2014, when we recognised that RN staffing levels in the NHS were woefully low, we had responded to plan the investment needed to enable an increase in staffing levels to be achieved, we would be in a better position than we are now.

Where has that “get real” got us? With a reduction – not an increase – in the investment put into the education of nurses, and one in four hospitals continuing to routinely run with unsafe levels of nurse staffing. In contrast, the investment in medical workforce has continued to increase year on year.

”Our research found that trusts’ adoption of safe staffing policies had made a difference”

If ‘getting real’ means accepting nurse staffing levels that put patients – who come to us at their most vulnerable times, for care and for support – at risk, if it means that being a nurse has to be an exercise in constant compromise, continuous and unsustainable stress, then that’s not a reality I’m willing to accept.

Our research found that trusts’ adoption of safe staffing policies had made a difference. Trust boards were more aware of nurse staffing as a patient safety issue and more willing to invest in the nursing workforce. And the processes to plan and roster staffing, and frequency of staffing reviews has improved.

But their ability to actually achieve safe staffing levels, not just plan them, has been severely hampered by the fact that as a nation, decisions and actions have not been taken to ensure an adequate supply of RNs, and provision of working conditions that are needed to retain staff.

Fortunately three think-tanks – The Health Foundation, The King’s Fund, and The Nuffield Trust – have stepped into the planning void, and set out a plan to avoid a worsening national shortage of RNs. Without these actions, they estimate that in 10 years’ time we will have a shortfall of 108,000 FTE nurses.

The gap can be closed; it is possible. But it needs the will – from top to bottom - to do so. This won’t happen, if we resignedly accept the status quo of insufficiency, and let policy makers and governments off the hook.

When we compromise nurse staffing, we compromise patient safety. A resigned attitude today perpetuates a worsening situation tomorrow. Each of us needs to hold on to our motivations for going into nursing – to make life better for patients. And for their sakes, we need to push for a better, safer reality.

Professor Jane Ball is deputy head of school (research and enterprise), School of Health Sciences, University of Southampton

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