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Exclusive: Transfer of safe staffing work a 'devastating blow'


Workforce experts have reiterated the importance of nurse to patient ratios, with nursing directors currently between a “rock and a hard place”, as they struggle to reach recommended staffing levels.

One leading researcher described the recent decision to transfer safe nurse staffing guideline work from the National Institute for Health and Care Excellence to NHS England as a “devastating blow”.

“We all had hope that post Francis, something was changing, they were putting patient safety first”

Jane Ball

The ratio was recommended by the NICE in its safe nurse staffing guidance last year for adult hospital wards.

Speaking at Nursing Times’ Directors’ Congress last week, Southampton University research fellow Jane Ball said recent announcements urging trusts to work within budgets “did not help [nursing directors] make sure staffing meets patient need as outlined in the NICE guideline”.

She said the transfer of safe staffing guidance from NICE to NHS England was a “devastating blow” for the principle of safe staffing.

“We all had hope that post Francis, something was changing, they were putting patient safety first, we were going to have some strong guidance about nurse staffing levels,” she said.

“I feel that is no longer what we are talking about when we are talking about staffing in general and not looking at the outcomes,” she added.

NHS England has also indicated that future staffing guidance will be multidisciplinary rather than only focusing on nursing.

But Ms Ball said: “The little evidence that we do have which looks beyond just nursing doesn’t suggest that you can offset other members of the team for a nurse.”

“We’ve got to make sure we eradicate waste and don’t overestimate what we need – we manage quite a conflicting financial position”

Flo Panel-Coates

Nursing directors themselves admitted it was currently a “conflicting” time, as they were required to deal with increasing pressure to help increase the efficiency of their organisation while ensuring patient safety.

Also speaking at the Directors’ Congress last week, University College London Hospitals Foundation Trust chief nurse Flo Panel-Coates said there was clear evidence that better ratios of registered nurses produced improved outcomes.

However, she added: “We also know, as chief nurses, we are a member of the board of directors and we’ve got to make sure we eradicate waste and don’t overestimate what we need – we manage quite a conflicting financial position.”

University of Southampton

Jane Ball

She said some solutions to achieve safe staffing were within the nursing director’s power – such as workforce planning, good roster management and using robust staffing tools – but that “pressure” also needed to be applied to the healthcare system too.

Salford Royal NHS Foundation Trust’s deputy director of nursing Peter Murphy said there were “huge amount of challenges” to overcome for safe staffing.

He agreed with Ms Panel-Coates that nursing directors were between a “rock and a hard place”.

But he said his organisation was committed to maintaining the minimum 1:8 nurse to patient ratio that it currently enforced.


Readers' comments (9)

  • Where did 1:8 registered nurses:patient ratio, a minimum come from + what setting? It is still unsafe. When giving IV or CD medication it ties up 2 registered nurses for whole duration. How many times patients need to go to toilet at same time as 2 or 3 other patients, to be told to wait as youre already transferring another on a hoist too. Miracle that people are cared for without too many incidents.
    Think its time policymakers have to work a month on a acute ward, a rehabilitation ward, a nursing home to experience these ratios are not safe for everyone. Just because its not intensive care, emergency or high dependency patients, patients are more likely to have falls when trying to be more independent to manage their needs otherwise theyll also get institutionalised + dependent on carers = worse for patients in long term.
    After a fall, arrest, etc patients only have minutes before more irreversible damage occurs to the body. Also quieter stuff like dehydration, bleeding, sepsis, changes of consciousness, malnourished (too much / little), deteriorating patient may go unnoticed where treatment becomes more difficult.
    1:4 ratio is better for the wards as it enables staff to cover each other temporarily to get equipment, breaks + deal with problems or help with ADLs, unless patient deteriorates.

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  • michael stone

    I think I see this the same way that Jane Ball does.

    And it is very complicated - as Shandy has pointed out - which means that even if the right people did the work (and lets be clear - NICE should be doing this work !), it would still leave plenty of room for either misunderstanding, or misapplication, or deliberate management 'gaming'.

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  • Having recently completed a return to practice course after being out of the profession for 10 years - I have to say the changes are huge and the demands on nurses enormous. On 'normal' wards the ratio is about 1:12 - not counting HCA's, who are often tied up 'enhancing' or doing 1:1 on confused patients. On top of what has already been mentioned, there is all the paperwork that nurses have to do. Thanks to the litigation and claims culture that has become part of healthcare you always have to look over your shoulder these days and make sure nobody will have a leg to stand on should they try and 'sue the pants off you'. Nurses are seen as a much easier target than doctors in this respect - it takes a lot of the joy out of nursing. And a court case will be much more costly for a Trust than employing extra staff - even if they win the case, it will certainly dent their reputation ...

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  • 1:8 hahahahahahahahahah we were 1:16

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  • Shandy's comment is spot on.

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  • Anonymous | 27-Oct-2015 6:59 am

    Shandy's comment is spot on.

    I agree.

    Also when did 1:8 become the desire ratio?In a busy medical ward you cannot do your job properly with those numbers.

    Somebody should also get a grip on the ridiculous paperwork, half of which never gets read. Scrap the tick boxes too.

    If money needs to be saved there has to be a dose of reality in the situation.

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  • I long since retired but my heart goes out to Shandy and everyone like her - those with kindness and education and the motivation to nurse well.

    Re the litigation costs currently incurred by the NHS.. remember these include the costs of mismanagers who instead of dealing with complaints in a proper and timely manner, go flat out to disable the whistleblower-including false allegations resulting in court costs!

    If judges made the lawyers pay for their own court costs when these costs are unreasonable because the lawyers have recklessly mislead the court with false allegations, then would it deter lawyers from representing NHS bodies which persecute whistleblowers?

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  • The civil servants/accountants have successfully diverted the conversation into arguing about a "number" rather than a "principle". Remember the old story about Rolls Royce not quoting the horsepower of their cars, describing it only as "sufficient"? You CANNOT let a bean-counter declare something as "safe" - that responsibility should belong to the nurses on the spot. What we need is a return to trusting the professionals involved, not a number that "management" can feed into a spreadsheet.

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  • Most of the time I work 1:8 on a busy acute ward and I am fed up to the teeth of staying on, unpaid, catching up on work. I do the patients' notes on MY time UNPAID and I am really fed up. The NHS owes me lots of money, I cannot give charity any more, people are really taking advantage of me. My health and wellbeing is greatly at risk. I am feeling stressed all the time.

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