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Nurses vote in favour of law on staffing ratios

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The Royal College of Nursing has called on its leaders to campaign for legally enforceable staff-to-patient ratios, despite fears that the measure could prompt a “race to the bottom” to minimum levels.

The RCN agreed a motion on safe staffing levels yesterday, during its annual congress in Liverpool, urging the RCN council “to campaign for legally enforceable staffing levels to safeguard standards in the current economic climate”.

Laura Collier, of the RCN central Manchester branch, told delegates there were two elements to the issue – that staff-to-patient ratios should be set and sustained, and that nurses should contribute to the levels, and take into account training for staff and students.

“This issue underpins the patient experience and can make or break a career”, she said, adding that “at this time of restructuring and redundancies, NHS trusts must not be allowed to compromise patient care”.

Statutory staff-to-patient ratios are already in place in California and Victoria, Australia.

Bruce Hopkins from the East Dorset branch backed the measure, arguing: “We need a legal stick to hit managers over the head with as they chip away at our working conditions”.

Clair Drot, from Southampton, argued legislation was necessary as under current arrangements, the Care Quality Commission has “no teeth” to enforce safe staffing levels.

However some expressed concern that bringing in minimum staffing levels could have unintended consequences.

Chris Butler urged delegates to view the motion with caution, as “in the wrong hands it could be no more than a rush to the rock bottom of staffing numbers”, and questioned whether the measure could work in practice.

Former RCN president Maura Buchanan said a minimum number would soon become the norm, and would not account for the mix of skills required on a shift.

The motion was passed by 372 votes to 92, with 26 abstentions.

During yesterday’s congress proceedings, the RCN also agreed to lobby for services to be provided on the basis of “outcome rather than income”, and to lobby for all students to be given “appropriate quality placements” leading to a minimum of a one year position with preceptorship on registration.

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Readers' comments (10)

  • Fantastic!

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  • I think it is a fantastic idea, but how would it relate to areas like the Emergency Department?

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  • Absolutely agree, I have been saying this for a long time!

    We should have a ratio of 1 staff Nurse and a couple of HCA's to every 6 patients on an average ward, perhaps 4 patients in more critical areas. And Anonymous | 13-Apr-2011 5:19 pm, this would basically go on expected numbers of patients I think.

    Whatever kinks need to be worked out, all we need to do is look at places like Australia as a model, they have had this in for some time now.

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  • i will be starting a job in australia soon and i will be in heaven. 1 trained to 4 patients only. fantastic can't wait. proper patient care

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  • I agree with Mike.
    Having just return to Adult wards I find that 1 trained with a floating HCA unacceptable to six dependant patients unacceptable. And the paperwork is ridiculous, a tick box exercise that is supposed to indicate that you have done your work. When I ask why there is so much paperwork I was told is was to prove that you have done it in case of complaints etc, but anyone one can lie. I remember when I could actually sit and talk to the patients but not anymore. And they wonder why nurses can't give basic care.

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  • Lucky people.We have 1 trained and 1 HCSW to 10 patients on a busy surgical ward and if we are short staffed we are told to 'fill out an incident form' and 'work across the teams' which then means 1 trained to 15 patients! I'm sure there will be some clause in it somewhere to enable management to get round it. Lets just see.

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  • @katherine-wilkinson-carr
    I agree as a student nurse I have never understood the ratios of 1:8 or in some cases 1:12? Plus all the ever Increasing amounts of paper work, which has the potential and in some cases distract from pt care. I remember being in charge of a bay of 8 pts and it was hard going but the pts all responded to me and I made the pts laugh (seeing they gave me the bay in the qualified's words "miserable pts") I found that just talking to pts and making thier hospital stay a bit more interesting. Sadly I got told off for that, even though all the paperwork and all pts needs were identified and attended, I think they were plannin g that I'd crumble, I just ignored the qualified's comments seeing that the Pts and their relatives kept asking will I be in the next day and they have not seen their love ones so happy.

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  • Paper work is the nurses biggest burden. Somebody needs the guts to scrap 90% of it and let us get on with the job we were trained to do.
    How many of you on here get to read the reams and reams of pages that make up the care plan? The duplication of observations and the inability to find information you want when you really do need it?

    Katherine, laughter is the best form of medicine and it does combine with professionalism and being a good nurse. Don't change the way you are.

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  • i'm not in to this having ago at other branches but there is a distinct difference in my own branch of mental health and pherhaps learing disability that when patients are no problem it seems a waste of resource to have 3/4 qualified staff to a ward of 20....the difficulty is when patients have more challenging needs as and when mental health units and ld settings can be very hard work when patients are disturbed and in these cases the hcas just do not handle it and when a ward had 4 or five patients like this at once you cant be everywhere as a trained nurse, i always worry that if i am not personally there and a patient was to hurt themselves or someone else on a hcas watch because i have no choice but to get on with the things i have to do they cant that i will lose my pin... and you are also without the norm of an onsight doctor like in a genreal hospital...surely there should be a degree of flexibility for nurses to be honest and say when they dont think they can meet x amount of patients needs with x amount of staffs and not have to go through scores of managers to ok this....the actual life saving jobs general nurses do i cannot compare and i find admirable as i could not do it...but the risk as an RMN on my pin i dont think general nurses have anywhere near the stress, there should be a mechanism to have x amount of staff assigned to clinical work and x amount to all the admin messing about stuff to ensure safety in mh.

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  • As I have stated on here a few times, in Victoria Australia we have had the 1:4/5 patient ratio in for some years now. And it is one of the best laws that came in for us and for patient care. The state of NSW has also just had this law passed, and I would now think that all States of Australia will move on to this.
    We had the full backing and support of our union who did all of the negotiating with government for us however, so your union has to really pick up on this.
    Also as said before patient acuity has increased so much in the past decade, patients level of care is much more intense and time consuming on the ward settings now.
    Our patient ratios are staffed with only Division 1 Registered nurses and Division 2 ( Enrolled Nurse ), we do not have HCAs here.
    Yes paperwork is repetative here too, and a "simple" Riskman ( Incident report) can take at least 20 minutes of your time with the complexity of it. Another challenge!
    The quote " Outcome rather than Income " hits the nail on the head as far as patient/ staff safety is concerned.

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