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Practice comment

'Put nurses at the bedside, then work out how many are needed'


Marion Collict argues that, in the debate about how many nurses are needed, we’re looking at the situation from the wrong perspective and that we should start by putting nurses back at the bedside before answering that question.

We have become obsessed with nursing numbers and ratios. Tweets and blogs regularly call for more nurses. The debate regarding the right nursing numbers and skill mix to properly care for the UK population in acute settings has been going on for years.

A number of nationally accredited tools are available that look at clinical acuity and functional dependency. These tools are being used to undertake skill-mix reviews in hospitals up and down the country. However, it is rare that the findings from these tools are fully implemented or perceived to be viable.

Findings are often contested either by finance teams or experienced staff who question the validity of the results. Skill- mix reviews are then repeated using another tool and the original results are discredited, and the whole process of change and improvement stalls because there is such a significant difference in the findings available.

In the meantime, staff who have been promised change become frustrated and disillusioned, which affects morale.

So the debate and frustration goes on. After this year’s report by Robert Francis QC on Mid Staffordshire Foundation Trust, we are still no further forward with standardising nursing levels and skill mix to suit our patients’ needs than we were five or 10 years ago.

I believe we are looking at this from completely the wrong perspective.

We need the right number of staff to meet the needs of patients and staff. We claim we don’t have enough nurses yet we are happy to sit back and allow nurses to be distanced from the bedside. Nurses are now undertaking additional activities that add no value to true nursing care and, in turn, its role in patient safety.

It is time to take a step back and re-evaluate the situation. We need to unpick the mess the “system” has created. However, we are the “system”. We have taken our eyes off the real role of nurses and we have allowed ward nurses to become everything to everybody and, in so doing, robbed them of their true professional status and their relationship with patients.

Nurses are not the only staff group that contributes to the wellbeing and safety of patients, and enable patients to have a positive care experience. Support staff, working alongside nurses, are the backbone of the ward. Without them, the team is weakened and becomes ever more dysfunctional. Historically, when cuts have been made, it has been this group that has suffered the most. This is a false economy

We then have our nurses becoming cleaners, receptionists, administrators, progress chasers, “mini doctors” and so on. Is it then any wonder we find ourselves with an empty space at the patient’s bedside and confusion over how many nurses we need?

Let’s put nurses back at the bedside where they belong, then we can properly debate whether we have enough nurses.

Marion Collict is director of transformation, Luton and Dunstable University Hospital.

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Readers' comments (28)

  • we don't have enough nurses to care for patients properly, why do we need another debate.

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  • tinkerbell

    sorry Marion, you are making far too much sense, therefore, no one in government is going to be listening. Most nurses would dearly love to get back to what they came into nursing to do 'nurse'.

    'A false economy' asking nurses to take on ever increasing demands that have nothing to do with nursing, what's wrong with you, have you taken some kind of common sense pill? If you have any left over can you hand some out to the department of health.

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  • I am trying to persuade our Nursing Director to let me pilot one month of "Back to the Future" on one of our medical wards. The sister will be a real sister not a manager, we will staff it exactly as she tells me to and we will monitor patient and staff satisfaction scores, and some clinical things I don't understand because I'm a manager.

    We will then compare it with our other ordinary ward costs and adjust for patient numbers and dependency, but measure the same things.

    Every manager worries that putting nurses back in the driving seat pushes costs through the roof but I want to quantify a pilot and prove this isn't true.

    Any constructive suggestions welcome.

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  • The Nobody | 5-Apr-2013 10:12 pm

    Sisters are managers - normally!

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  • I believe that 13 hour shifts are responsible for many of the problems in nursing.Simple fatigue must surely be considered in the frantic search for reasons for poor basic nursing care.Add regular night duty and sleep disturbance to the mix.Whether we like it or not nursing involves a large element of manual labour.

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  • we are not 'obsessed' with staffing numbers and skill mix - we are worried that our patients and ourselves suffer as a direct result of understaffing and inadequate skillmix.
    the fact that it's 'been going on for years' is a clear indication that it's about time something was done to address the issue.
    we don't want silly initiatives, we want more staff, hard-working and skilled ward managers who have specialist skills and actually do some nursing, time off for study, decent hours, a decent pay rise and a bit of respect from all those who think we are useless and uncaring.

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  • all of these silly and wasted initiatives which seem to have been going on for some time must waste more money than it would to invest wisely in resolving the core issues.

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  • Perhaps you wouldn't have a problem with the number of nurses if the ones I work with would stop flirting with security staff, reading soap magazines and eating biscuits.

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  • Anonymous | 5-Apr-2013 10:20 pm

    Sorry, I should have said, they will be supernumerary.

    Re the other comment about 13h shifts, we would also like to pilot shorter ones for 5 or 6 hours for very intense ward areas to see what impact it has on stress and Bradford scores, working with Occy Health.

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  • Anon 5.51pm
    You don't work in occupational health at the Daily Fail/ Torygraph do you?

    The Nobody
    Thinking outside the box with the short hours, but you will need at least 4 full shift loads of nurses, instant 25% increase in staffing costs. Dunno what the other Srs/ CNs on here think, but it can take over an hour for me to hand over to the nurse in charge of the next shift ( and I work in a very intense area) so my patient time will be 3 hours a day. Lastly, people would have to work 7 days a week to get their time in, unless you want to have 'watches' like the navy, then we'll have to build 150,000 beds for the nurses to roll in/out of, but at least you are thinking proactively.

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