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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