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'The case for mandatory staffing levels is clear'


The news that nurse to bed ratios will be published for every hospital in England after the NHS reforms have been introduced is welcome, but doesn’t go far enough to protect patient safety and ensure the provision of good, fundamental care.

This “dashboard”, being introduced by the National Quality Team, will give some degree of benchmarking trust to trust, which will be useful – if those organisations take notice of it. But that’s a big if. The trusts that continually overload their nurses will be made aware of how far they are pushing their nursing team. But without some degree of compulsion to change, will they recognise the error of their ways and do something about it? Or will they continue to flog their nurses and overstretch them just because they can?

While many in healthcare can’t find common ground over the decision to introduce nurse to patient ratios, most nurses I have spoken to feel that it would provide a benefit to the profession – and to patients – to police these ratios.

In fact, many nurses have told me that they are being asked to look after more and more patients each shift, and that care is deteriorating as a result. Some have said that they’ve been regularly left alone in charge of up to 20 patients on an older people’s ward during a night shift. And that just isn’t acceptable.

Have we moved on at all since charge nurse Graham Pink blew the whistle on what was happening on his older people’s ward two decades ago?

We know older patients are likely to have a complex set of conditions and are probably less mobile so they cannot get themselves water or walk to the toilet. To be left in charge of so many dependent patients almost guarantees that essential care will be overlooked.

Are managers really going to continue to pile more pressure on nurses without thinking of the consequences?

From the nurses I have spoken to I think we have evidence that the profession is still being taken for granted. And I think it’s fair to assume that nothing will change unless something forces it to.

Those who are too busy to give their patients water, write up their records or provide pain relief in a timely manner know there is a case for setting mandatory ratios. So why aren’t there more people who recognise the benefits of properly resourcing their teams?

It’s not all bad news. We know there are good stories out there, so don’t miss your chance to share them. The Nursing Times Awards deadline has been extended to 6 July, so enter today at


Readers' comments (16)

  • While I think this is important it will neglect one important part of nursing.
    The average nurse to patient ratio in Emergency Departments.

    The majority of ED's are completly under resourced for the number of patients they see. Eight level 2-3 pt's to 3 nurses sound safe to anyone?

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  • This is an excellent idea and one that the Private Sector have been subject to for the past 20 years. It is also monitored, in the Private Sector, by the Care Quality Commission, and that must apply to Hospitals also. Otherwise it is pointless to introduce this change, if there is to be no audit trail.

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  • I work in the private sector for a day surgical unit that looks after NHS patients and I have had to look after 12 patients to 1 nurse!
    we don't have patient to staff ratios! the only reason I am not looking after twenty patients is because we don't have enough beds!!
    The nurses that work for this company stay on average 6 months before they are burnt out and realize how much they put themselves at risk!

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  • The evidence is and has been out there for many years. There is no more need for further evidence research or trials that patient and staff safety in acute healthcare settings should be RN1:4- 1:5 and mandatory.

    We have had those ratios for years now, but they were not mandatory. Hence we have just fought a 7 month blood battle with State Government to actually keep ratios.We kept ratios and stopped the introduction of healthcare assistants as numbers into the acute health sector.
    We have been told by governments opposing side that the first thing they will do for nurses will make Ratios mandatory if they win the next election.
    Nurses have amazing memories and we will be holding them to this promise in the election which is 2 years away.
    We fought to maintain patient and staff safety this time and we will fight again if need be.

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  • michael stone

    'From the nurses I have spoken to I think we have evidence that the profession is still being taken for granted. And I think it’s fair to assume that nothing will change unless something forces it to.'

    Jenni, who was the 'we' in there - is it Nursing Times ?

    And, if it NT, and you do have the evidence, has NT passed the evidence on to the DH ?

    Moan, at the people who can actually, perhaps, change things - talking amongst yourselves, isn't very effective as a lever for change.

    'Or will they continue to flog their nurses and overstretch them just because they can?'

    'Just because they can' is nearly always the thing you end up fighting against, when it gets to the crunch - you need to work out how to apply some pressure, to the 'they'.

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  • Trying to nurse acute medical patients with confused patients at risk of falls is an impossible task. Our ratio is 1:10 in the day time and 1:15 at night. If anything is missed or a patient falls it is looked on as our fault. Yes I would welcome mandatory staffing levels as it could't get any worse could it?

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  • It isn't just in hospitals - primary care and particularly in the community need to have high nurse/patient ratios - to provide excellent care and continuity. Especially as we often read about the ageing population, need to remain in the community etc. etc.

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  • our ratio on a late and night is 1 RN to 12 acute medical patients, it's really hard work and we are all at breaking point.

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  • I work in a rural community mental health team working with very difficult people. All the nursing models I've looked at suggest I should care coordinate 6-8 people, even the urban model says 10-12. Currently I coordinate 20. So although I welcome this initiative but wont hold my breath. When I worked in the private sector the Care standards commission set the ratio for elderly care at 1 qualified staff to 8 patients during the day. This was at a time when recruitment was difficult. Their answer to the problem? Increase the ratio to 1:10.

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  • Nurses are disrespected due to politicians being out of reality. Patients appear neglected because of staff shortage putting nurses registrations at risk. I think a national strike would do the trick. Guess who gets the blame again.

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