The Royal College of Nursing has specified precise recommendations around staffing numbers and skill mix for wards caring for older people.
The key recommendations of its report, which is to be published in full in a few weeks, are to increase the nursing staff to patient ratio from its current average level of 1:4.6 in older people’s wards. The college warns that ratios this low are endangering patients.
A ratio of between 1:3.3 and 3.8 the college considers to be ideal for good-quality care.
Other recommendations include increasing the skill mix between registered nurses and healthcare assistants from 50:50 to 65:35. It also recommends increasing the registered nurse to patient ratio from 1:9 to be at least 1.5–1.7 and increasing the number of RNs on shift from three to 4–6, and making the total staff on duty at least eight in total.
The recommendations are for an average 28-bed ward and were based on a survey of 300 nurses across the UK who worked in care of older people in acute settings.
There are also recommended numbers for “basic, safe care” although this is not considered “ideal care”, and the report says current numbers and figures are not safe for patients and will cause staff burn-out.
Speaking at an RCN congress fringe event last night, Nicky Hayes, older people’s advisor for the college, said the spate of reports by the Patients Association, Care Quality Commission and the Commission on Dignity and Care over the past two years had triggered the RCN’s work in this field.
“It’s time to draw a line under the negative stories,” she said. “And focus on the positive. We want to give nurses a toolkit to help them do that successfully. We have to pin it down, or we won’t get satisfaction on this.
“You heard Andrew Lansley say this morning that nurses need to tell their managers when there are not adequate numbers, and we wanted to help you do that – with something that provided an evidence base so you wouldn’t just be seen as whingeing.”
Nurses present at the event said they supported the RCN’s activity in this area. One nurse talked of standing alone in her hospital to try to increase patient numbers, while her colleagues cautioned her to “keep quiet or you will lose your job”.
Others said things had not improved “since the days of [pioneering nurse whistleblower] Graham Pink”, with some nurses claiming that only six staff were looking after 30-bedded wards.
Ms Hayes stated that government, managers and commissioners needed to be made aware of the greater need for increased nurses on older people’s wards because of the complex needs – with patients often being frail, at greater risk of falls, as well as having dementia or delirium.
“Our survey found that nurses enjoy nursing older people, but we must be able to say when the caseload is too much, just as a social worker or doctor would,” said Ms Hayes.
She told Nursing Times her research had discovered some really good care and she now wanted to share that best practice.
But she warned some other stories showed “very distressed nurses who were burnt out” with “harrowing” stories of nurses “struggling” in wards that were operating with “highly dangerous numbers”.
The RCN summary and guidance on safe staffing for older people’s wards are available to download at the RCN website. The report in full will be published later this year.