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RCN outlines staffing needed for 'safe' care of older people


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.


Readers' comments (3)

  • Good iseas but that;s all they are. Cut backs Mr. Carter, cut backs in NHS! Nursing homes would have tp increase fees which would mean less would afford care! Solution to prob's is more employment in production industry and so more tax, NI payments and, hopefully. RCN DREAM mightr come true

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  • not much good in just increasing numbers of the staff don't have the right specialist skills and on going training to keep abreast of new developments in the care of the elderly.

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  • This is excellent, but what about out in the community? Many admissions to hospital many be avoided in the first place if there were adequate staffing in community nursing homes, allowing for proper care to be completed.
    There does not seem to be any real guidance on safe staffing levels for Nursing homes, meaning residents are allowed to become unwell, as avoidable things are missed or mismanaged under the huge burden of providing basic care, in chronically short staffed areas.
    This is frustrating for the staff who work there, for the residents and their realatives as well as costly for the NHS.
    Please publish similar guidance for the care of elderly people in the community.

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