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Trish Morris-Thompson: 'Nurses are uniting to demand safe staffing levels – join us'


We must not allow care to fail due to our lack of courage as leaders, says Trish Morris-Thompson

Unprecedented unity between senior nurses is taking place in the demand for mandatory safe staffing levels. Nurses have come together to form the Safe Staffing Alliance as a response to the increasing anxiety expressed by the profession and the public regarding staffing levels.

There has been much debate about staffing ratios on NHS wards. The primary focus of media attention is on acute hospital wards. However, the challenge that exists within the profession relates to all service areas.

The debate stems from Robert Francis QC’s report on how poor staffing levels were found at Mid Staffordshire Foundation Trust and has also been fuelled by recent surveys by Nursing Times and the Royal College of Nursing. Added to all of this is the anecdotal evidence that has come from frontline staff.

“We must push for mandated minimum staffing levels now’”

The RCN survey found: a quarter of hospital wards are operating with unsafe staffing levels at least once a month; a
third of respondents reported evidence of unsafe staffing levels on a weekly basis; and one in ten reported that this occurred on every shift. Unison has also reported a similar anxiety within the profession regarding staffing levels being unsafe on a regular basis.

To provide safe, high-quality care it is clear there is a need for mandatory staffing levels. To date, the Department of Health, NHS England and the Care Quality Commission have declined to enforce ratios, stating this is the responsibility of trusts. However, we have ratio standards for children services, intensive care units and maternity services, which were nationally led. Why not adult services too?

The formation of the Safe Staffing Alliance in response to the above conundrum is a timely reaction. We are a group of nurse leaders and key opinion leaders who have come together to source evidence where it exists and to make recommendations where they are needed.

Professor Peter Griffiths, chair of health services research at the University of Southampton, is a key researcher in this area and is also a member of the alliance. He has published much work that demonstrates the correlation between staffing numbers on mortality and length of hospital stay.

Other countries, for example Australia, as well as some states within the US, have mandated staffing levels. The current turmoil the NHS is experiencing due to a new untested organisational structure and an increase in demand would indicate that we must push for mandated minimum levels now. We must not allow care to fail due to our lack of courage as leaders.

This alliance will work with the profession and the NHS to campaign for minimum staffing levels. The National Institute for Health and Care Excellence has been tasked with providing guidance on staffing levels. We, as an alliance, have offered to work with them on this. In addition, we have met with health minister Dr Dan Poulter to push our case forward and a further meeting is planned.

As an alliance, we have stated that under no circumstances is it safe to care for patients in need of hospital treatment with a ratio of more than eight patients per registered nurse during the day on general acute wards, including those specialising in care for older people. Registered nurses must at all times be supported by a sufficient number of healthcare assistants and a senior registered nurse in charge of the ward.

There, we’ve said it. Now let’s join forces and demand it.

Trish Morris-Thompson is visiting professor of nursing, Buckinghamshire University; RCN clinical fellow; trustee of the Florence Nightingale Foundation; and patron of Britain’s Nurses


Readers' comments (18)

  • 8 patients could be manageable, as long as all the RNs are drug assessed, IV assessed, able to look after 8 patients themselves, able to take over and offer support when a patient becomes acutely unwell and are confident in their chosen 'speciality' (if that even exists any more). fine if there is a supernumerary shift co-ordinator and ward manager. if not then it's a paper exercise.

    what about the night, weekend and bank holiday ratio? - patients get very poorly when there are fewer staff around, don't fool yourself into thinking you will get support from any other wards or the site managers.

    just out of interest where are all these nurses that we need coming from?

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  • Great - and very good that leaders are leaeding but please take account of the comment above - not all RNs are equal and acute care should be a 24 hr service.

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  • Its all very well to have an Alliance and talk to nicely to NICE, but the Alliance MUST speak and tell the public what is going on.

    The reason the Government isn't doing anything is because the Trusts are in control of recruiting nurses. The Government has cut and cut budgets so where will the Trusts get the money to recruit new nurses?

    You see, the system isn't working.
    Nobody will admit that directly.
    How many Trusts have spoken out openly that they have too few nurses to keep patients save?

    The Government will say "That is how the Trusts chooses to spend their money"

    Why doesn't the Government admit to nurse staffing levels?
    Once the Government decides to enforce these levels, the Trusts will simply say "We want the money to recruit more nurses otherwise we cannot staff wards safely".
    And who will pay?

    NICE will give advice, recommendations on safe staffing levels but it cannot enforce these.

    Australian Nurses went on strike.
    Will the Alliance recommend strikes?
    Will the Alliance tell the public about all this?
    The Alliance works inside the Health Service.
    It needs to work with the public outside the Health Service to get anything done.

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  • tinkerbell

    i will join the alliance in a heartbeat.

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  • Marc Evans

    There seems to be a focus on NHS, What about Nursing homes and private health services. There is still a need to deliver high quality care in those areas and staffing can sometimes be a massive issue too. I have seen one RN and four HCA's to 30 residents, very unsafe and it compromises care delivery.

    I am lucky in the Nursing home where I work at the Moment, we have two RN's to 29 residents with 6-7 HCA's. This is a comfortable level and care delivery is at a high level. There are always going to be management pressures to cut costs but at what cost to our patients?

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  • tinkerbell

    You can always report concerns about staffing levels and lack of care to CQC if management won't listen. You can even remain anonymous.

    Just inform them that due to low staffing levels patients lives are being put at risk.
    Nothing to lose and everything to gain, give them a ring.

    It's quite easy to do.

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  • I welcome the initiative but I feel the reality is the Safe Staffing Alliance is just another voice for the coalition to ignore. It's going to take forceful action from the major unions like the RCN and Unison to see change here and it appears the chances of that happening are just the near side of never.

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  • tinkerbell

    then we must make our own reality and not one that is dictated to us. We are allegedly still living in a democracy. If each and every one us joined forces to do the 'right' thing and make it happen and this is a step forward in the process for speaking out.

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  • tinkerbell

    those who say it can't be done shouldn't stand in the way of those who are doing it.

    'Well done' is better than 'well said'.

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  • tinks - how can I report what I believe to be unsafe staffing and skill mix to the CQC, do you know if they investigate it. This is a genuine question, I've looked up their web site but don't seem to get very far, can we also report to the safe staffing alliance? does anything actually get done if we do report it.

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