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