A new report from the Royal College of Nursing (RCN) says that staffing levels should be given much higher priority throughout health organisations, given the clear link between failing care and poor staffing levels. In order to help healthcare providers look at their staffing needs the RCN has published a range of indicators that need to be monitored by providers, commissioners and regulators.
The report examines staffing levels and skill mix in hospitals, care homes and the community. It highlights evidence proving a link between staffing levels and patient outcomes, including a study reporting a 26% increase in mortality rates for patients in hospitals that have the highest patient to nurse ratios. Two-fifths of nurses in the UK report that care is compromised at least once a week due to short staffing.
The report looks at how many patients are cared for by nursing staff. While there is no overall recommended figure, the research shows that NHS wards where care is compromised daily due to short staffing, have twice as many patients per qualified nurse, compared to those where care is not compromised – an average of ten versus five on the uncompromised wards. With the average NHS hospital ward having a ratio of eight patients per qualified nurse, this raises potentially serious questions about how frequently patient safety is put at risk.
The report also highlights skill mix changes on NHS wards over the last five years. In 2005 the average - which is the RCN benchmark - was 65% qualified nurses to 35% who were not. This figure fell between 2005 and 2009 when qualified nurses accounted for an average of 60% of nursing staff.
The RCN reviewed evidence from a range of NHS wards by specialty. Paediatric wards have on average a richer skill-mix and care for fewer patients per nurse than other specialties. At the opposite end of the spectrum, qualified nurses make up less than half (48%) of the nursing staff on older people’s wards, and the average ratio is 11 patients per qualified nurse. Similarly, on mental health wards the mix of qualified nurses to all nursing staff is also lower than average, at 50%, with an average ratio of nine (9.2) patients per qualified nurse.
Dr Peter Carter, chief executive & general secretary, said: “We have seen time and again examples of failing care when poor staffing levels have been the key factor. With NHS beds running near to capacity it is absolutely vital that staffing levels are prioritised – this means collecting the right information to get the base level right as well as continuing to monitor and maintain safe staffing levels. We are urging all healthcare organisations to have the mechanisms in place to make sure staffing levels are prioritised from board level through to having robust arrangements on the ground to collect information.
“Our research raises challenging questions for more vulnerable services such as mental health and older people’s care. Where these services are concerned there needs to be further examination around what appear to be relatively low staffing levels on wards. With cuts starting to bite on the frontline we are worried that the picture may only get worse over the coming period.”
The RCN indentified the following key indicators which need to be routinely monitored by providers, commissioners, and regulators:
• Actual nursing staff in post as a proportion of total establishment
• Proportion of registered nurses as percentage of total nursing staff
• Nursing staffing relative to population served
• Nurse staffing relative to patients
• Staff turnover and sickness absence
Guidance on safe nurse staffing levels can be downloaded from www.rcn.org.uk/publications
