More than eight patients per nurse ‘increases risk’
An NHS watchdog recommends a ratio of no more than eight patients for every hospital nurse. But the target will not be mandatory.
The National Institute for Health and Care Excellence (Nice) has drafted new guidelines on staffing levels for adult inpatient wards in acute hospitals in England after the Francis Inquiry into failings at Mid Staffordshire NHS Trust.
The watchdog said there is more risk of harm with a lower ratio of nurses to patients, but stopped short of saying one to eight was an absolute minimum, saying hospitals need flexibility over day-to-day staffing.
A Nice spokesman said: “The draft guideline recognises that if each registered nurse is caring for more than eight patients during the daytime on a regular basis, there is an increased risk of harm.
“It stresses the importance of checking if patient needs are adequately being met in these situations.
“The lead nurse should consider any ‘red flag events’ as indicators of the ward becoming in danger of being under-staffed and therefore tailor the number of available nursing staff as needed.”
Red flag situations include patients not being provided with help to go to the bathroom, not being asked about their pain levels or delays in providing medicines.
Professor Gillian Leng, deputy chief executive and director of health and social care at Nice, said: “There is no floor or ceiling number on the required number of nursing staff that can be applied across the whole of the NHS.
“What the safe staffing advisory committee concluded was that assessing patient needs was paramount when making decisions about the number of nursing staff and planning should allow for flexibility on a day-to-day or shift-by-shift basis.
“This guideline is an important step forward in addressing the issues of having adequate numbers of nursing staff within the NHS.”
Peter Walsh, chief executive of patient safety charity Action against Medical Accidents, said: “More than eight patients per nurse on acute wards is definitely unsafe – so why shouldn’t it be mandatory not to exceed that ratio?
“The Care Quality Commission should now use this guidance and include clear requirements on staffing in its standards and enforce them.”
Dr Peter Carter, chief executive of the Royal College of Nursing (RCN), said: “We are encouraged that these guidelines have been created – following considerable and consistent evidence from the RCN of the danger to patients where there are too few staff.
“They underline what we already know – that a registered nurse caring for more than eight patients under these circumstances is a cause for concern – in many cases, considerably more nurses will be needed.
“Hospitals simply can’t deliver what today’s patients need if they are staffed for care from another century. Too often, staffing levels are allowed to yo-yo because of finances, and this puts staff under strain and patients at risk.
“For any patient to receive substandard care is unacceptable. Nurses will be hoping that once the full set of guidelines is completed, the NHS will never again be so vulnerable to short term financially driven decisions about patient care.”
A Department of Health spokeswoman said: “There are over 5,100 more nurses on our wards since 2010 and in response to the Francis Inquiry we have been tough on insisting on compassionate care in our hospitals.
“We have increased the NHS budget in real terms and are clear that hospitals must balance their books whilst ensuring compassionate, quality care for all. We know this can and is being done – safe staffing levels lead to better care and can save the NHS money.”