Don’t Make Minimum the Norm – why staffing ratios need to be managed at the bedside.

By Gail Beer, Director of Operations, 2020health

Calls for the government to set minimum levels of nursing staff per ward hit our headlines today.

There is no doubt that a ratio of 15 patients or even eight patients to one trained nurse is not safe. It is argued that a minimum of six patients should be allocated to one nurse.  While all this is sensible, before we hand over the rostering of nurses to DH or NHS England we should think carefully about setting minimum standards.

As an ex-ward sister I would argue that on some days of the week having five trained nurses on an early shift was quite adequate, whereas on others it was far too few. My fellow ward sisters and I would make sure we covered shifts with suitably qualified people,  making sure that our patients were cared for properly and that our staff were working in a well supported environment. By mixing up the expertise and skills, providing support to juniors and enabling staff to take on more responsibility,  not only were we  thinking about  the needs of patients today but making sure we were training nurses who would be able to care for the patients of tomorrow.

The Sister or Charge Nurse has to know their ward and its busy quieter times, they need to know their staff and their strengths and weaknesses and cover  three shifts, seven days a week to enable high quality care to be given. To do this that they need the right tools,  the right  skill mix and the powers to  manage  their ward; it goes without saying that having the privilege to do this requires  Sisters and Charge Nurses to shoulder the responsibility  for providing high quality care.

It is the ward Charge Nurse /Sister who should determine the right level of staff for his or her ward, they may have to justify it but at the end of the day only they really know when they need one trained nurse per six patients or seven.

 The trouble with setting minimum standards is often they do become the standard. Wards vary in need and seniority of staff, according to speciality, day of the week, and the acuity of the patients.  The people best placed to determine this are ward sisters and charge nurses.  Give them the tools  and the authority to do the job and  put determining staffing levels where  they belong  at the bedside.

Ward sisters and charge nurses need to be given the tools to do the job and the authority to do it.

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