Safety critical red lines

When there are too few nursing staff, they can be stretched dangerously thin. With tens of thousands of vacant nurse posts across the UK right now, this happens too often. We know one nurse can be left caring for 10, 12, 15 or more patients at a time.  

It’s not safe. It’s not effective. And it’s not acceptable.  

That’s why, this week, the RCN held its first ever safe staffing summit, bringing together global nursing workforce experts with senior nurses across the UK to agree a vision for the future and how to fight for it.  

We heard compelling evidence about the impact of safe nurse-to-patient ratios, set in law in other countries, where there are limits on the number of patients one nurse can safely care for.  

Places like Queensland in Australia, for example, which first implemented nurse-to-patient ratios in 27 public hospitals in 2016. Ratios there specify an average of 1:4 on day shifts and 1:7 on night shifts in acute adult medical-surgical wards.  

Within the first two years, 145 patient deaths were avoided, 255 readmissions were avoided, and 29,222 hospital days were avoided with an estimated cost saving of $20 million US dollars.  

Yes, this is about costs. Yes, it’s about patient safety. But it’s also about nurses. Safety critical, highly skilled, degree educated, experienced nurses, who in the UK are being treated with such disregard.  

At the summit, we heard the findings of another global study on nurse burnout. In that, out of six countries, nurses in England have been shown to have a significantly higher level of burnout, intent to leave, job dissatisfaction, poor work/life balance, overall poor health, high anxiety and depression. 

We must not stand for this. The same study showed the most effective way to tackle nurse burnout is to improve staffing levels. So, let’s do something about it.  

We can’t sit back and accept the status quo anymore. For too long, nurses have been too polite, too accepting. We must fight for the future we want to see, and for me that’s safe nurse-to-patient ratios implemented in every care setting, in every part of the UK.  

Of course, every part of the UK is in a different place when it comes to staffing laws and each should learn from the other as well as look to the best examples internationally. Our strength as a UK-wide organisation will be to share the evidence across our different health systems and use our international relationships for guidance. 

I'm under no illusions about how difficult our goal may be to achieve, and I acknowledge concerns about ratios being a “race to the bottom”, whereby setting a safe maximum number of patients could mean optimum numbers are not achieved. But this being difficult can’t mean we do nothing, and evidence shows that where ratios have been implemented, it establishes minimum staffing levels only, with variation in nurse staffing numbers maintained across hospitals.  

This was the case in California, where ratios have shown not to reduce professional nurse judgement about appropriate staffing as there is no upper limit to the number of nurses required to care safely and effectively for patients. In fact, evidence from California shows that hospitals with staffing levels above the required minimum prior to ratios being introduced did not revert to the minimum afterwards, but continued to staff above.  

Introducing safe nurse-to-patient ratios isn’t about insisting “one size fits all” and it isn’t about taking professional judgement away from the nurse leader on how to staff their area. It’s about establishing minimum requirements only and supporting nurses with a safety critical red line under which staffing levels should never go.   

The nursing workforce in the UK today is in dire need of investment. We’re still running at one in ten nurse posts vacant and there’s untenable pressure on staff. We need drastic action to remedy this situation.  

While optimum levels of nurse staffing may differ from one setting to the next, knowing what danger looks like is consistent. It’s up to us to set that safety critical red line when it comes to how many patients we’re expected to care for.  

Nursing has the solutions, and we will lead this change. Will you join us? 

Our campaign for safe nurse-to-patient ratios is still in the planning phase, but we need all of you to play your part - and that begins with evidence. Over the coming weeks and months, we'll be asking different parts of our membership to provide us with vital data on staffing levels, your pay, your day-to-day experiences at work and the cost of living. We want to paint a full picture, covering every aspect of your lives, giving us indisputable evidence to make our arguments.  

We want you to come on this journey with us. Become an RCN campaign supporter and be kept up to speed with the latest developments and suggestions of things you can do to help our cause. With half a million RCN members, together we can be a powerful force for change.