The Importance Of Safe Staffing Levels

In this video, Lillie, a student Nurse, talks us through how staffing levels affect both Nurses and patients alike, not just affecting staff morale but also the quality of care provided.

Hello. My name is Lillie and I am a second year student Nurse from Newcastle.

And today I am going to be talking to you about the ‘importance of safe staffing levels within the NHS’.

The Affects Of Inadequate Staffing Levels

It’s well documented that safe levels of Nursing staff, within the NHS, is associated with improved outcomes for both patients and staff. 

For example such as lower mortality rates, higher patient satisfaction, shorter hospital stays and increased staff morale.

So why are 8 in 10 shifts under staffed?

The Royal College of Nurses stated that currently, “Eight in 10, which is 83%, of Nursing staff who responded to their survey, said there weren’t enough Nursing staff to meet all patient needs safely and effectively on their last shift.”

This is extremely worrying as understaffed wards can lead to several negative consequences, such as; a delay in administering critical medications; documentation of Vital Signs being missed; a delay in patient checks, such as personal, pain management, placement of water and comfort.

Inadequate staffing levels also have a negative effect on staff.

The RCN revealed that "59% of staff said they felt upset that they couldn’t provide the level of care they wanted."

As Nurses we want to give the best possible person centred care, it’s the reason we all decided to be nurses, to care for those in need. However staffing issues is standing in the way of this want.

Lessons Learned From Past Experience?

Next, I’m going to talk through some of the history behind NHS staffing levels.

Research and concerns regarding safe staffing within the NHS have been discussed for many years.

However, the importance of safe staffing levels was brought to the forefront upon the Mid Staffordshire hospital public inquiry in 2013.

This public inquiry concluded that a structure and culture of decision making was deeply flawed and resulted in serious failures to occur.

The government reviewed this inquiry and subsequently agreed with its findings that suggested a fundamental review of parts of NHS England.

The inquiry also highlighted that Nurse staffing levels had been neglected, with the trust’s priority focused on controlling finances, and subsequently disregarding patient safety.

Following this inquiry, national policies and guidelines were produced, leading to fundamental changes within the NHS, ensuring staffing levels were safe to protect patient’s safety.

Alongside the structural and cultural problems of Mid Staffordshire, the implementation of austerity measures, are thought to play a part in the Mid Staffordshire failings.

Following the 2008 global financial crisis, the government imposed national austerity measures where the NHS were expected to make savings of up to £20 billion.

At the time, concerns were raised about potential negative effects on staffing, but no policy regarding staffing was introduced.

As for staff retention and attracting new Nurses. The latest figures from the Nursing and Midwifery Council (NMC) have shown that the number of new Nurses coming from the EU to work in the UK has dropped by 87% from 6,382 in 2016/17 to 805 in 2017/18.

The NHS relies quite heavily on workers outside the UK to make up for the shortfall in staff.

Alongside loosing staff from the European Union, staff retention also has a part to play in staffing levels.

Research suggests that NHS staff are leaving due to a deterioration in their professional environment.

The shortage of staff means that those who chose to remain within the NHS, working conditions have worsened. Therefore, causing even more staff to leave.

This chronic shortage of staff means that conditions for those remaining have worsened, thus prompting ever more staff to leave.

While the number of NHS Nurses in June 2021 were over 300 thousand. This figure has increased significantly since the birth of the NHS in 1948, but this figure does not keep up with modern healthcare requirements, such as an increased population and ageing.

Current Issues With Staffing Levels

I’m going to talk through some recent examples of the staffing crisis within the past few years, just to paint a picture of what the reality is in nursing up and down the UK.

In Jan 2021, the RCN released a statement expressing that they were seriously concerned about staff wellbeing and patient safety with ITU as they were running considerably beyond their capacity.

Usual Nurse to patient ratios in ITU are 1:1, whereas Nurses were having to work with multiple patients to meet demands.

This creates pressure on Nursing staff and becomes harder to provide safe care to patients.

But the shortage isn’t limited to ITU, the same shortage has been seen across an array of wards, up and down the country.

For example, Glasgow’s Queen Elizabeth University Hospital saw that there was 1 registered Nurse in the whole ward and this was across a number of different wards, such as, gastroenterology, rheumatology, and diabetic wards.

Results from a survey from the RCN showed that only a quarter of shifts had the planned number of registered Nurses. 

This means that essential care can be left undone - patients wait for longer for treatment and vital services remain undelivered. When a ward or community setting is short staffed, those delivering care have no option but to carry on or to leave the profession. This ongoing pressure is unsustainable.

What Are Safe Staffing Levels?

Although NICE doesn’t state an exact golden number of qualified nurses within their guidelines. It does highlight a number of ‘’red flags’ for nurses to watch out for.

Such as;

- Unplanned omission of medications (this is crucial as some medications, such as Parkinson’s meds are time critical). It can be really detrimental to the patient if delayed or missed.

- Patients having to wait more than 30 minutes for pain relief (This is really important, as Nurses we want to help people and help manage their symptoms such as pain.Pain management is really important as a nurse. It can be a pretty straight forward task to give someone pain relief for their pain. So, it can be quite frustrating not being able to achieve this task.

- Vital observations such as blood pressure and heart rate are missed (This is also a really important red flag as vital observations give us insight into a person’s clinical conditions and allow us to escalate care when necessary and appropriate.

- Delay in patient checks. This is really important because as nurses we need to uphold people’s dignity. If patients are left unchecks, they may become uncomfortable and pressure sores may develop.

My Experience As A Student In An Understaffed Ward

Sometimes it can feel like you’re missing out on key learning opportunities.

And sometimes feel as if Nurses simply don’t have time to show and explain things in the detail they’d like.

Spend a lot of time levelling patients, ensuring they are safe and don’t fall. Although I accept that this is part of the role and very important to keep patients safe.

Students are supernumerary and aren’t counted in the numbers. Therefore, it can feel a bit frustrating at times being counted in the numbers to be used on bay watch.

You feel like you can’t give the care you want to give due to time restraints and shortage of staff.

There’s also been times where I’ve missed breaks.

Which is really detrimental.

As Nurses and health care professionals, we work long shifts.

So, it’s really important to get that break in order to rest and recuperate. Even if it’s just for 30 minutes.

Although this issue of safe staffing is really complex. The Royal College of Nursing is campaigning for change.

It wants The Secretary of State for Health and Social Care to undertake and publish a detailed assessment and analysis of future workforce demand and supply requirements for all health and care services across England.

The RCN also focuses on the expansion in the number of Nursing students and full financial support including abolition of self-funded tuition fees, and grants that reflect the real cost of living.

A lack of financial support for students on Nursing degrees has resulted in a worrying decline in the number of people applying to study Nursing in England.

The RCN also suggests that employers and the government to retain the current Nursing workforce, through improved pay, terms and conditions.

My Conclusions Aren't Suprising

Nursing staff are the heart of our health and care services.

We work across wards and the community.

We care for those in need and keep people safe to the best of our abilities.

But the simple truth is, there are not enough Nursing staff to provide the care that patients need.

If Nurses were paid fairly and working conditions were kinder, we wouldn’t have such a crisis in staffing levels.

This shortfall in staff could be solved by abolishing tuition fees, and reintroducing grants that reflect the cost of living.

Nurses work really hard to keep people safe and provide patient centred care, Nurses deserve higher pay and would also help attract more Nursing staff.

I hope you enjoyed my video and that it showed an insight into what it’s like being a nurse in the UK at the moment.

Thanks for watching.