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Let’s not mistake ‘safe’ staffing for therapeutic staffing, congress urges RCN

Therapeutic relationships need more than just safe staffing, mental health nurse warns

Simply having safe staffing levels is not good enough for therapeutic settings, the RCN congress in Belfast was told.

Nurses spoke of the importance of taking time with mental health patients and expressed concern about the implications of safe or minimum staffing numbers for these therapeutic relationships.

Leading the discussion, RCN mental health forum chair Ed Freshwater, who is a community mental health nurse, said: I know in my practice that a chat over a coffee is as important as doing baseline observations.

Spending time listening to someones fears and dreams, anxieties and hopes, can be as vital as a surgical procedure. Being too busy to listen to someone is a clinical incident that can lead to harm.


Edward Freshwater: ‘Listening to someone’s fears and dreams, anxieties and hopes,
can be as vital as a surgical procedure. Picture: John Houlihan

Simply having safe staffing levels is not good enough for therapeutic settings, the RCN congress in Belfast was told.

Nurses spoke of the importance of taking time with mental health patients and expressed concern about the implications of safe – or minimum – staffing numbers for these therapeutic relationships.

Leading the discussion, RCN mental health forum chair Ed Freshwater, who is a community mental health nurse, said: ‘I know in my practice that a chat over a coffee is as important as doing baseline observations.

‘Spending time listening to someone’s fears and dreams, anxieties and hopes, can be as vital as a surgical procedure. Being too busy to listen to someone is a clinical incident that can lead to harm.’

Too blunt an instrument

Mr Freshwater said having only safe staffing levels meant more of these interactions fell by the wayside.

‘That requires having more staff than just covering the paperwork or dishing out the drugs,’ he said. ‘Inadequately staffed teams have to cancel activities, a daily occurrence for many of our members.’


Becky Hoskins: Patients need
compassionate, effective care. 
Picture: John Houlihan

In the UK, safe staffing legislation has currently been introduced only in adult acute medical and surgical wards in Wales, with Scotland planning to follow suit. As part of its implementation, Wales is also trying to determine appropriate staffing levels for mental health inpatient services.

Congress expressed concern about using what some see as such a blunt approach to mental health staffing, leading to a vote urging the RCN to commission research into therapeutic staffing levels.

Compassionate, dignified and effective care

Becky Hoskins, also a member of the mental health forum, told congress: ‘I listened to Janet Davies [on Sunday] making a commitment to lobby for safe staffing levels in law and heard the clapping and cheering in this room resonate.

‘But for me, working in mental health, this just isn’t enough. We need to make sure that staffing levels in all areas of healthcare are not just safe but allow our patients to receive the necessary, compassionate, dignified and above all effective care.’

Ms Hoskins gave three examples of what she had had to tell patients because having only safe staffing levels, the bare minimum of staff, meant she had been unable to deliver therapeutic care:

  • ‘I can’t take you to see your new flat today and start helping you get ready for your discharge because we only have safe staffing levels.’
  • ‘I can’t take you to visit your mum at home today as we haven’t got enough staff.’
  • ‘I’m not able to sit down and talk to you right now about your care and treatment as I’m needed to go and help a ward next door. I’ll be back later.’


Laura Falconer: Minmum staffing
isn't enough. Picture: John Houlihan

Laura Falconer, of the inner north central London branch, also spoke in support of the motion but said the issue was larger than just mental health.

‘I don’t want to detract from the very important research and attention that mental health needs,’ she said. ‘However, therapeutic relationships happen in other areas too.’

Target to aim for

Ms Falconer urged congress to consider the wider implications of research into therapeutic staffing levels.

‘When this research is complete it must be utilised to ensure safe therapeutic staffing across all the specialities because safe minimum staffing levels isn’t enough,’ she said.

In his closing remarks to the debate, Mr Freshwater admitted that at a time when nursing was facing a recruitment and retainment crisis, looking at one discipline might seem unusual.

‘Perhaps it’s naive for us to be chasing an understanding of therapeutic practice in the face of such pressures,’ he said.  ‘But without a target we’ve got nothing to aim for.’


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