Nurses’ views bypassed in higher-level staffing decisions

Data given precedence over nursing judgement for strategic staffing decisions, at the cost of patient care, study finds

Data given precedence over nursing judgement for strategic staffing decisions, at the cost of patient care, study finds

A photo of four nurses sitting at a meeting with one speaking to unseen people on the other side of the desk
Picture: iStock

Nurses have described how their professional judgement and requests for more staff on the ground are often bypassed when it comes to high-level decisions on staffing levels.

A study led by researchers at Cardiff University found nurses’ opinions and judgements were valued and relied on when it came to managing day-to-day staffing issues, but did not carry the same weight when it came to agreeing staffing at a strategic level.

Nurses’ views overlooked when strategic staffing decisions are made

This means that while staffing levels may be safe, they do not necessarily allow nurses to deliver the best quality care, the researchers found.

The fact nurses did not feel listened to when they asked for more staff had a negative impact on job satisfaction and morale, increasing the risk of nurses leaving, they warned.

The Pro-Judge study, funded by the RCN Foundation, focused on three NHS trusts in England and three health boards in Wales. The findings are based on interviews with senior nurses, ward managers, matrons, directors of nursing and other NHS managers. The research team also observed staffing meetings and analysed relevant documents.

Data on nursing capacity does not reflect the reality or complexity of staffing needs

The study suggests that data used to determine nursing capacity does not always reflect the reality of busy wards or capture key aspects of quality care and staff well-being.

Nurse respondents also said they struggle to explain or quantify the need for extra staff in economic terms.

‘It’s more than the data isn’t it? It’s what’s going on here and now,’ said one nurse manager who took part.

A divisional director of nursing said: ‘You’re saying you need two more nurses because your ward is very busy. When they ask you ‘That would be a cost pressure and what will they be doing?’, it’s subjective.’

A corporate director of nursing added that the staff well-being benefits, including having enough people to enable staff to have breaks, ‘are things you can’t really measure’.

Nurses need guidance in articulating staffing needs, says study lead

Cardiff University school of healthcare sciences study lead Davina Allen said: ‘Healthcare systems lean on nurses' professional judgement for operational staffing decisions, valuing their real-world understanding of clinical environments over data. However, when it comes to strategic decision-making, data takes precedence over professional judgement.’

She said more guidance is needed for nurse managers on how to successfully articulate their staffing needs. The way data is collected should also be refined to better reflect the complexity of care and nursing workloads.

RCN Foundation director Deepa Korea added: ‘With nurse retention rates and staff shortages at a critical rate, it is fundamental that we use nurses in the workplace, giving them the tools to empower themselves and appropriate their professional judgement, ensuring that their voices are heard.’

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