Paediatric inpatient safe staffing guidance published in Wales

Principles for nurse staffing levels designed to prepare employers for change in the law

Principles for nurse staffing levels designed to prepare employers for change in the law

Picture: John Houlihan

Guiding principles for nurse staffing levels in paediatric inpatient services have been published by the Welsh government.

They state the ratio of nurses to patients should not fall below one to four, equating to providing an average of six hours of care per child per day.

Preparation for a change in the law

The interim guidance is designed to help health boards prepare for the extension of the Nurse Staffing Levels (Wales) Act to paediatric inpatient services.

Details of the principles are set out in a letter by chief nursing officer Jean White to health boards chief executives, nurse directors, directors of workforce and organisational development and directors of finance.

Principles include:

  • There should be a minimum of two nurses rostered at all times, one of whom is competent to be team leader. This should not include a ward sister, charge nurse or manager.
  • All health boards should have protocols to escalate situations where staffing falls.

Nurse Staffing (Wales) Act 2016

The act aims to ensure adult acute surgical and medical wards have adequate nurses to care for patients.

It requires a senior nurse to calculate a staffing level for their workplace using a range of criteria. The formula should allow for flexibility when circumstances change, for example in the event of sickness absence or maternity leave.


RCN Wales associate director (interim employment relations), Nigel Downes, said the college is concerned about implementation.

‘We are mindful of how long it has taken for the interim guidance to be published,’ he said.

Mr Downes said the college was looking for more nursing areas to be covered by the act.

‘Safe nurse staffing levels are not just needed on certain hospital wards; they are needed across health settings to ensure safe patient care,’ he said.

Variable staffing levels

Chief nurse Jean White.

In her letter, Professor White said an initial gap analysis had shown ‘great variation in staffing levels across Wales’.

She added she would be writing to executive nurse directors later this year with further details and a template for completion.

‘I would welcome your collective support to implement these principles and work towards compliance over the coming two years as we prepare for the legislative extension of the act,’ Professor White said.

Wales was the first part of the UK to enact a nurse staffing law, which came into force in April 2018.

Since then, the Scottish parliament has passed a staffing law applying to all clinical groups, in May this year.

The RCN is campaigning for comprehensive safe staffing legislation to be adopted everywhere in the UK.

Related material

The letter from CNO for Wales Jean White

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