Good management, not legislation, is the key to safe staffing

UK-wide safe staffing laws are only a small part of the solution

UK-wide safe staffing laws are only a small part of the solution

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The RCN has called for legislation on safe staffing throughout the UK, following similar initiatives in Wales and Scotland. But while there is an appetite within the profession for legislation, is it really the means by which safe staffing levels can be achieved, patients protected and nurses supported? I am not convinced it is.

There is widespread recognition that appropriate nurse staffing is critical to safe patient care, but little discussion of the fact that it sits alongside the need for the right staffing in other disciplines too.

An art as well as a science

The boards of healthcare organisations have governance responsibilities for regulated services to ensure they are safe and effective. This means that with or without legislation, each board is accountable for staffing of services and every board member plays a part.

As a non-executive director – at NHS community healthcare provider CSH Surrey – I am acutely aware of these responsibilities.

Board executives manage the organisation. While nurse staffing is in the nurse director’s portfolio, other executives and managers also have a role. Staffing is an art as well as a science. It is complex and multifactorial, and requires local knowledge and professional judgement.

When I was a nurse director my leadership with regard to nurse staffing – such as levels in different clinical settings, skill mix, bank and agency staff, and the ratio of registered nurses to healthcare support workers – was an important component of my role.

Training and CPD issues

I do not believe that, in a well-managed organisation, the absence of legislation is the problem. Nor do I think that legislation will resolve the difficult staffing issues that prevail currently – in either good or poorly performing organisations.

Funding overall and the pressures in healthcare have an effect on our ability to provide the staffing needed. Changes in funding for initial training and continuing professional development for nurses in some parts of the UK also have detrimental effects.

A reduction in nurse training places in the 1990s affected staffing for several years afterwards. The current reductions will similarly be felt for years, even if these decisions were to be reversed now.

Everyone taking responsibility

Legislation does not resolve this. Rather, everyone taking responsibility for their part in the process of ensuring the right numbers of nurses with the right skills in the right place does.

Much of the evidence about safe staffing concerns wards in acute hospitals, and the focus of discussion has reflected this. However, there are other areas, such as mental health and community nursing, where safe staffing issues are also of grave concern. Despite this the legislation in Wales covers adult inpatient wards in acute NHS hospitals only, although there are plans to extend this.

In contrast, the Scottish law covers ‘some hospital wards’, but has gone further to consider community, maternity, mental health and learning disabilities, and some staff other than nurses.

A partial solution at best

Neither addresses all the services in every aspect of healthcare, so at best legislation provides a partial solution and does not decrease the shortages that are key in the ability to staff safely.

If the models in Wales and Scotland prevail, then the legislation is largely aimed at NHS boards, which already have such responsibilities. Yet much nursing care is provided outside the NHS, and the legislation to date does not address this.

While everyone hopes that legislation will help, we all need to take responsibility for safe staffing, increase our knowledge of the standards required in different areas, support funding for education and consider whole teams when managing safe staffing levels.

These factors should be supported by good practice in engaging and rostering nurses, ensuring productive use of time, improving retention and reducing absence rates. People, not legislation, make these happen.

Caroline Shuldham is chair of the RCNi Editorial Advisory Board. A former nursing director, she is an independent adviser on research, teaching and mentoring.


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