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Why it’s not enough to focus on nurse numbers

Without the right skill mix across the healthcare team, it's not safe staffing

Without the right skill mix across the healthcare team, it's not safe staffing


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When implementing a safe staffing programme there is a danger in thinking only about the nursing complement without considering other members of the team.

For those who lead clinical services and for the patients in their care, safe staffing involves having a team comprising the right people, in sufficient numbers, with the skills to meet patients’ needs safely.

Some of them will be nurses, others will come from various clinical disciplines and support staff groups – this is safe staffing. It should be considered in all areas, whether hospital, clinic, home or community.

Roles intersect

Despite this, the concept of ‘safe staffing’ has become strongly associated with the need for safe nurse staffing, with a focus on the shortages that make it difficult to achieve, and the need for legislation that might assist in meeting safe staffing levels.

‘Nurses do not work in isolation from other members of the multidisciplinary team’

New support roles are being introduced to help mitigate the shortages in England, but many roles intersect or overlap, so changes in one part of the team affect others. Also, there are not only vacancies in nursing positions but in other disciplines too.

Nurses do not work in isolation from other members of the multidisciplinary team, so the composition of the whole team is key to ensuring safe staffing levels. Take for example a clinic where the numbers and skills of doctors, pharmacists, physiotherapists and administrators, among others, all affect the safety of the care that patients receive.

Crucial mix

Safe staffing is achieved when the team is properly constructed and resourced, the mix of staff being a crucial component. If some people are unavailable, such as a clinically based pharmacist or administrator, then other staff are left to fill the gaps.

When these gaps are filled by nurses there will be an effect on the overall number of nurses needed and their skills, but also on other members of the team. The availability or lack of members of other vital disciplines will create a positive or a negative experience for patients and staff.

Safe staffing of clinical services means paying attention to the whole team, not just the nursing contribution. It is essential that managers take a broad approach and plan for all parts of the team as a prerequisite for safe staffing in healthcare.


Caroline Shuldham is chair of the RCNi editorial advisory board. She is a former nurse director and is an independent adviser on research, teaching and mentoring

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