When NHS England took over work on safe staffing guidance last month from the National Institute for Health and Care Excellence (NICE), the nursing profession reacted with outrage.

NICE was originally given the brief to head off a growing clamour for nurse staffing ratios. But this was a near-impossible task. It was asked to apply its high standards of evidence grading to an issue that is virtually evidence free – the relationship between nurse staffing and patient outcomes.

Other than adult acute care and midwifery, which were the subjects of the first two NICE safe staffing reports, there is almost no relevant published research on which NICE could draw. Most of the research is from North America, and is mainly context-specific, meaning it can be dismissed as such when trying to develop evidence-based guidelines.

The relative paucity of UK research on nurse staffing levels reflects a lack of funding, but it also highlights a general disinterest from most nurse academics. With the notable exception of a handful of able and active nurse workforce researchers, determining safe staffing levels in the NHS has been left to nurse managers and management consultants. It has been driven by operational priorities, rather than an appetite to develop independent evidence and guidance.

That NHS England is now leading the work on safe staffing is essentially a return to this status quo. New evidence on safe staffing may be developed, but this will be an incremental process at best, with many nursing specialities to cover.

In the meantime, there is still a pressing need for wards, units and community settings up and down the country to have the right numbers of staffwith the right skill mix to provide safe and effective nursing care – today, tomorrow and in the future.

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