The National Institute for Health and Care Excellence (NICE) has released guidelines for hospitals in England on safe staffing levels for nurses. The draft guidelines, and the extensive research behind them, were unveiled earlier in May 2014.
The ratio of nurses to patients should not fall below one nurse per eight patients, but the guideline allows flexibility to allow for many factors which are known to vary.
“Safe staffing is more complex than setting a single ratio”.
Triggle, N. (2014). Hospitals get guidelines on safe nurse numbers. London: BBC Health News, July 15th 2014.
This relates to:
Safe staffing for nursing in adult inpatient wards in acute hospitals. NICE Safe Staffing Guideline (SG1). London: National Institute for Health and Care Excellence, July 2014.
“Red flag” events include patients not being provided with basic care (such as pain relief or help to visit the bathroom). An appropriate response to such events could be to provide more skilled nurses or increase numbers of staff. A simple overview explains:
NICE unveils safe staffing plans for nursing care in wards. London: National Institute for Health and Care Excellence, July 15th 2014.
There is also an associated NICE care pathway:
Safe staffing for nursing in adult inpatient wards in acute hospitals. NICE Pathways. London: National Institute for Health and Care Excellence, July 2014.
An analysis of the overall implications for the NHS, from BBC News:
Triggle, N. (2014). How many nurses short is the NHS? London: BBC Health News, July 15th 2014.
Recruitment From Overseas
Nurses and midwives who trained overseas make up about 10% of the workforce registered to work in the UK. Nurses and midwives who completed their training outside of Europe may be subject to shorter, more streamlined (potentially less stringent / potentially more stringent?) tests to check their fitness to work.
The Nursing and Midwifery Council (NMC) plans to introduce a more “agile” computer-based exam, and tests in simulated clinical scenarios, to replace the minimum three months of supervised practice required currently. The revised tests / procedures aim to ensure that growing numbers of nurses and midwives who trained overseas (outside the EU and EEA) can be assessed more rapidly but in a robust and objective way.
Mundasad, S. (2014). Overseas nurses and midwives ‘face shorter assessments’. London: BBC Health News, August 27th 2014.
This relates to:
Changes to overseas registration for applicants educated outside the European Union (EU) and European Economic Area (EEA). London: Nursing and Midwifery Council (NMC), August 2014.
An examination of the nationalities of NHS England staff, considering the national origins / country of qualification of “all staff”, doctors and nurses.
NHS staff: How many foreign staff work in the NHS? London: BBC Health News, August 1st 2017.
Some employers are thought to be frustrated and concerned that “good” foreign nurses may be blocked from registering in the UK, and have suggested that NMC language rules should be overhauled. The director of workforce at Royal Wolverhampton NHS Trust (which struggles to recruit nurses from outside the European Union as many fail the English test) sat the exam, presumably out of humorous devilment.
Full Text Link (Note: This article requires a suitable Athens password, a journal subscription or payment for access).
Kendall-Raynor, P. (2016). Overseas recruits’ English exam: a proper safety check or red tape? Nursing Standard. May 4th 2016, 30(36):12-13.
Foreign Nurse Recruitment
More questions on the economics, and ethics, of foreign nurse recruitment:
Dreaper, J. (2015). Recruiting foreign nurses ‘frustrating and expensive’. London: BBC Health News, July 28th 2015.
Dreaper, J. (2015). NHS nurse recruitment from EU ‘too aggressive’. London: BBC Health News, July 31st 2015.
Immigration Rules: a Barrier to Recruitment / Retention and Patient Safety?
The heads of 10 NHS Trusts, and NHS Employers, have written to the home secretary recommending that nurses should be added to the list of occupations for which there is an official shortage.
Dreaper, J. (2015). NHS warns nurse immigration rules ‘harm patient safety’. London: BBC Health News, September 10th 2015.
Nurses from outside the European Union may have to leave the UK after six years, if they are not earning £35,000 at least.
Triggle, N. (2015). Migration rules need re-think – NHS boss. London: BBC Health News, October 6th 2015.
Nursing Workforce Planning: Awry For Decades?
The UK may be heading for a major nursing shortage.
“Thanks to years of short-term thinking, the UK is completely unprepared to deal with the challenges posed by an ageing workforce, increasing demand and now the uncertainty caused by leaving the EU”. Janet Davies, RCN General Secretary
Triggle, N. (2016). Nurse shortage ‘could last for years’. London: BBC Health News, July 7th 2016.
The Royal College of Nursing has been assessing attitudes before planning strike action:
Nurses to stage ‘summer of protest activity’ over pay cap. London: BBC Health News, May 14th 2017.
Gallagher, J. (2017). Nurses consider whether to strike over low pay. London: BBC Health News, April 13th 2017.
The pay cap for public sector staff may soon be relaxed:
Triggle, N. (2017). Heroic public sector staff deserve more pay – Hunt. London: BBC Health News, June 15th 2017.
July 2017 Update on Numbers
The number of nurses and midwives registered in the UK fell by 1,783 to 690,773, in the year to March 2017, says the Nursing and Midwifery Council (NMC).
“Other than retirement, the main reasons given for leaving were working conditions – including staffing levels and workload – personal circumstances and disillusion with quality of care to patients, according to an NMC survey of more than 4,500 leavers. Other reasons included leaving the UK and poor pay and benefits”.
No mention is made of any incentivised structural migration, involving nursing staff leaving the NHS deliberately in order to take-up better paid agency work, to the financial detriment of the NHS (and the taxpayer) as a whole.
More UK nurses and midwives leaving than joining profession. London: BBC Health News, July 3rd 2017.
More on the same trend, but still no statistics or investigative narrative on how many “leavers” return shortly after as agency workers:
Triggle, N. (2018). NHS ‘haemorrhaging’ nurses as 33,000 leave each year. London: BBC Health News, January 17th 2018.
Nursing Workforce Reform
Reforms announced in October 2017:
Health Secretary announces nursing workforce reforms. [Online]: Department of Health, October 3rd 2017.
Perception and Reality?
A YouGov for the Royal College of Nursing found 74% of people think there are not enough nurses to care safely for NHS patients. Statistics for England show that one in nine nursing posts is vacant.
Triggle, N. (2018). ‘Three-quarters of public worried about nurse staffing’. London: BBC Health News, May 13th 2018.
Concerns about likely future changes in the composition of NHS staffing:
Homer, A. (2017). Share of European Union staff leaving NHS rises following Brexit. London: BBC News / BBC Health News, October 16th 2017.