Safe and Effective Staffing: Nursing against the Odds

The Royal College of Nursing has just published a report  this September (Borneo, Helm and Russell 2017) on staffing. This followed from a previous report in May 2017: ‘Effective staffing –  the real picture

The RCN also provided evidence in Scotland in July 2017.  Half of the survey  said patient care was compromised by insufficient staffing on their most recent shift. These claims emerged in a submission to Holyrood’s health committee on the 2018/19 draft budget.

In September 2016, NHSI published a report  stating that demand for nurses was outstripping supply while providers responded by hiring more agency nurses.

Roy Lilley commented upon the RCN 2017 report and his conclusion is devasting:

This report says to me the profession of nursing is over.  The damage is done.  Read this and no-one will want to be a nurse. The future?  De-skilled.  Care provided by health-care assistants, apprentices, technology and a handful of real nurses trying to hold the ring. My conclusion; don’t go into hospital if you can possibly avoid it.  Don’t have an episode of mental illness and on no account put yer-granny in a care home.  Nothing and no-one is safe.  Even more important; don’t let your kids or your partner consider a career in nursing; it’s an exhausting, exploited profession… going nowhere.  Expect tears, more tears, stress, pressure and life to be easier working in a salt-mine”.

Given that commentary, I thought I’d take a look myself. Is it a bed of nettles or roses for nurses?

In the forward, Janet Davies (RCN CE and Gen Sec) stated:

  1. Over 50% of the nurses said their last shift was not staffed to the level planned and that care was compromised.
  2. 33% stated that care had to be left undone.
  3. 66% are working overtime each shift with no pay.
  4. Tea breaks are missed.
  5. Some patients are without dignity and some dying alone.
  6. Reports of burn out and sickness.
  7. Many question their future.
  8. Many had raised concerns only to feel ignored.
  9. For the first time more are leaving the register than joining
  10. EEA nationals are leaving.
  11. 1 in 3 are due to retire in 10 years.
  12. International recruitment is plateauing.
  13. In 2009 the proportion of RNs in Adult wards was 62%, it is now down to 58%.
  14. 20% of RNs were temporary staff.
  15. Unpaid time worked by nurses equates to £396 million annually.
  16. Safe and effective staffing is the exception not the rule.

This current report was based on a survey based on 30,000 responses. The RCN asked people about their last shift or day worked in health or social care. The majority of shifts, 97%, captured in the survey were in May 2017, after any winter pressures.


Lets be critical of this later report, because Tory ministers will be. It was a self reported survey and so open to respondent bias. It could be the case that only the disillusioned answered the survey and so skewing the result. The responses are subjective and not verifiable with objective data. It reported only on the last shift they worked in May and so could be open to bias, that shift may not have been representative. The report’s publisher, the RCN, has a vested interest and is not possibly a disinterested party.

While some of these points have merit, the results however indicate that there is some validity to the responses because they fit with other data such as that of the NHSI 2016 report. The King’s Fund (2017) states:

“New data highlighting an increase in the number of vacant NHS posts in the first quarter of 2017 underlines the pressure on the NHS workforce as a result of growing workloads and staff shortages. This is affecting staff morale – one of the top two concerns reported by NHS finance directors in each of our last four quarterly monitoring reports“.

The Safe Staffing Alliance  argues that:

Evidence shows that 45 per cent of wards in England are operating at unsafe levels. When you add the 27 per cent drop in district nurse numbers over the past four years, and the fact that 25 per cent of nursing directors are only in post for one year, it is little wonder the health service is in meltdown“.

Just two of the many quotes from the survey:

I feel that I am totally burnt out. Don’t think I can continue to work at this pace. I have resorted to anti depressant medication. I am seriously thinking of retiring next year as I will be 60 after 44 years in the NHS

“I feel exhausted, demoralised and do not want to go back for another shift”

Care is political. Responsibility rests with Jeremy Hunt who has presided over this for years. Pointing a gun in his back is Osborne’s Austerity. This is a direct result of the strategic decisions taken at the highest levels of government. Ministers blather about ‘more nurses’ and try to kid us that ‘more’ is the same as ‘enough’.

At heart is an ideology that undervalues nursing, that seems to think they are too expensive and not necessary (educated uppity nurses), and that actually individuals, families and care assistants could be better placed to do the job.

I cannot see the current Tory government budging one inch on this. They are fixated with Brexit and the deficit. I shudder to think of it, but perhaps when middle england wakes up and via the Daily Mail start to rant, perhaps and only perhaps something might be done.



Borneo, A., Helm, C., and Russell, J. (2017) Safe and Effective Staffing: Nursing Against the Odds. London. RCN.

Photo by Melinda Pack on Unsplash


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