Nurse talking to a patient in a hospital bed.
Most nursing shifts in England’s public health service are under-staffed, according to a survey of 11,000 members of the Royal College of Nursing.
Only a third of respondents said there were enough registered nurses working when asked about staffing levels during their most recent shift, the survey found.
Both community and hospital settings had major gaps in staffing, with around 33% of hospital shifts missing a quarter or more of the registered nurses they needed and nearly 4 in 10 of community shifts up to 50% short on registered nurses.
This leaves nurses caring for potentially large numbers of patients at the same time. The RCN said that “chronic” staff shortages meant nurses were “often” caring for between 10 and 15 patients at once.
In emergency room settings, some nurses told the industry body they were looking after more than 51 patients at once. In outpatient settings, these kinds of caseloads were reported “consistently.”
Overburdened staff in overcrowded settings don’t have as much time to devote to individual patients, leading to patient safety concerns.
Some 80% of members surveyed told the RCN there weren’t enough nurses to care for patients safely.
“Nurses are being made responsible for dozens at a time, often with complex needs. It is dangerous to patients and demoralising for nursing staff,” said RCN acting general secretary and chief executive Nicola Ranger in a statement. “When patients can’t access safe care in the community, conditions worsen, and they end up in hospital where workforce shortages are just as severe.”
With the U.K., just two days from a general election, she called on future leaders to spend more on its nursing workforce and “enshrine” nurse-to-patient ratios in law.
England’s public health system has “safer staffing” target levels to try and ensure shifts are appropriately staffed. But these are not legally-binding, unlike in neighboring Scotland and Wales, both of whom give health providers and commissioners a statutory responsibility to ensure safe staffing.
Healthcare is a devolved matter in the U.K., meaning that England, Wales, Scotland and Northern Ireland have different commissioning bodies, policies and laws.
“We desperately need urgent investment in the nursing workforce but also to see safety-critical nurse-to-patient ratios enshrined in law,” Ranger said. “That is how we improve care and stop patients coming to harm.”
A spokesperson for National Health Service England, which commissions public healthcare in the country, told me the body “has had safe staffing guidance in place for several years so trusts can ensure that all patients are treated safely and with adequate care.”
They added: “The NHS is continuing to invest in our nursing workforce and the latest statistics shows that there are a record number of nurses working in the health service.”
As of March this year, there were around 392,900 nurses working in England’s public health system. Some 229,900 of these work in adult and general nursing.
A longterm workforce plan published last summer “aims to increase the number of nurses in training by 80% by 2031/32,” the spokesperson told me. This would involve increasing training places to more than 53,500.
Short staffing has been a critical issue across the country’s public health services for years. It’s a major driver of ongoing healthcare strikes. And it’s a problem that will probably intensify as the population gets older and sicker.
Although RCN members voted to end months of strikes last spring, other healthcare staff continue to walk out. Junior doctors — roughy equivalent to interns, residents, and fellows in the U.S. — finished a five-day hospital strike on Tuesday. It was the 11th junior doctor strike since members of the British Medical Association voted to begin industrial action in February 2023.
