It’s an ancient tradition in many parts of the world to start a new calendar year by making some resolutions. I’m calling on all nurses to resolve to take action to highlight the true value of nursing.
That nurses are undervalued – and underpaid – has been highlighted for all to see in the industrial disputes and strike action that took place in the UK last year. Yet nurses continue to be rated in public opinion polls as the most trusted profession. National and global shortage of nurses has reached a critical level, with direct impact on health systems, care quality and nurses themselves.
But given that nursing is a popular career choice, and the profession is valued by the public, why is it that we have this chronic and debilitating deficit of nurses?
Inquiries and research both make plain that the consequences of nurse insufficiency are dire. Research published in the Lancet reported that each additional patient per nurse corresponds with a 7% increase in the likelihood of avoidable patient deaths in hospital. When registered nurse staffing levels are too low, necessary patient care is left undone. This contributes to a higher risk of patient death. However, while better nurse staffing is associated with lower mortality rates, the same is not true for the level of support staff: hospitals with more support staff have higher (not lower) mortality rates. Despite the national trend of a steadily diluting skill mix, a shortage of registered nurses cannot be ameliorated by increasing reliance on support workers.
As the long-term workforce plan makes clear, the future sustainability of the NHS requires a radical uplift in nurse numbers. Addressing their under-supply is critical.
Yet in England, the ‘compelling research evidence’ on the value of nursing has not been applied to workforce policy. Ongoing national nurse shortages are the consequence of a consistent failure to prepare enough nurses to meet our health care needs. Despite enthusiasm for embracing ‘safe nurse staffing’ after the Francis Inquiry (2013), ward staffing remained below NICE recommendations in many Trusts (1:8 is a red flag, prompting review). Our evaluation found that the policy vision set out by the government to put patients ‘first and foremost’ and ensure Trusts are safely staffed with sufficient nurse numbers was not matched by robust regulation to enforce, nor investment to enable, the staffing increases needed. England remains the only country within the UK to not have nurse staffing standards set by government or legislation.
For years the tacit assumption, founded on not truly understanding the value of nursing, has been “We’ll get by”. That nursing headcount can be cut in times of financial difficulty, without any serious risks. That we can plug nurse staffing gaps with less highly qualified staff. But evidence shows the dangers of such assumptions.
If we truly value nursing, as we head into 2024, we need to resolve to:
- Invest in the nursing workforce, and properly reward nurses
- Challenge a status quo that sees talented and experienced nurses leaving the profession
- Demand nurse staffing levels that are safe for both patients and staff – so that nurses can do what they came into nursing to do: deliver good care.
Nurses are frequently told that issues related to compromised care and coping with pressures due to short-staffing are their problems. But these are not nursing problems, they are societal and political. In my opinion, these problems stem from failing to truly value nurses and nursing.
If society is to benefit from a strong nursing profession – one that can attract and retain talented people for many years to come – we must resolve to value nurses and nursing. We can’t wait for someone else to do this. We need to take up with conviction and tenacity this resolution to:
- recognise and be vocal about the value of nursing
- support those who do it
- hold decision makers and politicians to account for ensuring that all health services have enough nurses to provide high quality care, in every setting
And we can start our resolution, by backing the RCN’s efforts to ensure there are minimum nurse to patient ratios, to safeguard standards and protect both patients and nurses from the negative effects of too few nurses. We need to eradicate dangerously low nurse staffing levels from our health care systems. To do that we need enforceable red lines to act as safety limits, below which services do not go. This is how we and society can truly value nursing.
The public trust nurses. Let’s make sure we can deliver on that faith by ensuring there are enough nursing staff on every shift to meet care needs safely and well.
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