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Care of older people let down by low staffing levels – RCN

Published: 20 March 2012

Older people are being let down by low staffing levels in many UK hospitals, the Royal College of Nursing (RCN) warned today (20 March) as it called for a ‘patient guarantee’ setting out the number of nurses needed on older people’s wards.

New evidence from the RCN sets out for the first time a threshold of staffing levels below which care becomes compromised on older people’s wards. However, the RCN said that most hospitals are failing to meet even this safe level of care.  Despite older people often having the most complex needs, the evidence suggests that they regularly suffer from a severe shortage of nurses and healthcare assistants (HCAs), coupled with an inappropriate skill mix of HCAs to nurses. 

The RCN has repeatedly raised concerns about poor staffing levels, with many nurses saying they are too busy to provide the standard of care they would like. Today’s evidence shows that currently one nurse cares for around nine patients on older people’s wards. The RCN says that this is not enough to provide basic, safe, care which requires one nurse to seven patients. Ideally, there should be at least one registered nurse for between five and seven patients.

Hospitals are also leaving too much of the care of older people to HCAs with work split evenly between them and registered nurses. To provide good quality care the RCN recommends a ratio of two thirds (65 per cent) nurses to one third (35 per cent) HCAs. Senior nurses should be able to decide their own levels locally depending on patient need.

Today’s paper shows that key tasks that nurses want to deliver are being compromised due to short staffing. These include:  comforting and talking with patients, promoting mobility and self care and helping patients with food and drink.

RCN Chief Executive & General Secretary, Dr Peter Carter, said:

“Patients on older people’s wards are being let down by systemic failings in our hospitals. Despite working tirelessly to provide patients with high quality care, nurses in these settings have repeatedly told us that they are unable to do this because of pressures caused by short staffing.  It is unacceptable that there are not enough nurses on older people’s wards. This is an outdated historic disadvantage dating back to ‘geriatric’ wards of the past and must be urgently addressed. It is also a shocking indictment of the way society treats older people. To deliver safe nursing care to this group of patients demands both skill and time.

“Safe staffing levels and mandatory patient to staff ratios are fundamental safeguards to provide quality patient care. The RCN has been monitoring and producing guidance on mandatory staffing levels for some considerable time, including working on a proposed amendment in the Health and Social Care Bill. Nurses also voted overwhelmingly for legally enforceable staffing levels at Congress last year. Now is the time for the Government to provide a guarantee that older people will get safe care.”

Today’s research also shows that staffing levels on older people’s wards compare poorly with other areas. On adult general wards each nurse cares for around 6.7 patients while on children’s wards this falls to 4.2 patients per nurse.

A survey of almost 1,700 nurses, including 240 working on an NHS hospital ward for older people, also found that different aspects of care are frequently compromised due to lack of time and that overall the risk of compromised care is correlated with staffing levels.

With mounting pressures on NHS staff, nurses reported that the following activities were left undone or were done inadequately on their last shift due to lack of time:
- Comforting/talking to patients – 78 per cent
- Promoting mobility and self care – 59 per cent
- Helping patients with food and/or drink – 34 per cent
- Helping patients use the toilet or manage incontinence – 33 per cent
- Care for dying patients – 17 per cent

As part of its wider work, the RCN has today also published a policy briefing looking at mandatory staffing levels in different countries. In particular, it looks at guaranteed levels in California and New South Wales and Victoria, Australia and points to the benefits for both staff and patients.

Dr Carter added:

“There is much to be proud about within the NHS and it is quite rightly seen as the envy of other health systems across the world. However, we believe the development of safe mandatory nurse to patient ratios is crucial to the future of the NHS, and that improved patient outcomes will not be delivered without them. These ratios must be adopted by providers, regulators and commissioners of health services as a matter of urgency.”

Notes for Editors


1. The RCN’s employment survey in 2011 revealed that more than half (52 per cent) of respondents were too busy to provide the level of care they would like and nearly a third (32 per cent) were reporting the quality of care decreasing.

2. For copies of the RCN’s policy briefing, please contact the RCN Media Office on 020 7647 3633, press.office@rcn.org.uk or visit  http://www.rcn.org.uk/newsevents/media

3. The Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.