Safe staffing: community nursing needs the full team too

Once seen as a rewarding place to work, nursing in the community is under pressure like never before. “This team, and many others like it, is extremely short-staffed,” says district nursing team manager Alison Magor, who works for Aneurin Bevan University Health Board. “We advertise time and time again, but rarely get any applicants.” 

Under the existing safe nurse staffing legislation the RCN campaigned for, in Wales, health boards have a legal obligation to provide sufficient nursing staff to provide sensitive patient care.

In acute medical and surgical wards, and in children’s wards, the law goes even further and specifies that the level of “sufficient nursing staff” must be precisely calculated to reflect patient need.

However, the legal obligation to calculate and maintain nurse staffing levels doesn’t apply in community settings, which adds to the difficulties faced by community nursing staff.

“Over the last year particularly, we’ve taken on a lot from hospitals that we didn’t do before, which means we’re looking after patients with many more nursing needs and going from call to call,” says Alison. “The price of petrol isn’t helping either. At the moment, the national agreement isn’t covering the cost of what we’re using.”  

Patients must stay at the heart of all we do

Currently Alison is four members of staff down, without taking into account anyone who may be off due to sickness or leave.

“But it’s nothing new,” she says. “It’s been going on across Wales for many years. It’s a continual priority for us. We rely a lot on the goodwill of our team, who often come in early and work late. We can’t keep expecting all of our staff to keep doing extra shifts, staying late, waiting for annual leave or returning early because eventually they will get tired and burnt out. We firefight on a daily basis.” 

Staff worry whether their documentation is correct and whether they are referring patients who need extra help to different agencies. “This is just as important, but it’s time-consuming,” says Alison. “Our patients need to feel they’re receiving holistic care, tailored to them. Patients must stay at the heart of all we do.” 

Extending Section 25B of the safe staffing legislation to district nursing, taking into account the complexity of patients’ needs and their acuity, would improve her team’s working lives dramatically, Alison believes.

“Our staff would then have an accurate amount of time per visit,” she says. “They would also have specific time for online training and updating their skills. Their work-life balance would be improved and they could go home at the end of the day not feeling guilty that they can’t stay on. Until that happens, we’ll be struggling, as nurses won’t want to come into district nursing – which is such a shame as we offer so much.” 

Now RCN Wales is calling for section 25B of the legislation to be extended to cover all areas where nursing takes place, beginning with the community and mental health inpatients, launching its For the Full Team campaign last November. 

Safe staffing is a crucial issue for members, patients and their families, says Helen Whyley, Director of RCN Wales.

Alongside helping to retain current nursing staff, having the right numbers also helps reassure patients and their loved ones, she says. “But those who are working within the community and mental health are telling us there’s just not enough staff,” says Helen.

To enable real improvements, being able to apply a tried and tested methodology to the numbers of staff needed is key. “Nursing establishments can be quite historical,” she says.

Unless we shout from the rooftops that we don’t have enough nurses, quality of care will be reduced

“That means that the acuity of patients and an appropriate skill mix may not have been examined for a while.

"But it’s been well researched that if you use a methodology that also includes professional judgment, you will have sufficient nurses to be able to deliver high-quality care to patients. And we know that a consistent team ensures safer and more effective patient care.” 

Legislation is needed now to protect patients, says Alison. “I adore being a district nurse and I wouldn’t be anything else,” she says. “But without enough appropriately qualified staff, we can’t achieve everything we want. Unless we shout from the rooftops that we don’t have enough nurses, quality of care will be reduced.”