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Nurse-to-patient ratios are essential to safe staffing in every setting, RCN says
An RCN briefing explains why having enough registered nurses is critical to safety and wellbeing, and makes good economic sense
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The RCN has published an evidence-informed briefing setting out why we believe enforceable minimum registered nurse (RN)-to-patient ratios are needed across the UK to protect patients and nursing staff from avoidable harm.
Minimum RN-to-patient ratios are an essential failsafe to ensure staffing levels don’t fall below a safety critical minimum. While they’re vital as a means of preventing nurse staffing falling to dangerously low levels, they’re not a replacement for estimating the exact number of nurses needed for effective care.
Research has consistently shown a direct relationship between the number of RNs and patient outcomes, including avoidable hospital deaths.
We’ve launched a resource that brings together the latest guidance and evidence, where available, on RN-to-patient ratios across a range of health and social care settings.
Nursing staff can use the resource to identify the recommended ratios in existing guidance for different specialties and settings. Our resource pinpoints where there are gaps in the evidence and guidance, and how these vary.
While the significant evidence gaps in some nursing settings present challenges, this is also an opportunity to influence future research and workforce planning. Areas such as learning disability nursing, primary care and care homes currently have limited robust published evidence on safe staffing requirements.
These gaps raise important questions about how staffing decisions can be made confidently where evidence is lacking. We will be updating the resource as new standards and guidance become available.
Director of the RCN Institute of Nursing Excellence Jane Ball has been appointed to a refocused role titled RCN Director of Safe Staffing and Evidenced-Based Nursing. This role will begin from December this year and will provide the dedicated leadership and focus needed to advance the RCN’s safe staffing agenda.
Jane said: “Our interactive resource is designed to help everyone involved in nursing care to have access to evidence-based information, to make sure that there are always enough RNs, and that guidelines are followed. Where there are evidence gaps, we’re determined to address those, so that there is clarity across all care settings on what staffing levels are needed to keep patients safe.
“For far too long nurse staffing levels have been far below what is required. Care is being compromised. Patients are put at risk. Time and time again, nurses are being asked to deliver more care than it is possible to do safely.
“Many services and settings are routinely running below safe levels, and we see avoidable harm far too often. Meanwhile trusts are freezing or deleting vacancies, not filling them. And we have new nursing graduates struggling to get work – even though they are desperately needed.”
Having fewer RNs can also lead to an increase in overall costs (due to longer lengths of stays and higher rates of complications), undermining claims that nursing investment is unaffordable.
Aside from patient safety, adequate nurse staffing protects nurses from burnout and moral injury. That's psychological distress arising from a sense that you feel prevented from doing your job properly and in line with your moral or ethical code. It also improves satisfaction and wellbeing, and means staff are less likely to leave the profession.
Having low RN staffing levels also has an impact on the wider nursing team; support staff are left with inadequate RN input and supervision.
Jane added: “The evidence is clear, when RN-to-patient ratios are in place, to ensure that minimum nurse staffing levels are exceeded, care quality improves, working conditions improve, patients get the care they need and leave hospitals sooner.
“Having mandated minimum RN-to-patient ratios does not replace evidence-based workforce planning, but minimum staffing levels draw a red line.
“Registered nurse staffing is not a luxury – it's the foundation of safe patient care, and quite simply, it’s a lifesaving intervention.”
RCN members should report staffing and safety issues, following their organisation's incident reporting procedures, for example, via Datix or an incident form.
The RCN has developed letter templates to support members to document concerns. If the matter remains unresolved, please refer to our raising concerns guidance.
