The RCN is calling for safe staffing legislation in all four countries of the UK. We take a look at what's happening in Scotland...
Since the Health and Care (Staffing) (Scotland) Bill was introduced in May 2018, RCN members in Scotland have been helping to shape what a new law for safe nurse staffing levels might look like.
Sarah Atherton, RCN Scotland Public Affairs Advisor, says: “This campaign is about harnessing the power of members and the nursing voice to say this is why we need legislation and this is the difference it will make.
“It’s about influencing and shaping the new law from a professional and trade union perspective to make it the best law possible for nursing staff and patients. But it’s also about making sure nursing staff are aware of what’s happening and involved every step of the way.
This campaign is about harnessing the power of our members to say this is why we need legislation and this is the difference it will make
“It’s one thing to get the right legislation in place but it needs to be delivered and rolled out in a meaningful way so it’s important that nursing staff understand where they fit in it. We want them to know that it’s coming and to be involved in it from the beginning.”
What’s happened so far?
The Ask for More campaign was launched in September last year following the introduction of the bill into the Scottish Parliament at the end of May.
On 6 December 2018, the bill reached an important milestone when the Scottish Parliament voted unanimously in favour of its general principles meaning the bill now moves on to the next stage of the parliamentary process.
“There are three stages to the parliamentary process in Scotland,” explains Sarah. “In Stage 1, the committee responsible for the bill calls for written and oral evidence.
“The RCN was very much involved in this stage, making sure nursing staff working on the ground were heard from.”
The committee then considers what they’ve heard and writes a report indicating to parliament whether it agrees with the general principles of the bill – in this case it did. A Stage 1 debate was then held.
The RCN was very much involved in Stage 1, making sure nursing staff working on the ground were heard from
“The debate was really positive,” says Sarah. “It was great to see so many MSPs (Members of the Scottish Parliament) standing up and making the case for nursing, some reading out direct quotes from RCN members. It showed how powerful member stories are.
“More importantly, our members who attended the debate to observe felt that those representing them genuinely understood their concerns and the strain that not having the right staff with the right skills puts on them every day.”
Although the debate highlighted the impact the campaign is having, Sarah says there is still a lot of work to be done, and in a short time period.
“We still need people to get behind the campaign, show their support and share their stories,” says Sarah. “The bill is now in Stage 2 so it’s back with the committee for detailed scrutiny.
“MSPs can put forward amendments to the draft legislation so a lot of our work now is focusing on talking to MSPs and lobbying them to lodge amendments to improve the bill based on what RCN members have told us they need.
“A key amendment is that the bill needs to work in real time. At the moment there is nothing that would instantly help a nurse when they come onto shift. There needs to be a process for monitoring and mitigating risk when issues arise there and then.”
We still need people to get behind the campaign, show their support and share their stories
“Another key ask is to make senior charge nurses (SCNs) non-caseload holding. SCNs have said they don’t have time to talk to patients’ families and provide the level of care that they need and want to.
“It’s really important for members who are SCNs to speak out and say how staffing levels are affecting them to support this change.”
If the bill and amendments pass Stage 2, it will then enter Stage 3 where further changes can be made but through a meeting of the whole of Parliament rather than the committee. The Scottish Parliament is expected to hold the final Stage 3 vote, which will decide if the law is passed or not, before Easter recess in April.
Making sure the nursing voice is heard
RCN reps like Jas Clark have been instrumental in making sure the voices of nursing staff in Scotland are heard by the MSPs who are considering the bill.
Jas says: “My interest in this campaign developed because of my previous post as an advanced nurse practitioner. While working nights, I witnessed first-hand just how short-staffed the wards are and how hard nurses are having to work to make sure patients are cared for. It’s an issue that’s close to my heart.”
Jas has been helping to gather evidence from nursing staff to illustrate the enormous pressures they’re under.
I witnessed first-hand just how short-staffed the wards are and how hard nurses are having to work to make sure patients are cared for
“I think to engage members, you have to go to them,” says Jas. “This whole campaign is based on the fact that nursing staff don’t have enough time so I go out and physically visit them on the wards. I start by asking them “Are you short staffed today?” and the conversation develops from there.
“We’ve been asking nursing staff to record their answers to five questions about how staff shortages are affecting them and what safe staffing levels would mean. It’s been really popular with staff.
“You can feel the buzz in the department – people want to answer the questions because they feel so passionately about making things better for patients.”
Jas is hopeful that legislation will make a difference but says that some areas still concern her: “I do worry about how it will work. What will happen if one day you haven’t got safe staffing?
“How will nurses be able to report it? There needs to be failsafe mechanisms. It’s about being able to provide quality patient care which is safe for both patients and staff.
“People won’t speak up unless they feel they’re being listened to so I think reps and the RCN have an important role to play once a law is in place. We can reassure nursing staff that it’s OK to report things and support them to do this.”
Sarah agrees: “One of the key principles underpinning this campaign is that any legislation supports a strong professional voice. It needs to empower nurses at all levels to be able to exercise their professional judgement about whether the number of nursing staff and the skills that those staff have is right at any given point to provide safe and effective care.”
What’s happening elsewhere in the UK?
The RCN's campaign for safe nurse staffing legislation in England is being designed in partnership with members.
Safe staffing legislation which covers NHS hospitals has already been introduced in Wales. The RCN is continuing to campaign to ensure this delivers improvements for nursing teams and their patients and for the law to be extended to other areas of nursing.
In Northern Ireland there is no law on nurse staffing levels, but the Department of Health (Northern Ireland) has outlined nurse staffing in the Delivering Care framework.