For years evidence has consistently shown that when Registered nurse (RN)-to-patient ratios are in place, to ensure that minimum nurse staffing levels are exceeded, care quality improves, working conditions improve and patients get the care they need. 

You will have seen countless statistics, reports and studies which demonstrate this direct correlation, but more importantly, it’s you, our members, who witness and feel the impact of not having enough registered nurses every shift you work.  

We are clear – safe staffing improves patient outcomes, supports nursing wellbeing and retention and makes good economic sense. And critically, safe staffing saves lives.

Our new briefing sets out why minimum registered nurse-to-patient ratios are an essential safety net to help ensure staffing levels do not fall below a safe minimum. Though let’s be clear – minimum ratios are not, and should not, be viewed as a substitute for effective workplace planning, workload assessment tools or professional judgement.

Alongside our new briefing, we’ve also launched a new resource which pulls together all the current guidance on safe registered nurse-to-patient ratios across a range of different settings. The intent behind this resource is less about showing the overwhelming evidence to prove the need for safe staffing levels, but instead to have the evidence in one place to be used as a tool to help you identify and quantify when staffing in your workplace has fallen below the evidenced minimum required to deliver safe care.

The resource also highlights where the evidence falls short. Some guidance is in the process of being updated and most strikingly – some specialties do not have any guidelines at all on what nurse staffing levels should be. No national minimum level has been identified yet, nor is there a yardstick average to refer to.

Our goal now is to address these gaps - commissioning new work where necessary, and collaborating with experts and stakeholders to develop and refresh guidance on RN staffing levels. We want robust, evidence-based recommendations, supported by expert consensus, to be available across all care settings so that no specialty or care setting is left without credible guidance on the staffing levels required to keep their patients safe.

But we are clear: for nurse staffing levels to be adhered to, they must be enforceable. That’s why we’re calling for minimum RN-to-patient ratios to be underpinned by legislation, to not only keep patients and staff safe from avoidable harm but to ensure proper accountability. Mandated minimum ratios exist in other parts of the world and have made a huge difference to patient safety, staff morale and retention.

I have spent most of my career researching the impact of effective RN staffing on patient outcomes. It has frustrated and saddened me that the extensive evidence on safe nurse staffing has not been used to improve workforce planning, staffing decisions or public policy. We know that more RNs are needed, yet recruitment freezes remain in place across the UK. Newly graduated nurses are struggling to secure their first roles, and many are leaving the profession before they even had chance to begin their careers. 

This can’t continue. That is why I’m so pleased to have the chance to bring about change through my new refocused role as the RCN’s Director of Safe Staffing and Evidence-Based Nursing starting from December this year. This role will provide the dedicated leadership and focus needed to advance our agenda, strengthen the evidence base and advocate for the action needed to deliver safe, high-quality care. 

The value of nursing is still not being recognised where it matters most: on hospital wards, in people’s homes and across the services that patients rely on every day. We must ensure nursing is seen not as a cost to be managed, but as an investment that is fundamental to patient safety, outcomes and the sustainability of health and social care services.

So, what can you do next?

• Know the signs and report concerns: If you have staffing and safety concerns in your workplace, use our resources to help establish what staffing levels should be and then report your concerns through your organisation’s incident reporting process, for example via Datix or an incident form.
• Use RCN resources to raise concerns effectively: Our guidance and template letters can help you document and escalate staffing concerns. If issues remain unresolved, consult our guidance on raising concerns.
• Stay informed and support the campaign for safe staffing: Sign up to our weekly email to hear about the latest developments, opportunities to influence change and ways to get involved.
• Be a champion for safe staffing in your workplace: Become a Nursing Workforce Standards Champion and help embed safe staffing standards in your organisation, supporting colleagues and driving improvements for patients and staff.

Together we’ll make sure safe nurse staffing isn’t just an aspiration, but a reality for all patients and staff, throughout the UK.