Nurse staffing capacity must exceed critical minimum staffing levels and always be protected from budgetary constraints, the Royal College of Nursing (RCN) says.

According to its newly updated Nursing Workforce Standards, when setting workforce establishments nurse staffing must always exceed the minimum registered nurse-to-patient ratios.

Additionally, the standards recommend that if substantive workforce figures drop below 80% then an employer’s board must be notified immediately. An executive nurse, operating at board level, should be empowered to set safe and effective staffing levels to inform organisational financial planning, not the other way round.

For the first time, the RCN has specified a minimum uplift of 27% in nursing establishments to account for planned and unplanned absences, almost five percentage points higher than the figure in 2018 NHSE guidance.

The RCN guidance also says that registered nurse leads in different health and care settings should be 100% supernumerary, and so not counted among the nursing workforce allocation, allowing them to lead and manage services more effectively. The college reiterates that registered nurses should never be substituted with a nursing support worker.

The College has urged employers to adopt the measures as a “matter of urgency” in the wake of an ever-deepening nursing workforce crisis and rising concerns over patient safety.

Originally introduced in 2021 at the height of the COVID pandemic, the standards were the first national blueprint for addressing nursing shortages across the UK and set out the RCN’s expectations for the nursing workforce in all health and care settings. Since then, the corridor care crisis has intensified, and issues of shortstaffing and overwork have only become more acute. 

The new guidance also covers tackling racism and discrimination in the workplace, preparing for future health and climate emergencies, and reasonable adjustments for disabled staff and pregnant people.

Changes to the standards include:  

• The setting of workforce establishments now states that nurse staffing must always exceed the critical minimum staffing levels, defined by registered nurse-to-patient ratios.
• A new recommendation that the registered nurse lead will be 100% supervisory/supernumerary and not counted in the numbers as part of the nursing workforce allocation.
• For the first time, the RCN has specified a minimum uplift of 27% in nursing establishments to account for planned and unplanned absences (almost five percentage points higher than the 22.2% in NHSE guidance from 2018). This is in addition to the RCN's work on defining minimum staffing levels.
• Guidance that a registered nurse must never be substituted with a nursing support worker (which includes registered nursing associates) or any other health care professionals.
• An added directive that all members of the nursing workforce must have access to high quality, contractually funded continuing professional development (CPD) with protected (paid) time to undertake it.
• Changed guidance on the scope for both NHS staff and those working in the independent sector to negotiate their pay, terms and conditions when doing extra shifts.
• A list of ‘red flags’ to highlight to nursing colleagues some key areas of no compromise in the workplace, such as the need to take breaks while on shift.

Since the first publication in 2021, the College has urged its members to become “Standards Champions” and advocate for the standards in their workplace. Across the UK, there are nearly 100 Standards Champions using the RCN Standards to improve their workplaces.

The RCN encourages nursing staff to use the standards to help frame concerns to their managers. Nurse managers can use them to raise issues with senior nurse leaders; and senior nurse leaders can use the standards as evidence to their boards to bring about evidence-based change.

RCN Chief Nursing Officer Lynn Woolsey said: "The Nursing Workforce Standards are already being used by RCN members to challenge staffing and safety issues in their workplaces. I am delighted that the newly revised edition takes into account new evidence as well as feedback from our members and nursing experts. 

"This will ensure that the Nursing Workforce Standards remain relevant, useful and accessible to all members working across the nursing profession to articulate what is needed by employers to ensure their nursing workforce can provide safe and effective care.

"We know that fewer nurses in health care settings leads to poorer patient outcomes. That is why employers must take up our standards as a matter of urgency.”

Ends

Notes to editors

Read the updated Nursing Workforce Standards here.

National Quality Board (NHSE) 2018 guidance on safe staffing here.