‘Right staff, right skills, right place, right time’

Professor Michael Lavelle-Jones, Former President of the Royal College of Surgeons of Edinburgh from 2015-2018. 

As the Scottish Parliament’s health and sport committee scrutiny of the Health and Care (Staffing) (Scotland) Bill continues, Professor Michael Lavelle-Jones reflects on the importance of staffing for safe and effective care.

‘Right staff, right skills, right place, right time’ - it’s a mantra crucial to delivery of safe patient care. As surgeons we cannot do our job when these principles aren’t delivered in practice. It’s something that applies to all of us in the NHS, no matter our professional background. That’s why, the Royal College of Surgeons of Edinburgh fully supports the Royal College of Nursing in its campaign to ensure none of us lose sight of the goal: staffing for safe and effective care.

It’s apt that nursing is leading the charge on this – because the nursing profession is constantly at the forefront of patient care; which means that it feels the pressure from all directions. Medical colleagues; managers; patients and their families all interact with nursing teams on a daily basis.  All too often I hear from senior charge nurse colleagues that administrative pressures and bureaucracy distance them from patient care to the extent that they can no longer function as role models to their junior team members. This must change. Senior charge nurses in acute settings are clinical leaders. As such, they must have the time to work with their team to hone new skills and to ensure that their teams are effectively managed so that patients receive safe, high quality care. These are the nurses who are central to ensuring that the ‘right staff, right skills, right time’ mantra is a reality.

But senior charge nurse colleagues are often bound in such bureaucratic processes that they are unable to thrive, and do not derive the job satisfaction that led them to choose the nursing profession in the first place.

I believe this is the ideal time to look again at the role of Scotland’s senior charge nurses to ensure that they have the time to deliver in the clinical setting.

The rise in roles such as extended role nurse practitioner, often re-designates an existing member of the team, leaving a gap in the service. It is frequently the nursing service on wards which suffers as experienced nurses are drawn away to other areas of consequence. As professional colleagues, and as patients, we must value all nursing roles  and lobby for adequate resources to ensure that there are enough nurses to provide safe care to patients, wherever that care is delivered.

There are other areas of concern too, for example when an extended role nurse practitioner trained in the role of a surgical first assistant has to continue operating as a scrub nurse because of staffing level difficulties. This can have a longer term impact.

This summer we have introduced the new ‘Improving Surgical Training’ programme designed to deliver exactly that – better training for surgeons in training. The extended role nurse practitioners will play a pivotal role in supporting surgical teams to ensure that trainees can have the time required to access this additional training - relieving pressure, where appropriate, in the ward, theatre and outpatient setting. 
Valuing our workforce is one of the key elements of putting ‘Realistic Medicine’ into practice in Scotland – all of its principles apply to the nursing profession as well as the medical profession. Elsewhere, in Wales, in a similar initiative called ‘Prudent Practice’ I have been struck by one of their underpinning principles   - ‘only do what only you can do’. This seems to me to represent the future as we reshape our health care teams optimising the roles of each team member – right staff, right skills, right place, right time.

Page last updated - 04/08/2019