The RCN’s Nursing Workforce Standards have been created to explicitly set out what must happen within workplaces to ensure the delivery of safe and effective patient care.
The 14 standards – the first of their kind – have been designed for use by those who fund, plan, commission, design, review and provide services which require a nursing workforce.
They can also be used to help nursing staff understand what they should expect to be in place to enable them to do their jobs safely and effectively.
The standards are grouped into three themes. They are:
- Responsibility and accountability – outlining where the responsibility and accountability lie within an organisation for setting, reviewing, and taking decisions and action on staffing levels and skill mix.
- Clinical leadership and safety – outlining the needs of nurse leaders with professional responsibility for teams, their role in workforce planning and the professional development of staff.
- Health, safety and wellbeing – outlining what’s needed to support nursing staff to provide the highest quality of care, including safe shift working, the ability to raise concerns and the right to work in a safe environment that prioritises staff wellbeing.
The standards apply across the whole of the UK and to every setting where nursing care is delivered. They’re being launched as new polling reveals seven in 10 people believe there are too few nurses to provide safe care. Of the 1,752 members of the public who were surveyed, more than a quarter said they felt themselves or their families may not get the care required when needed.
There are currently more than 50,000 nursing vacancies in the NHS across the UK, with many more unrecorded vacancies in social care. This is expected to be exacerbated by the pandemic, as many nursing staff face burnout and exhaustion.
RCN Acting Chief Executive & General Secretary Pat Cullen said: ‘The shortage of nursing staff across all specialties, in the NHS and independent sector, compromises patient safety. We are acting to address this by setting standards that represent the gold standard in workforce planning and management.
‘There are so many examples of excellent delivery of care and for the first time, we have set out our expectations so we can ensure that these standards of care are consistent across the UK.
‘Nursing is the largest safety critical profession in health care and it’s vital that we have the right staff, with the right skills, in the right place, at the right time.’
The standards have been created in partnership with RCN members and seek to address the lack of formal guidelines around safe staffing.
They will help nursing staff recognise what good practice looks like in terms of how services should be staffed and, when the standards aren’t being met, how to safely escalate concerns. The RCN will support members to do this, where appropriate.
Rachel Hollis, Chair of the RCN’s Professional Nursing Committee, which has overseen the development of the standards, said: ‘For too long, massive under-investment and lack of robust workforce planning has left a threadbare nursing workforce, unable to deliver that safe, high quality care that we aspire to, and our patients have the right to expect.
‘These standards are a positive tool for change, and we expect all workplaces to adopt and apply them.
‘The setting of nursing workforce standards across the UK has never been achieved before but the time to do that is now. We have a unique opportunity to build on the collective nursing leadership demonstrated during the pandemic, and together advocate for a safer, more effective nursing workforce that works now, and is fit for the future.’
Meanwhile, thousands of nursing and medical staff feel under pressure from employers to work extra shifts, often unpaid, according to unions.
As lockdown restrictions begin to ease, the Royal College of Nursing and British Medical Association are calling on UK governments not to rely on the goodwill of NHS staff to deal with current backlogs.
Instead, they said that ministers should look to ensure that services resume in a way that is safe for both patients and those providing care.
To do so, the UK governments must start having ‘honest and open conversations’ with the public about what the NHS can realistically deliver so that an accurate expectation is set, they said.
Governments must also commit to developing a robust plan, which addresses actions outlined in the RCN’s Principles for Return to Service – staff recovery and patient safety.
This includes prioritising protecting the health, safety, and mental wellbeing of the workforce and providing the service with additional resourcing dedicated to helping to tackle NHS backlogs.
The RCN pointed to the experiences of registered nurses and nursing support workers, based on figures from its survey of members’ experience of the pandemic.
In July 2020, one third of nursing staff in all sectors reported working longer hours. Of these, 40% were not being paid for the additional hours, with a further 18% only sometimes being paid.
In addition, the RCN flagged the latest NHS England staff survey which found that over 65% of nurses and 30.4% of nursing support workers worked extra hours that were unpaid.
These figures also showed that around half of all nursing staff worked in the previous three months despite not feeling well enough to do so and a quarter felt under pressure from managers to work when unwell.
The college quoted a critical care sister from Hampshire, who said: ‘Vast numbers of nurses are burnt out, experiencing severe anxiety, depression, and post-traumatic stress disorder.
‘We now have the huge task of “catching up” with cases that were put on hold during the pandemic, so for us the work is not over. Unsafe staffing levels compromise the care and safety of our patients.’
The RCN’s Pat Cullen said: ‘Exhausted health and care staff, without whom we would not have turned the tide of the pandemic, must be supported to recover.’
She said: ‘We cannot return to the understaffed wards, care homes and clinics from before the pandemic. Investment in staffing and pay is about both patient safety and the health of our workers.
‘After this experience, nursing staff expect decisive action and investment to guarantee there are enough highly-skilled health care workers to meet our country’s needs now and in the future.’
She added: ‘That means leaders must take steps to retain the nursing staff we have, as well as to increase entry into the profession.”
Doctors’ union the British Medical Association (BMA) council chair Dr Chaand Nagpaul said: ‘To learn that an already depleted and now exhausted workforce feels forced into doing more and more hours, with many reporting higher levels of fatigue than ever, is extremely worrying.
‘Governments should be doing all they can to ensure staff have an opportunity to rest and reset – no one should feel pressured to take the NHS backlogs on a goodwill basis.’
The impact of the pandemic on staff mental health and wellbeing has been a cause for concern since the outbreak hit the UK last year.
This sparked the launch of Nursing Times’ Covid-19: Are You OK? mental health campaign last spring.
Meanwhile, media coverage of nurses’ work during the pandemic has helped shatter gendered stereotypes of the profession, a poll commissioned by the RCN suggests.
Old-fashioned views of nursing as ‘women’s work’ or ‘vocational’ have bedevilled the profession for years but what the public has seen of the profession during the pandemic has cast it in a new light, the RCN says.
The poll, to mark Nurses’ Day today, May 12, which is Florence Nightingale’s birthday, found that media coverage of the pandemic has been an ‘eye opener’ and revealed the ‘full range of skills and duties’ nurses are required to undertake, respondents said.
TV news reports have shown nurses battling to save the lives of patients, deploying techniques including ‘proning’ – regularly turning them – to help treat the sickest.
Media reports have also shown them coping with the huge emotional burden imposed by the pandemic, with nurses describing losing several patients a day, often without loved ones to comfort them because of the lockdown restrictions.
They have also been at the forefront of the vaccination programme, giving life-saving injections to patients.
The poll canvassed 1,752 UK adults. Of those who said their understanding of the role of nurses had improved, more than half (54%) said media coverage of the nurses’ work during the pandemic has helped to improve their recognition of their skills.
The RCN’s Pat Cullen said: ‘Outdated notions of nursing and nurses have failed to match the reality of a professional life defined by high-level technical, emotional and cognitive skills.
‘Unfair stereotypes have inhibited efforts to improve the standing and attractiveness of nursing as a career at a time when there are tens of thousands of nursing vacancies in England alone.
‘This poll suggests the amazing work that the public has seen nursing staff doing in the media during the pandemic has transformed that perception.
‘This will give nurses a much-needed boost at a time when they are on their knees after a year of unprecedented challenges.’
Nursing staff have enjoyed huge public support during the pandemic with nearly three quarters (71%) of respondents saying they deserve more recognition.
RCN President, Professor Dame Anne Marie Rafferty, said: ‘The public has been right behind nursing staff throughout the pandemic and rightly so.
‘Throughout it, they have been at the heart of the response, innovating the ways they design and offer care, refashioning infection control practices, connecting patients with their loved ones and families. Nursing has been on display during the pandemic in ways the public has not seen before.
‘Many of the very same nurses are now leading the roll out of the vaccination programme which the roadmap relies on for our exit route out of the pandemic.
‘Nurse leadership has supported us out of the pandemic, and I am so proud of what the profession has accomplished at the crucial time.’