Director of the RCN Institute of Nursing Excellence. A career spent researching nursing workforce to inform policy & practice.
#safestaffing
And singing.
โAnd although nurses make up nearly half of the worldโs health-care workforceโand 90% of patientsโ contacts with health workersโthey are often not at the table when health-policy decisions are madeโ
Key mission for โฆ
@NursingNow2020
โฉ โฆ
@ICNurses
โฉ
โThe study concluded that increasing registered nurse staffing could:
-avoid 50 deaths per year and
- prevent 4,464 bed-days.
Adding that while staffing costs could increase, overall costs would decrease due to fewer bed-days.โ
โWe need to improve the retention of older nurses, otherwise we risk losing the most experienced members of the profession at a time when the pandemic has exposed the risk of global nursing shortages.โ says Prof Jim Buchan. Report with โฆ
@ICNurses
โฉ
I donโt seem to be able to tweet anymore. My drive has always been using evidence to try and create better conditions for nursing: staffing levels sufficient for good quality care, so both patients & nurses get what they need & expect from nursing.
But feels increasingly futile.
NEW PAPER
โConclusions: RN staffing & seniority levels were associated with patient mortality. The lack of association for HCSWs & agency nurses indicates they are not effective substitutes for RNs who regularly work on the wardโ โฆ
@BenZaranko
โฉ et al
I am so looking forward to this new role โฆ
@theRCN
โฉ
Itโs an honour to have the opportunity to serve the profession I love, the best way I know how: harnessing evidence and critical thinking to inform practice & policy.
Iโm worried about our students, especially those out in clinical practice at the moment. What can we do to support them? What - if anything - would help?
Any ideas?
NEW PAPER:
Achieving safe nurse staffing requires an understanding of its critical importance: to ensure sufficient supply of nurses & provide working conditions that can retain & develop the nursing workforce, to meet current & future health needs.
Iโm weary of 31 wks of home working.
Not sure if itโs unhinged or inspired... but this week Iโm having a โwork-cationโ. Booked myself a flat to stay in Mon-Friday, to get out of house, so it can feel like home again when I return.
Change is as good as a rest? Hope so.
Glad to have been on
#BBCr4today
to talk about criticality of nursing workforce.
Vital that staff feel valued & appropriately rewarded so that we can retain (and attract) nurses into the NHS to address the ongoing national shortage.
Canโt afford lose more nurses right now.
โAn increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% and every 10% increase in bachelor's DEGREE nurses was associated with a decrease in this likelihood by 7%โ
'It's pointless getting all nurses to have degrees.'
Professor Angus Dalgleish responds to this caller who says the system of nurse training is inefficient.
@IainDale
A bedside care workforce with a greater proportion of professional nurses is associated with better outcomes for patients and nurses. Reducing nursing skill mix may contribute to preventable deaths, erode quality & safety and contribute to nurse shortages.
NEW PROJECT: Evaluating recruitment & retention of nurses in NHS.
How well have we been doing?
What do we need to do more of, or do differently? What does success depend upon?
JOB OPPORTUNITY: 2 yr Senior Research Fellow
@unisouthampton
Advert coming soon (will post here)
The RCN set Workforce Standards. Now itโs time to make the case for Nurse : Patient ratios.
Iโll be setting out the evidence that demonstrates the critical importance of getting nurse staffing right.
#RCNRatios
#safestaffing
#valuingnursing
โThe world is short of 6 million of the 29 million nurses it is estimated to need, so there is a huge deficit in healthcare capacity worldwide.
We are at a critical juncture in our history. Staffing standards matter...โ p40-43 article by
@annemarieraffer
NEW PAPER:
โHospitals with more physicians & RNs had lower mortality rates. Higher levels of nursing assistants were associated with higher patient mortality. Only 2 studies included other health professionals, providing scant evidence about their effectโ
โWe canโt sit back and accept the status quo anymore.
For too long, nurses have been too polite, too accepting. We must fight for the future we want to see, and for me thatโs safe nurse-to-patient ratios implemented in every care settingโ โฆโฆโฆ
@theRCN
โThis invisible surveillance system by highly trained & experienced RNs is the most criticalโbut least understoodโof the services they provide.
But the effectiveness of that surveillance depends on how many patients a nurse has to care for
#safestaffing
โHow staff are treated significantly influences care provision & organisational performance so understanding how leaders can help ensure staff are cared for, valued, supported & respected is important.
Research suggests โinclusionโ is a critical part...โ
โYou think youโre going to save money when you reduce nurse staffing. NO. You ADD costs. It is NOT a cost savingโ. Concludes
@JackNeedleman
Take note health policy makers & managers worldwide.
Wonderful to hear
@alisonleary1
again.
โNURSING is a profession of VIGILANCEโ
But that is not factored into nursing workload tools or health care workforce planning.
We need to change how nursing is understood and planned.
#RCNRatios
#valuingnursing
#safestaffing
NEW: โUnderfunding of the NHS (demonstrated by the erosion of nursesโ real pay) has led to poor health outcomes, which is stifling economic growth. Therefore, properly funding the NHS will lead to higher - not lower- economic growthโ say
@LondonEconomics
NEW BLOG:
โNurses donโt just deliver the intervention; they are the intervention.โ
It is only by understanding the reality of the job โ its highs & lows โ that we will be able to retain & grow the mental health nursing workforce to the level needed.
NEW: Lower nurse staffing in A&E is associated with delays in patients receiving treatments and poor quality care - including an increase in leaving without being seen, delay in accessing treatments and medications, and cardiac arrest. โฆ
@JdaDrennan
โฉ
Nursing jobs must be satisfying & tenable to avoid burnout & retain RNs
โAdverse job characteristicsโhigh workload, low staffing levels, long shifts, & low controlโare associated with burnout in nursing.โ
The consequences of nurse burnout can be dire.
#safestaffing
We have the evidence. We donโt need to keep proving that not having enough RNs is dangerous.
Itโs time to act, to safeguard nursing for the benefit of all patients.
Our latest paper on staffing due to be published in
@BMJ_Qual_Saf
next week:
โNurse staffing, nursing assistants & hospital mortality: retrospective longitudinal cohort studyโ
@workforcesoton
@HSciences
โYou canโt take the canary, teach it to be more resilient, and stick it back in the same coal mine and expect it to survive.
You need to focus on the coal mine.โ
A growing body of evidence supports a system approach to staff well-beingโฆ
It needs repeating, over & over until message is heard and understood:
A โshorter degreeโ would
no longer be a degree & it would no longer create a registered nurse.
Both of which are KEY to patient safety.
#ValueNursing
@JessLSainsbury
@alisonleary1
@nursingpolicy
@NurseStandard
Which ministers? Can you be explicit about sources? Iโd like to write to them and share the research evidence.
A โshorter degreeโ would
no longer be a degree & it would no longer create a registered nurse.
Both of which are key to patient safety.
NEW PAPER:
โnurses need evidence of strong, inspired and passionate professional leadership in order to reignite the spark of enthusiasm and optimism that will get them through this pandemic.โ writes โฆ
@salthorne
โฉ
1/2
Many ways to be a โreal nurseโ...
โ...without our own research, policies, & education, we would cease to be a profession.
Nursing needs all of us, now more than ever. Our call to leadership requires a firm focus on addressing complex problems together.โ
This has felt like the most important event of my career.
A pivotal moment: the profession, so ably led by Nicola Ranger at the RCN, coming together to commit to action that can ensure nurse staffing levels are safe - protecting patients & nurses from harms of insufficency.
#WorldPatientSafetyDay
Having enough nurses is key to patient safety, but in many parts of the world there are not standards in place to ensure we have
#safestaffing
Time to put the evidence into practice.
Please watch & share this film
100% thank you.
But nurses donโt just need thanking on one day of the year.
They need valuing EVERY DAY - with staffing levels guaranteed to allow them to nurse without endangering themselves or their patients.
Which means enough registered nurses on every shift.
#IND2024
Happy
#InternationalNursesDay
!
Nursing is a safety-critical, highly skilled profession, in need of more recognition.
Join us in saying thank you to nursing staff everywhere for the remarkable difference they make to so many lives everyday.
#NursesDay
:
NEW BLOG:
โIf we truly value nursing, as we head into 2024, we need to resolve toโฆ
Demand nurse staffing levels that are safe for both patients and staff โ so that nurses can do what they came into nursing to do: deliver good care.โ
#safestaffing
#ratios
โOver the past few years, the UK has seen a loss of experienced nurses andโฆan increased need for nursingโฆ workloads have increased & have now become unsustainable. Nurses are compromising on patient care & pt safety, and they find that intolerableโ โฆ
Nurses & the CNO do not WANT nurses to be on strike.
What we (and most of the public) want is for the strike to not be needed.
For NHS nurses & their work to be properly funded so the profession can attract & retain numbers needed to deliver nursing care safely, in all settings.
NHS nursing numbers have not kept pace with growth in NHS activity over the last 10 years.
The NHS will need sustained expansion in registered nurse numbers just to maintain current services.
Read latest
@HealthFdn
report:
NEW PAPER on nurse staffing tools:
โThere is no evidence to support the choice of any particular tool. Future research should focus on learning more about the use of existing tools rather than simply developing new ones.โ
This is the staff kitchen & rest space on a ward in Sweden - complete with food for staff to breakfast together.
Also publicly funded health sysytem...
#valuehealthstaff
#yearofthenurse
#retention
Pat Cullen announced that โฆ
@theRCN
โฉ will โfirmly put its stake in the ground, campaigning for safe nurse to patient ratios under her leadership. We need staffing levels that safeguard quality of nursing care and the wellbeing of our professionalsโ ๐
โNursing is the golden thread that links healthcare policy and practice. It holds the solution to many of the healthcare problems the world is facing, and that is why we are calling for governments to urgently invest in nursing.โ Says โฆ
@HowardCatton
โฉ
Lower RN staffing & higher levels of admissions per RN are associated with increased risk of death during an admission to hospital. | BMJ Quality & Safety
โEvidence on the impact of minimum nurse staffing standards in California, and Victoria and Queensland in Australia, demonstrate that fears about costs & quality are unfoundedโ
Nurse-patient ratios work.
Great piece in
@thetimes
from
@annemarieraffer
NEW PAPER: RN staffing improvements produced reductions in mortality, readmissions & LOS.
โIn addition to producing better outcomes, the costs avoided due to fewer readmissions & shorter LOS were more than TWICE the cost of the additional nurse staffingโ
Stay at Home -don't go out
Commit to it 100% for the next 7 days
โขLive off what you have in
โขDonโt buy ANYTHING (from shops or online)
โขBecome a โZERO-DEMAND' household
Do it NOW for a week - so we end this sooner
#7daySTOP
#coronavirus
#itsuptous
NEW: COVID has caused unprecedented damage to the global nursing workforceโฆ
Without sufficient well motivated & supported nurses, the global health system cannot function.
We need urgent action & shared long-term vision/plan for global nursing workforce
NEW: Review of economic studies to identify costs & consequences of different nurse staffing configurations in acute hospitals.
Increases in absolute or relative numbers of RNs
is associated with IMPROVED OUTCOMES and potentially, REDUCED NET COST.
The โzombie tropeโ and covert sexism & snobbery of the โnurses donโt need degreesโ
โWhateverโs causing our problems in nursing, they wonโt be solved by giving people less education & trainingโan argument that should surely have had its day.โ โฆ
Yes.
NEW PAPER: Failure to meet nurse needs for safety at work has damaged morale.
Nurses told us what they most needed.
Meeting these needs would have improved their lives then, and may also be key to preventing worsening nurse shortages now & in the future
My last walk to work
@unisouthampton
Itโs been a great 10 years. Iโve learnt so much and worked with some fabulous people. Thank you
@workforcesoton
and colleagues.
Iโll miss youโฆ and the beautiful trees.
Clinical & academic leaders in nursing: โWithout clear and transparent mentorship, those who do not follow the traditional PhD and post-doc path may become disillusioned and frustrated, and may leave academiaโ
This โalways relying on goodwill of nursesโ
Has got to STOP.
The whole profession - from newest graduate to highest ranks nationally need to say โNo Moreโ. Nursing is valuable.
We MUST have the RNs we need to deliver care safely - for staff and patients.
If not, close beds.
@alisonleary1
Wow! The total lack of support just gets you every time. Always relying on the goodwill of nurses. We can only do so much until lives are lost or mental health suffers more than it already is. HELP!!!
The problems:
1. Blame culture
2. System needs over-ride staff well-being
3. Unintended personal costs of upholding values at work
4. Interventions donโt recognise cumulative chronic stressors
5. It is hard to design, identify & implement interventions.
@HSJEditor
Aside from ethics, surely this is a counter productive step.
It is not possible to effectively โpoliceโ responses to a pandemic - scale is too huge.
Behaviour modification and compliance with safety measures needs to be built on trust and persuasion of the rationale.
Day 2
@theRCN
Loving it even more than Day 1! Fabulous meeting with Chief Executive & General Secretary, Nicola Ranger.
So much positive energy, vision and commitment.
โDespite the affection for nurses... the delivery of nursing itself is not valued. If it was, why would we ever doubt that having nursing delivered by degree-educated professionals is a good thing?โ
#IND2019
We MUST have minimum RN:patient staffing levels set in legislation.
Patients deserve nursing care led & delivered by registered nurses.
Without enforceable minimums, zero RN staffing is an option - regardless of the HUGE risks to pt safety, and reduction in care decision making
Had several concerning DMs about
#safestaffing
this weekend.
There is an agency/bank ban currently in England and I have reports of wards without registered nurse cover.
This is dangerous and also unlikely to force people into poor substantive contracts. False economy
JOB OPPORTUNITY:
Interested in working with me โฆ
@theRCN
โฉ Institute?
Getting nursing workforce right is absolutely key to achieving nursing excellence.
Could you lead the RCNโs work on workforce? A great opportunity to make a huge difference
Good nursing is not a โnice to haveโ.
It is the essential ingredient for cost effective care.
Resourcing nursing properly makes good economic sense AND saves lives.
#IND2024
#InternationalNursesDay
#valuenursing
ICN asked
#nursing
experts, academics and economists to reveal the true value of nursing in our
#IND2024
report! Hear from one of the experts on the economic power of care! Watch this space for more:
#OurNursesOurFuture
@HowardCatton
โwe propose that the hero and angel constructs undermine the professionalism of the nursing workforce, and reinforces the perception that nursing is an innately feminine, nurturing role.โ discussion article by โฆ
@j_stokesparish
โฉ et al
Study finds nurses primarily ended health care employment due to systemic features of their employer.
We can improve nurse retention by:
โก๏ธ Reducing & preventing burnout,
โก๏ธ improving nurse staffing levels,
โก๏ธ Supporting nursesโ work-life balance
PUBLIC LECTURE:
โValuing Nurses,Valuing Nursingโ
@unisouthampton
12 May 2022 17:15
#IND2022
#nursingNOW
To book your ticket, please visit: and select if youโd like to attend in person or online
What do we know about burnout so far?
REVIEW: โThe patterns identified by these studies consistently show that adverse job characteristicsโhigh workload, low staffing levels, long shifts, and low controlโare associated with burnout in nursingโ
NEW PAPER:
โgood teamwork between doctors & nurses are not only important for the team, but also can have consequences for patients. It provides additional incentive to find mechanisms to breakdown disciplinary barriers & improve cohesionโ
EVERY nurse should expect (and insist upon individually & collectively) that these basic workforce standards are met where they work,to ensure:
- services are properly staffed
- safety is prioritised, and
- they are supported to perform their best
โPublished in the midst of one of the worst shortage of nurses in the history of the NHSโฆ.
If we value the contribution that nurses make to the NHS, then we need to value their careers.
It is impossible to do one without the other.โ
@CHancockC3
(General Secretary RCN, 1997)
Ensuring
#safestaffing
levels helps avoid burnout, which impacts on the wellbeing & health of staff (as well as morale & motivation).
Over-stretched & exhausted staff also leads to to a decline in performance - which increases the risk to patient safety.
โAmong a profession โwired to look after othersโ, staff may need to be nudged by colleagues about the importance of thinking about their own needs too. A โbuddying upโ system could help new or temporary team members feel safe, valued & welcome... โ
โin addition to nurse staffing levels, nursing skill mix is crucial for providing the best possible quality of nursing care from the patient perspective and both should be considered when designing policies such as minimum staffing regulationsโ
A position backed by the research evidence. There is NO substitute for degree educated registered nurses.
Other members of the team are important to support care but NOT to REPLACE nurses.
As we face the critical nursing workforce shortage in all health and care settings across the UK it is important to reiterate the position
@theRCN
on the risks of substituting the Registered Nurse with other Health Care Workers.
Planned retirement was main factor (39%), but nurses also cited:
- burnout/emotional exhaustion (26%)
- insufficient staffing (21%)
41% retired nurses had left for reasons other than planned retirement - including burnout and insufficient staffing
NEW: there is an increase in the risk of death among patients exposed to low nurse staffing or high proportions of temporary staff.
The risk of death associated with low nurse staffing is only partly mitigated by using temporary staff to remedy shortfalls
Itโs time to draw some redlines to ensure safe minimum nurse staffing levels. We canโt afford not to.
For the safety of patients, the health of nurses, and viability of NHS services, we must set standards to make sure there are enough nurses, every shift.