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Ireland Must Legislate For Safe Staffing. 08.05.14

PRESS RELEASE,  Thursday, 8th May 2014

INMO Launches Safe Staffing Campaign

-    Acute Wards – one nurse to four patients at times of high activity with one to seven on night duty; and

-    Agreed systematic approach to determine staffing levels in all other care areas.

The Irish Nurses and Midwives Organisation (INMO) has, today, called on the Irish government to legislate for mandatory safe staffing ratios if catastrophes, like that which occurred in Mid-Staffordshire Hospital, where up to 1,200 unnecessary deaths occurred, are to be avoided.

At the campaign launch the INMO also called for one registered nurse to every four patients in busy acute medical and surgical wards and, in the case of midwifery, one midwife to 29.5 births, which is internationally accepted as the necessary ratio in maternity services.

England, Scotland, Wales and Northern Ireland have all, since March this year, set mechanisms to determine minimum RGN/RM cover as a result of a succession of Health Commission reports cataloguing chronic failures in patient care.

Irish patients deserve the same protection, according to the INMO, which is also seeking that the staffing in each ward be publicly displayed, each day, as is now the case, by law, in the UK.

According to the INMO, staffing in Irish wards is lower than in equivalent wards in the UK and a recent snapshot review confirmed that the situation has deteriorated since 2012.

In 2012, the INMO undertook a comparative staffing survey which identified significant staff shortages, on medical/surgical wards, in Ireland, when compared to the UK.  In preparation for this campaign launch the INMO undertook a second sample study which confirmed that staffing levels in Ireland have further decreased in the past two years.  The details of the two studies are on the attached tables which confirm that nurses in Ireland:

  • have to look after 1.8 more patients per nurse on early/late shifts; and
  • have to look after up to 5.2 more patients on night shifts.

The launch also saw the publication of a compilation of all international research, undertaken in recent years, which confirms the added value the presence of a registered nurse brings to patient care and patient outcomes.  All of this research confirms lower staffing is associated with:

  • increased risk of mortality;
  • adverse events in poor care;
  • less effective and efficient care; and
  • higher nurse fatigue and burn out.

The conference agreed the objectives of the campaign will be as follows:

  • introduction of a nurse : patient ratio of 1 : 4 at times of high activity on acute medical/surgical wards with 1 : 7 at night;
  • staffing, at all other times, to be determined by an agreed best practice dependency tool managed/applied by a supernumerary ward nurse manager;
  • that all care of the elderly facilities should have a 60 : 40 skill mix (registered nurse : healthcare assistant) to adequately care for high dependency patients.  All other care environments again having their staffing determined by an agreed dependency tool managed by a supernumerary nurse manager; and
  • the INMO to immediately commission independent research to identify, and measure, “missed care” in the community. From this appropriate staffing/skill mix levels to be determined recognising the roles of the:
  • Public Health Nurse;
  • Community RGN/RM;
  • Practice Nurse;
  • specialist Nurse i.e. RNID; and trained healthcare assistant.

Today’s launch also received a strong message from Ms. Judith Kiejda, Assistant General Secretary of the New South Wales Nursing and Midwifery Association in Australia who have just completed the first stage of their one in four campaign with great success and measurable improvement in patient care.

The conference also agreed that the immediate next steps, for the campaign, will be:

  • To continue to seek the abolition of the flawed, and damaging, recruitment embargo which has seen 5,000 nursing posts axed from the health service over the past five  years;
  • Present the international evidence/research to government, Oireachtas Health Committee, TDs and Senators within three months;
  • Also present the research to other stakeholders and groups (including patient representative groups) with interest in the quality of healthcare; and
  • Sustained engagement with all political parties seeking commitments, to the introduction of a systematic approach to staffing, including one nurse to four patients at times of high activity, ahead of the next general election.

Speaking at today’s launch INMO President Claire Mahon said:

“This campaign, which is fully underpinned by international research, is targeted at creating, and sustaining, within our health service an environment for patients where their care is always quality assured and delivered with dignity.

The ratio of one nurse to look after four patients (1 : 4) at times of high activity, on medical/surgical wards will be a cornerstone of this campaign.  The current reality of one nurse looking after over eight patients, on day shifts, and over 12 patients at night cannot continue.  The research confirms the risks and dangers, for patients, associated with this high workload and government cannot ignore this any longer.”

INMO General Secretary Liam Doran concluded:

“The INMO is now actively involved in national campaigns seeking significant improvements in nurse and midwifery staffing levels.  These campaigns will continue until we secure the necessary staffing resources to allow nurses and midwives practice safely in the interests of the patients they serve.

This campaign will be sustained and will continue, ahead of the next general election, but the recruitment embargo, to allow some alleviation of the current unsafe practice environments, must be lifted immediately.

The evidence for safe staffing is compelling, as is today’s reality which sees care being compromised on a continuous basis.  Our call for a one to four ratio at times of high activity and for one nurse to seven patients at night, on acute wards, cannot be ignored by those who care about our public health service.

The challenge we now present government, and health service policy makers, is to act on the evidence, accept that patients come first and agree a systematic approach to staffing which is underpinned by international evidence”.

Click here for UK V Ireland Comparison figures

Click here for Safe Staffing: The Evidence Key facts from a review of published research findings