The 4:1 nurse ratio campaign argues nurses cannot look after an unlimited number of patients without patients suffering.
To ensure there is a safe number of nurses on shift there needs to be a mandatory patient to nurse ratio (4:1). Without that bottom line, financial pressures will always lead to reductions in nurses on shift.
NHS nurses have to look after up to 14 patients at a time. One person can’t even identify the needs of that many people, never mind meet them. Nursing practice becomes limited to giving out medications, while the ongoing care and assessment of the patient is carried out by unqualified healthcare assistants. Healthcare assistants are not adequately trained, supported or paid to be able to carry out this responsibility safely.
Research indicates mortality can drop by at least 14% if a high nurse to patient ratio is implemented. The demand has been met in some US states and Australia and nurses have found that patient care and the well being of nurses have both improved dramatically.
The government is simultaneously starving the NHS of money while blaming staff in the NHS for the resulting decline in standards of care. They want to cut the wages bill. But wages — and wages paid at decent rates for all staff — should be the bulk of spending in the NHS! Good healthcare is a joint effort, and a multi disciplinary approach is needed to ensure good outcomes, but the nurse is the lynchpin.
The nurse delivers almost all of the practical care. A healthcare assistant may be highly skilled and experienced, but will lack the authority to alert doctors to deteriorating conditions, or take part in emotionally difficult conversations with patients and families. Without adequate nursing staff warning signs are missed.
Lack of nurses has a profoundly dehumanising effect on patients and staff.
A recent Unison staff survey indicated that three in five nurses skipped breaks, and over half regularly did unpaid overtime. Hungry and tired nurses do not have time and energy to stop and talk to patients.
Nurses in this situation will try to make themselves less available. A patient reported to me, that in all the time he was an inpatient, only twice did staff make any eye contact with him. Staff would come to “do things” to him and walk away without saying a word.
He was in continual pain, unable to stand, and unable to sleep, and had no-one to help him. This is inhuman and degrading treatment. It is torture. And yet it is happening to patients in every NHS hospitals.
Everywhere there are nurses going home, having not eaten a meal for over 12 hours, exhausted, unable to relate to their families, feeling that they have failed their patients. In Unison’s survey three-quarters said they did not feel they had the time to deliver safe and compassionate care to their patients.
19.7% said that situations that happened in Mid Staffordshire Trust were occurring in their Trust.
Nurses, so psychologically damaged by working in under resourced departments, can no longer relate to their patients. This “burn out” syndrome can affect every aspect of a nurse’s life leading to psychiatric illnesses and relationship breakdown. The experience of being looked after by someone who is unable to recognise you as another human being is terrifying.
On the 4:1 website, nurses in California, and in Victoria Australia both point out that campaigning and winning this demand is about advocacy and solidarity between nurses and patients. It isn’t the guilt-ridden nurses who are the problem in some NHS hospitals, but the cuts in funding by government.
The miracle is, that despite the worsening conditions, the vast majority of patients still feel safe and well cared for in the NHS. And the good news is that that the 4:1 campaign is making progress; Unison and Unite have both signed up to the campaign, and the RCN are in talks about it.
But it will take more than speeches and motions at union conferences to achieve this. The campaign will need to be taken in every hospital, and every ward. It will need patients to stand with their nurses in demanding this. The campaign to win the demand was backed up by strike action in Victoria, Australia, and that’s what it might take here.
This is the demand that has the potential to transform the NHS.