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We also have a significant over-reliance on the supply of nurses on an ad hoc basis through the nurse bank and nursing agencies. There are alarmingly high sickness absence rates amongst nursing staff that are largely attributable to stress and mental ill health. The RCN has been highlighting the need to promote safe and effective care through safe nurse staffing for many years. Mortality rates increase by up to 46% in hospitals with a 1:8 nurse-patient ratio compared with a 1:4 nurse-patient ratio. Every patient added to a nurse’s workload is associated with a 7% increase in deaths after general surgery. Higher patient satisfaction is recorded in hospitals with fewer patient per nurse workload and good nursing work environments. However, we need to invest in safe staffing across all areas of nursing practice.

An RCN survey has shown that 83% of nursing staff in Northern Ireland said that the actual number of nursing staff on their last shift was not sufficient to meet patients’ needs safely and effectively. Only 17% of nursing staff agreed that they had enough time to provide the level of care they would like, whilst just over one-quarter (28%) said that they were able to provide the quality of care that they themselves would want to receive as a patient. Some 56% (the highest percentage across the UK) said that too much time was taken up on non-nursing duties. The survey also found that almost two-thirds (60%) of nursing staff were unable to take the breaks they were supposed to take during their last shift. A similar proportion (64%) worked additional hours on their last shift, of which 82% did so unpaid.

In order to promote safe nurse staffing, we need proper workforce planning that is based on health care needs, tackling inequalities and strategic priorities, not financial considerations. Politicians and policy makers must start to view nursing as an asset to be supported and developed, rather than as a cost to be suppressed and controlled. We need to implement the recommendations of a Department of Health report on promoting the retention of the nursing workforce. There is no point in recruiting additional nursing staff if we continue to lose them because of staffing pressures, low pay and unacceptable working conditions. Finally, we need to make sure that health and social care transformation is finally delivered and this requires appropriate investment in specialist community nurses such as district nurses, school nurses, and health visitors to deliver these transformed services.

The RCN in Northern Ireland remains fully committed to securing safe nurse staffing and our priority within this continues to be to hold the Department of Health and the Northern Ireland Executive to account for the delivery of the measures needed to provide the level and quality of health care that our members want to deliver and which the people of Northern Ireland are entitled to expect.

The RCN has responded to a Department of Health consultation on draft principles to underpin the forthcoming safe staffing legislation that is due to be introduced in the Northern Ireland Assembly in early 2025. This follows a commitment made in 2020 by the Department of Health (and endorsed by the Northern Ireland Executive) in response to strike action by RCN members in pursuit of pay parity and a safe staffing framework. The legislation will embrace statutory commitments on workforce planning and associated reporting, accountability and governance, along with measures related to the health, well-being and safety of service users and staff. We will keep members informed of progress with this important legislation.