Safe nurse staffing levels a ‘must have’, warns WHO

Safe nurse staffing levels are a ‘must have’ to ensure patient safety and quality of care, the World Health Organization (WHO) has warned.

In a new policy briefing published last week, the WHO stated that nursing is a ‘safety-critical function that is fundamental to protecting population health,’ and, consequently, staffing levels needs to be addressed ‘urgently’.

Concerns were raised in the report about staffing levels due to ‘persistent nurse shortages, an ageing nursing workforce, increasing care complexity and the long-term impacts of the coronavirus pandemic, and exposed structural weaknesses in workforce planning and deployment’.

To address these concerns, the WHO suggested the foundations for implementing safe nurse staffing include working conditions and workforce planning, education and training, professional autonomy and leadership.

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The WHO defines safe nurse staffing levels as ‘having the right number and mix of appropriately educated and supported nurses to deliver safe care’. It adds that evidence ‘consistently shows that when there are too few nurses without the right skill set, risks to patients rise, and so do stress, injury and mental ill-health among staff’.

As well as patient safety, staffing levels are important for ‘staff wellbeing and retention’, according to the WHO. As stated in the report, ‘overwork, burnout and insufficient managerial support’ are drivers for nurses leaving their jobs which can be inadequate staffing levels.

Though the report acknowledged that it is ‘predominantly focused on hospital settings’, it adds that it aims ‘to provide information that is pertinent to all settings where safe nurse staffing is essential to the functioning of service delivery’. This includes in ‘hospitals, long-term care facilities, and mental health and community settings.’

In the report, titled ‘Polices and approaches to promote safe nurse staffing’, the WHO states that when nurse staffing levels are reduced in comparison to workloads, ‘patient safety and quality of care is compromised, there are missed opportunities for care increase, and errors rise in frequency and health outcomes worse’.

It adds that, as a result, safe nurse staffing is not a ‘nice to have’ but rather a ‘must have’ for ‘core patient safety and quality-of-care requirement’.

Different foundations were set out in the report as suggestions for aiding nurse staffing levels, such as working conditions for example. The WHO said workplaces should strengthen employment conditions, including fair remuneration, career pathways and supportive environments, to ‘maintain a sustainable workforce and uphold quality care standards’.

Education was also stressed as important, with nurses having access to CPD, structured career pathways and promotional opportunities, in order to ‘strengthen nurses’ confidence and autonomy in addressing safe nurse staffing challenges’.

Leadership, nurse autonomy, and workplace planning were also quoted as ‘enablers’ for helping staffing levels and ‘securing the continuity of care and strengthen trust in nursing services’.

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Dr Hans Henri P. Kluge, WHO regional director for Europe said: ‘Nurses account for more than half – 56% – of the health workforce, the majority of whom are women.

‘Safe nurse staffing is therefore not a luxury or administrative detail.

‘It is a safety-critical investment – for patients and for the entire health system. If we are serious about patient safety in our health systems, we need to take concrete steps to adequately staff and support our workforce.

‘The EU already faces a serious shortage of nurses; we simply cannot afford to drive them out of the profession.’

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The report comes after it was revealed that graduate nurses are being put on job waiting lists despite government promises to provide more roles for newly registered nurses and midwives.

New evidence in the NHS Pay Review Body (PRB) report, published earlier this month, revealed that the transition into employment was ‘variable’ and ‘inconsistent’ for newly registered nurses.

This is despite the government’s ‘Graduate Guarantee’ scheme which pledged to provide more jobs for newly registered nurses and midwives.