NHS trusts and health boards are bypassing nurses’ professional judgement when making strategic decisions relating to staffing levels and patient needs, according to new research.
The ‘Pro-Judge’ study – led by Cardiff University and funded by the RCN Foundation – found that professional dissatisfaction and a lack of patient care was resulting from nurses’ voices being left out of the strategic decision-making process. According to the researchers, this could impact nurse retention and increase staff shortages.
The study – which focused on three NHS trusts in England and three university health boards in Wales between January 2021 and March 2023 – found that nurses are relied upon to use professional judgement for operational purposes and to manage risks during staff shortfalls.
However, their judgments do not carry the same weight when staffing levels are agreed at strategic level, with data taking precedence over real-world understanding of clinical environments.
Davina Allen, from Cardiff University’s School of Healthcare Sciences, said: ‘Nurses have voiced their concerns that formal measurement systems often fail to capture essential aspects of care quality and staff wellbeing, making it challenging for them to express their professional judgement for workforce planning.’
The study calls for healthcare organisations to ensure the inclusion of ‘clinical and contextual’ nursing knowledge, and to refine staffing systems to generate data that better captures the complexity of care and nursing workload.
‘If nurses are to deploy their professional judgement to proactively influence the conditions for care, as well as responding to the challenges of risk mitigation, there is a need for robust systems of nursing measurement aligned with agreed standards of care, a vocabulary through which these judgments can be articulated, and a reframing of strategic decision-making to be more inclusive of the clinical perspective,’ said Ms Allen.
Deepa Korea, RCN Foundation director, backed the call for nurses to be given tools to ‘empower themselves and appropriate their professional judgement, ensuring that their voices are heard’.
Ms Korea added: ‘With nurse retention rates and staff shortages at a critical rate, it is fundamental that we utilise nurses in the workplace.’
The study, published last month, was based on the findings of interviews conducted with key individuals involved in the nurse staffing systems, staffing meetings and formal documents, tools and technologies. A limited number of observations in clinical areas were also conducted to gain insights.
