66% of nurses felt they did not have enough time with each patient.

54% reported that care was left undone due to under staffing

There is currently no legislation that sets out minimum nurse-to-patient ratios. UNISON believes this should change. We want legislation that ensures there is a minimum of one registered nurse per four patients for every department across the health service.

The inquiry into care failings at Mid Staffordshire Foundation Trust identified a link between appropriate staffing levels and safe, compassionate care.

Over 90% of respondents in UNISON’s 2013 staffing levels survey said they support mandatory minimum staffing levels.

A squeeze on staffing levels leaves too few nurses trying to care for too many patients.


The facts

How this affects you if you’re a nurse

UNISON’s 2014 staffing levels survey running on empty showed that staff reported having to work longer and being unable to provide the care they would like to.

  • The majority of staff regularly worked unpaid extra hours.
  • 50% worked through their breaks and over their shift time.
  • 61% felt they did not have enough time with each patient.
  • 58% said there were not enough staff to deliver safe, dignified and compassionate care.
  • 51% said they were not cofident about raisong concerns.
  • 54% said care was left undone due to staffing

How this affects you if you’re a patient

When staffing levels are stretched, although vital care is still provided, patients may not be treated with the dignity and compassion they should be able to expect.

Patients may have to wait for some aspects of care such as cleaning of soiled beds or time to talk with a nurse.

How this affects you if you’re a student nurse or healthcare assistant

Increasingly, student nurses and healthcare assistants are being asked to do work they are not trained for or qualified to do.

If nurses’ workloads are stretched, they have less time to support student nurses and healthcare assistants providing care.

What UNISON is calling for

UNISON wants legislation to ensure a minimum nurse-to-patient ratio of one registered nurse to every four patients in every department across the health service.

Our members are raising their concerns locally when they believe that staffing levels are too low to deliver safe, compassionate and dignified care.

Nationally, UNISON is pressing politicians to commit to minimum care ratios. We want to ensure that those responsible for cutting care in the NHS are held to account and that healthcare professionals and the NHS are not blamed.


Take action

Sign the petition

Petition for a 4:1 mandatory minimum staffing ratio for nurses in the NHS

Responsible department: Department of Health

Most nurses employed by the NHS have to look after unmanageable numbers of patients.

A single nurse cares for on average 9 patients on a medical ward, 11 on an Elderly Care ward. This puts patients at risk and is the biggest reason for adverse patient care.

A survey of nursing staff in March 2013 found:

  • only 31% reported having enough staff
  • 76.8% reported not having enough time to care for patients
  • 19.7% said conditions in their hospital were like those at Mid Staffordshire

The Francis Report showed the role low staffing plays in poor patient care.

Research by nursing academics show the maximum number of patients that a nurse can effectively and safely care for is four.

We ask the Department of Health to implement a mandatory minimum staffing ratio of 4:1 to govern nurse staffing levels in the NHS, with the necessary increased requirements for complex areas like HDU and ICU, and develop mandatory staffing levels for primary care, to ensure all patients in the NHS are given safe care.

Sign the petition here

True story

New South Wales Nurses and Midwives Association

Nurse-to-patient ratios have improved clinical care and work satisfaction for nurses at the Royal Prince Alfred Hospital in Australia.

In the old days, only seven nurses could be there to care for patients in Ward 7 East 2 at the Royal Prince Alfred Hospital.

The Ward 7 East 2 surgical unit has a high patient turnover rate and is a multidisciplinary ward specialising in, among others, urology, melanoma, gynaecology, gynae-oncology, radiation oncology and dermatology.

Nursing unit manager Aaron Jones remembers just how difficult it was before nurse-to-patient ratios were put in place.

“The staff were very stressed,” says Aaron. “They would often get so busy that they wouldn’t have time to just stop for a minute and regroup, and that would build up the stress.”

After ratios were implemented in August 2011, he noticed significant improvements in staff morale and the quality of clinical care. “On a workplace satisfaction survey that we did after the new ward provisions came in, we saw a significant improvement on the previous staff satisfaction survey results.

“What I’ve seen as a manager is staff who were really stressed and not particularly happy at times, to staff that are less stressed. There will always be stress in this job, but now staff report to me that they have a lot more workplace satisfaction.”

New ratios have also allowed the ward to change its model of care, through the new staff they have taken on board. To add a much needed boost to the provision of care in the ward,  Aaron spent a couple of months recruiting graduates, a flow nurse, supernumerary and extra night shift staff.

The hospital’s quality improvement programme has also shown positive results. The Hand Hygiene Australia rating has risen from a 3.5 to a 5-star rating.