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Care assistants ‘cannot act as substitutes for Registered Nurses’, warns study

Researchers discovered the risk of patients dying decreased when more registered nurses were on duty.



nurse preparing IV medications

Researchers have found patients are at a higher risk of dying if there are fewer registered nurses are on duty.

A study by the University of Southampton and published in the BMJ has found a three per cent rise in the risk of death for each day there is a shortfall of Registered Nurses.

The study comes as official figures show 40,877 unfilled nursing vacancies in England alone.


Researchers followed nearly 140,000 patients in an acute trust between April 2012 and March 2015 to examine the impact skills mix has on patient outcomes. During the study, the overall morbidity rate was just over 4% reporting 5,662 deaths in total.

Researchers discovered the risk of patients dying increased when there was a shortfall of registered nurses but decreased with more registered nurses on duty. In contrast, the study failed to show any relationship between an increased number of care assistants and a decrease in morbidity rates.

The study says the figures show the potential consequences of a shortfall in registered nurses and the negative impact it can have on patient safety. Adding; “While nursing care assistants also have an important part to play in maintaining the safety of hospital wards, they cannot act as substitutes for Registered Nurses”. 

Going on to warn healthcare providers that registered nurse and nursing assistant hours “should not be treated as equivalent”.

A stark warning.

Dame Donna Kinnair, Royal College of Nursing Acting Chief Executive and General Secretary, said: “As the official count of vacant nurse jobs rises this year, this study shows the death count will too – it’s as stark as that.

“The Government and the NHS in England must pull together to resolve the staffing crisis – patients are paying the highest price for the shortage of nurses.

“This research is the latest in a long line of studies showing that patient safety is at risk from the failure to plan for a long-term workforce.

“Asking nursing students to take on thousands of pounds worth of debt to fund their courses has led to a dramatic fall in the number of students applying for university nursing degrees – so the RCN is calling for at least £1 billion to be invested into nursing higher education.

“This investment needs to go hand in hand with a law that enshrines safe staffing, and ensures we have the right number of nurses, with the right knowledge, in the right place.

“We need accountability at all levels for nurse staffing to keep the public safe.”


Nursing vacancies hit record high leaving patient care at risk

It can be “dangerous” when there aren’t enough nurses to provide care.



Patient Falls Risk with IV

There are now a record 43,671 empty nursing posts in the NHS in England alone.

NHS figures show that there are now a record 43,671 empty nursing posts in the NHS in England alone, according to the Royal College of Nursing (RCN).

The College says a global shortage of nurses alongside the removal of the nursing bursary has compounded this figure which now sees 12% of posts through the NHS in England without a full-time Registered Nurse.


Figures from the University and College Admissions Service (UCAS) show a 29% overall decline in applications to undergraduate courses since 2015, when the bursary was cut by the Government.

In a report released today titled ‘Standing up for patient and public safety’, the Royal College of Nursing outlines the evidence of the need for a new law that allocates specific legal responsibilities for workforce planning and supply.

A new law is needed.

The report states that in order to address the record number of vacancies, and the gap between the numbers of health and care staff needed to deliver patient care vs. how many are in the system.

Figures included in the report reveal that the number of nursing staff has consistently failed to keep up with the dramatic rise in demand for services and the number of emergency admissions.

The report finally makes a further call for legal clarity on the roles, responsibilities, as well as accountabilities, for workforce planning and supply.

In September, after pressure from RCN members, NHS England and NHS Improvement asked the Government for clarity over who is accountable for the nursing workforce.

‘Nurses are working harder than ever’.

Dame Donna Kinnair, Chief Executive and General Secretary of the Royal College of Nursing said: “Nurses are working harder than ever to deliver safe patient care but are being held back by a system that is legally lacking teeth. Despite the public, patients and nurses all agreeing that clarity is needed on responsibilities for delivering enough nurses, we have yet to see any government pledge anything of the like, and as a result are staring down the barrel at a record 43k empty nursing posts.

“We know how dangerous it can be when there aren’t enough nurses to provide care, but at present, almost all accountability rests with the frontline nurse working on the understaffed ward, rather than those responsible for the system they work in.

“We believe the time has come for change and that patient care was future-proofed by law, and that from the government down, decision makers are held to account.

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NHS calls for clarity on who is accountable for the nursing workforce

Figures suggest there are around 40,000 unfilled nursing vacancies throughout the NHS in England.



Working nurses in the CCU

Healthcare leaders are calling for legislation to be included in the forthcoming Queen’s Speech.

NHS England and NHS Improvement have called on the Government to clarify who is accountable for the nursing workforce and the chronic problems it’s currently facing.

Following ongoing pressure from nursing unions, the two organisations met today and recommend that the government should “revisit with partners whether national responsibilities and duties in relation to workforce functions are sufficiently clear.”


With around 40,000 unfilled nursing vacancies in the NHS in England and thousands more throughout social care, the Royal College of Nursing (RCN) believes the Secretary of State for Health and Social Care should be legally accountable for the workforce.

Along with other health care leaders, Dame Donna Kinnair, Chief Executive & General Secretary of the RCN, written to the Government calling for the legislation proposed by NHS England and NHS Improvement to be included in the forthcoming Queen’s Speech.

Staff shortages have reached ‘alarming levels’.

Responding to the news, Dame Donna Kinnair said: “We are pleased that NHS England and NHS Improvement has recognised the concerns of RCN members and the public and has stated that the issue of accountability for workforce planning and supply remains an area that needs be resolved.”

“In the week after we have launched a major public facing campaign calling for investment in the nursing workforce as well as for accountability to be clarified in the law, yet again, the case is made for this to be taken seriously.

“We are clear that government is well placed to determine how accountability can be clarified in law.

Adding; “Staff shortages have reached alarming levels with at least 40,000 vacant registered nurse posts in the NHS in England alone with thousands more vacancies in public health and social care.

“We now hope government will listen to this message, as well as the voices of the thousands of members that responded to the NHS England engagement process, and bring forward this legislation, taking the opportunity to include accountability in government and throughout the health and care system, for workforce planning and supply.”

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