RCN calls for return of pre-pandemic nurse ratios and funded staff rest time

The RCN has released a new document insisting that nurses have a voice and role in guiding the government as it maps the UK’s route out of lockdown.

“The prime minister must not bow to political pressure, only to pile it on health and care services instead”

Donna Kinnair

‘Principles for return to service – staff recovery and patient safety’ calls for a range of measures to ensure that staff are protected from Covid-19 and that nurses’ mental wellbeing and right to speak out is supported.

On staffing, the RCN emphasised the need for areas like intensive care – where staffing levels “were diluted to unsafe levels” – to return to their pre-pandemic ratio.

In intensive care units (ICUs), the standard pre-pandemic nurse to patient ratio was 1:1.

However, in the first wave of coronavirus, with services overstretched, ICU nurses were asked to care for up to six patients at a time with the support of a team of non-ICU staff redeployed from other areas.

During the second wave, this opting out of the normal staffing rules was modified. When capacity was exceeded, ICU nurses were allowed to look after two patients at a time with support from a non-ICU nurse.

The RCN said it was “increasingly concerned about the health and wellbeing of its members and their ability to provide current services safely and sustainably”.

The document calls for ‘long Covid’ to be recognised as an occupational disease requiring appropriate policy remedies, occupational health and support.

In the autumn nurse academic Dr Elaine Maxwell stated that an “urgent survey” was needed to understand the incidence of long Covid among the nursing workforce.

She said her team had heard “many nurses and other healthcare professionals” report ongoing symptoms, and that some had been off work for six months or more.

The RCN document is also calling for funded time off for nurses from all sectors impacted by Covid-19. This would be on top of regular holiday entitlement and be paid for by employers.

“Rest and recuperation for health care staff must be central to decision making on getting patients safely back to diagnostics and missed treatment,” it stated.

With the government starting to set out how it plans to lift lockdown restrictions – schools set to reopen on 8 March and outdoor gatherings allowed from 29 March – the RCN warned Downing Street against opening up too quickly.

“The UK government must not relax public messaging or implement incentives for people to mix in groups,” the document said.

“We have seen how mixed messages can directly result in increased pressure on the health and care system. Public messaging must continue to reinforce the importance of hands, face, space.”

The RCN is also calling for the higher Covid-19 risk affecting Black, Asian and minority ethnic (BAME) nursing staff to be considered and reduced as services return.

The proposals came as part of its eight principles to guide the NHS and private employers in a return to “normal” service delivery:

• A higher level of personal protective equipment (specifically FPP3 face masks) must be used
• Employers must fund confidential counselling, bereavement and psychological support for all staff
• Training and support for a return to substantive roles and changes in provision
• Nursing staff to have input in guiding a phased approach to reintroducing services
• Funded rest and recuperation for all nursing staff on top of annual leave
• Assessing the risk to health and social care staff versus the risk of delaying treatment to patients
• Measuring and tackling the higher risk to BAME nursing staff
• Staff enabled to raise concerns secure they will be dealt with fairly

The document also raised concerns that a “significant number of nurses” could choose to leave or retire in the coming months due to the impact of the pandemic.

As a result, the government and employers should draw up a recovery and retention strategy for staff after consultation with trade unions.

Releasing the document, Dame Donna Kinnair (pictured top), chief executive and general secretary of the RCN, said: “The prime minister must not bow to political pressure, only to pile it on health and care services instead.”

It was vital that the rules and messaging were not relaxed until there was a consistent decline in pressure on hospitals and health workers, she said.

“The messaging on hands, face and space must be reinforced, not diluted. Nursing staff are still telling me that the pressure on hospitals and other services are as bad as at any point last year.

“Exhausted staff must be supported to recover and pressure must abate further before we can enjoy the normality everybody craves.”