Debate: Mental health staffing

This resolution was passed

Much discussion has been made of minimum or safe levels of staffing.

The RCN is involved in the Northern Ireland Department of Health Delivering Care initiative, which seeks to define safe nurse staffing levels across a range of practice areas. Phase 5 of this work focuses upon mental health nursing practice settings and is currently underway.

In Scotland, there are mandatory workload and workforce planning tools for nursing in the NHS, including one for mental health. The Scottish Government is in the process of developing legislation to ensure staffing for safe and effective care (RCN Scotland, 2017).

A mental health workstream is established as part of the Welsh response to the Nurse Staffing Levels (Wales) Act 2016. The aim is to use an evidencebased approach to create robust methods, tools and techniques to determine appropriate staffing levels within mental health inpatient services, using a common model of triangulation.

Progress includes completion of a literature review on existing workload and workforce tools; development and piloting of a professional judgement workbook; a series of audits on professional judgement triangulated with information on admissions, transfers and discharges; deployed staffing and levels of observation and engagement and physical care; and algorithm development as a decision support tool.

Next steps include identification of quality indicators; information on the experience and outcomes of patients to detect impact on therapeutic relationships and care; support peer review of professional judgement with statistical learning and developing the method to use information collected through the audit to inform nurse staffing levels.

Establishing and developing therapeutic relationships underpins the mental health nursing professional skills. This can need open-ended interactions, and so staff must have both support and flexibility to build trust and encourage involvement for service users both on the wards and in the community. As such, minimum staffing levels are not helpful. Minimum staffing levels encourage a race to the very bottom where the emphasis becomes containment and quiet, rather than creative therapeutic dialogue, true understanding and contextualisation, trust and coproduction with those in our care.

Safety is not just about numbers, but effective, therapeutic relationships between nurses and service users. 

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