Phil Ní Sheaghdha: A nurse for every four patients is the basic safety standard. We don't have this
Phil Ní Sheaghdha: 'It is internationally accepted that for patients to be treated safely, there should be one nurse for every four patients or at worst one nurse for six patients.' File photo: Leah Farrell/RollingNews.ie
The recent publication of former Chief Justice Frank Clarke's report into the tragic death of Aoife Johnston at University Hospital Limerick (UHL) has once again opened the public debate about safe staffing levels across the Irish public health service.
My thoughts are with Aoife Johnston’s parents, her sister and all who loved her. I am also thinking of those who were on duty that weekend with inadequate staffing while working in impossible conditions within which they tried to deliver care.
Many so-called experts will share their views on how we can ‘fix’ the health service as we inch closer to another winter of known unknowns in our health service. Political representatives will cite the increasing investment into health services and repeat their mantra that staffing has never been as high — as if that relieves them of the responsibility to ensure the essence of safety is achieved.
Those of us representing nurses, midwives and other frontline healthcare workers know that this is all a smokescreen. Safety measurements in the delivery of healthcare are only achieved when the independently measured safe levels of staff are on duty throughout every shift.
During the period referred to in former Justice Clarke’s report into UHL, staffing numbers in the emergency department were out of kilter with best practise — there were over 70 patients in ‘Zone A’ at the beginning of the night, with three nurses on duty, at the end of their shift there were 85 patients.
It is internationally accepted that for patients to be treated safely, there should be one nurse for every four patients or at worst one nurse for six patients. Irish research has led the way in determining the association between nurse staffing and quality of care. This is not the reality in many wards across Ireland today.
The moratorium on recruitment that has been in place since October 2023 means replacement staff can’t currently be recruited when vacancies arise. This has degraded patient safety in areas that were previously able to provide safe levels of care.
Yes, the total number of nurses has increased in the public sector since 2021, however we started from a very low base. the moratorium introduced in 2007 slashed nursing and midwifery numbers that were not regained until mid 2020.
In the meantime, demand on the public health service has increased substantially since covid coupled with rapid population growth. The INMO’s daily trolley count figures have ceased to even raise eyebrows as the numbers are so consistently high.
When people attend an emergency department in the coming months, they should ask how many other patients are in the emergency department, how many nurses are on duty and what the safe number of nurses that should be rostered on.
The INMO is of the firm view that this information should be on display across emergency departments and wards. Patients and their loved ones should be aware of the staffing shortfalls that exist in our public health service.
It is a fact that in any healthcare ward or emergency department today, tonight or tomorrow the scientifically-based safety staffing ratios will not be in place. Senior management in the HSE know this and the Department of Health know this, yet they proceeded to introduce the recruitment moratorium, which is still being maintained by rigid caps on staffing.
This is the main argument supporting the introduction of a mechanism that takes away the veto held by financial/accounting managers over funding safe staffing. Ensuring nurse-patient safe staffing is correctly funded cannot be held by those without any clinical responsibility for the consequences of unsafe staffing levels.
The safety measures must have three main criteria;
- be scientifically based;
- have proven evidence-based patient safety outcomes;
- and the legal imperative for implementation.
The first two are in place in surgical/medical wards and emergency departments today but implementation is not.
Rather than words of condolences and apology to many families who have had to endure the agonising and, in some cases, avoidable loss of their loved ones, it is time for the politicians, the Department of Health, and HSE to step up and take action that will change this — expedite the passing of the Patient Safety (Licensing) Bill.
This would introduce a licensing system for acute hospitals and give the Health Information and Quality Authority (Hiqa) power of enforcement. Currently, HIQA does not have the power to regulate acute general hospital services and has no enforcement powers.
The powers within the Health Act 2007 to monitor public acute hospitals against nationally mandated standards encourage improvement. However, while they can identify deficiencies and propose recommendations, they lack the authority to compel hospitals to implement these changes.
In addition, the Health Act 2007 also gives them the power to conduct statutory investigations. Additionally, Hiqa is empowered to conduct investigations at the request of the minister or its board, but once again, their role remains advisory, with no means to enforce compliance.
The limitation in Hiqa’s powers is clearly illustrated through Hiqa’s assessment of acute hospital service through statutory investigations and monitoring exercises. In recent years, Hiqa has made assessments of the quality and safety of several emergency department services including Tallaght, Limerick, and Portlaoise.
In all instances, Hiqa clearly outlined through its findings and recommendations what measures were required to improve services. These findings and recommendations had implications for services locally and nationally. The responsibility for compliance with standards and the implementation of recommendations rests solely with the provider of services and where appropriate those charged with making policy.
For many years the INMO has written to senior HSE decision-makers at national and local level, various Ministers for Health, and Hiqa; has held numerous meetings, and has engaged in protest action seeking the strengthening of patient safety measures.
The issues of staffing deficits did not just occur in December 2022, and unfortunately, they still prevail in University Hospital Limerick and other acute hospitals.
The real change and a better measure to express regret and apology are to now introduce Patient Safety (Licensing) legislation and that should be the priority for all those championing real patient safety. One nurse for every four patients is the basic safety measurement; this should not be forgotten over the coming months.
- Phil Ní Sheaghdha is general secretary of the Irish Nurses and Midwives Organisation (INMO)
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