David Oliver: Nurse staffing levels are still not safeBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2665 (Published 13 May 2016) Cite this as: BMJ 2016;353:i2665
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I welcome David Oliver’s article pointing out that nurse staffing levels in the NHS are still not safe. I would also like a discussion about the nursing shortage in critical care because this has led to some hospitals closing their critical care wards.  Recruiting overseas nurses is a good solution but the current assessment process does not reflect where nurses are needed most, such as in critical care. In 2016, 40% of nurses starting work in the National Health Service (NHS) were overseas nurses compared to 10% in 2010  therefore demand for them is growing. I think that the current assessment process for overseas nurses set by the Nursing and Midwifery Council (NMC)  should add a critical care exam track. Currently, the assessment process has two stages. First, overseas nurses interesting in working in the UK take an online competency exam and then, if they pass that, they take an objective structured clinical exam (OSCE) in Northampton. There are 4 nursing tracks in the exams (adult nursing, pediatric nursing, mental health nursing and learning disabilities nursing).
The adult nursing track  exams only assess basic nursing skills equivalent to those held by new nurses starting work in the UK. The competency exam assesses general skills and some specialist skills but overlooks critical care skills. The OSCEs are taken in 6 stations out of which only 2 assess basic clinical skills e.g. wound care, disposing of sharps, calculating dosages, monitoring vital signs, basic life support, catheterization or injections. The remaining 4 stations assess non-clinical skills such as communication, writing patients’ records and writing discharge or transfer forms. I suggest that the clinical skills assessed in the adult nursing OSCEs are too general to recognize the skills of overseas nurses with experience in critical care. The NMC should develop the competency exams and OSCEs using standards set by the UK’s Critical Care Nurse Education Review Forum  and also the Faculty of Intensive Care Medicine.  Nurses interested in taking these exams should demonstrate key knowledge of respiratory abnormalities such as hypoxia, pleural occlusion, chronic obstructive pulmonary disease and acute respiratory distress as well as investigative skills and working in emergencies such as blocked or dislodged tracheotomy, pneumothorax tension and anaphylaxis.
If the NMC can add assessments that are more relevant to critical care, it will help speed up hiring decisions and reduce the current burden on lead critical care nurses to assess and train new hires. Placing overseas nurses with expertise in critical care will also present better job fit when they start working in the NHS, an environment in which job stress affects many nurses and makes them feel like quitting . The NMC can help the NHS solve its nursing shortage this way and help NHS critical care wards meet the national recommendation  of 1 to 2 nurses per patient and at least 50% of nurses in critical care suitably qualified.
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Competing interests: No competing interests
There is currently a 'headline article' in Nursing Times (online), written by Jenni Middleton who is NT's editor. It is about this issue of safe staffing levels, and starts by telling readers that Wales has passed the Nurse Staffing Levels (Wales) Act 2016. Jenni then asks a fundamental question in her article:
'England has been fudging the issue by claiming there is no evidence base for minimum safe-staffing ratios. How can that be true in England but not in Wales?'
The Nursing Times article is at:
Competing interests: No competing interests