Very few nurses in Scotland think that staffing is adequate to properly meet the requirements of the country’s safe staffing laws, according to new research.
The study, conducted by the University of Pennsylvania School of Nursing and Edinburgh Napier University, has uncovered the challenges facing Scottish health boards in implementing the Health and Care (Staffing) (Scotland) Act.
“The act’s overarching goal of ensuring safe staffing is not being met at the point of implementation”
Eileen Lake
The landmark legislation came into force in April 2024, following five years of delays, and has set out requirements for safe staffing levels across both health and social care settings.
The act places a legal duty on NHS and social care providers to ensure that there are always suitably qualified staff working in the right numbers for safe and effective care.
It also imposes a duty on the Scottish Government to ensure that there are enough registered nurses, midwives and medical professionals available to enable employers to meet their duty.
The study by the nursing schools assessed what the baseline staffing situation was like in Scottish health services when the act came into force.
More than 1,800 registered nurses working across Scotland were surveyed between 1 May and 31 July 2024.
The study found that just 9% of nurses felt that staffing was adequate to provide safe, high-quality care every shift.
Meanwhile, some 38% reported that they only able to provide safe, high-quality care several times a week, while over half (54%) said they could only do this once a week or less.
It comes as latest data has shown there are more than 2,000 whole-time equivalent vacancies across nursing and midwifery in Scotland.
Researchers set out that the Health and Care (Staffing) (Scotland) Act is underpinned by eight guiding principles:
Improving standards and outcomes for people using services;
Taking account of the particular needs, abilities, characteristics and circumstances of different people using services;
Respecting the dignity and rights of people using services;
Taking account of the views of staff and people using services;
Ensuring the wellbeing of staff;
Being open with staff and people using services about decisions on staffing;
Allocating staff efficiently and effectively;
Promoting multi-disciplinary services as appropriate.
For principles three and eight, 70% of respondents said they agreed these were being met.
However, with the other six principles, most nurses disagreed that these were being met.
Professor Eileen Lake, professor of nursing and sociology, and associate director of Pennsylvania School of Nursing’s Center for Health Outcomes and Policy Research, said: “These findings indicate that the act’s overarching goal of ensuring safe staffing is not being met at the point of implementation.
“The complexity of the act’s provisions may be a significant barrier to its successful implementation.”
The study also asked nurses about their plans for staying in the profession.
Nearly half of nurses (45%) said they would stay in their current position over the next year, while the other half said they would seek other nursing jobs, promotions or leave the profession altogether.
Researchers cautioned that this potential workforce disruption, combined with the challenges in implementing the act, raised urgent questions about the success of the legislation.
Professor Lake said: “While most nurses view nursing as a long-term career, the anticipated workforce turnover will require robust retention policies.
“It remains to be seen whether the act’s complex approach can truly achieve safe staffing and reverse the trend of nurses leaving their positions.”
Responding to the research, Eileen McKenna, associate director of nursing, policy and professional practice at the Royal College of Nursing in Scotland, said: “This research is vitally important as it provides a baseline at the point of implementation and gives a clear picture to measure against.
“Sadly, it comes as no surprise that only a small minority of nurses believe that staffing is adequate to provide safe, high-quality care on every shift.
“The findings underline the need for effective implementation of the legislation and monitoring for impact.”
Ms McKenna noted that the method used to calculate the number of nurses needed for safe care was “complex” and current staffing tools “underestimate what is needed”.
“We have been pushing Scottish Government to address these issues and while there has been some progress this has been far too slow,” she added.
“Scottish Government and employers must take action now to meet their obligations under the safe staffing law.”
A Scottish Government spokesperson said: “We continue to invest in our NHS Scotland workforce, with overall nursing and midwifery staffing up by 19.5% under this government.
“Individual recruitment and deployment decisions are a matter for each NHS Scotland board and should reflect the requirements of the Health and Care (Staffing) (Scotland) Act 2019, with outcomes for service users being a key focus.
“Boards have now published their first annual reports under the act and we will update parliament on next steps in due course.”
More on Scotland’s safe staffing legislation
