New government urged to act on nursing as union warns of ‘high risk of harm’

Nurses have warned of a “high risk of harm to patients” as a result of “unsafe” gaps in the workforce coupled with the need to deliver increasing complex care.

The Royal College of Nursing (RCN) said ministers are “too often failing” when it comes to their “first priority” of keeping people safe.

RCN Scotland executive director Colin Poolman said that despite legislation setting out safe staffing levels having come into force in 2024, “nursing shortages continue to have a damaging impact, with many nurses caring for unsafe numbers of patients”.

With a new government coming in at Holyrood following the Scottish election, the RCN is demanding that ministers “prioritise investment which acknowledges and values the vital contribution of nursing to the health of the nation”.

Mr Poolman said: “Failure to act is now no longer an option as, with increasing risk of harm to patients, inaction will lead to inevitable consequences for patients and staff.”

He spoke out as the union’s annual congress in Liverpool gets under way, with general secretary and chief executive Professor Nicola Ranger warning that governments across the UK are “asleep at the wheel” amid “rising, dangerously unmet levels of patient need”.

An RCN Scotland survey of more than 1,400 nursing staff – working in both the NHS and independent health and social care settings – found that 82% of nurses told them the clinical complexity of their work had increased in the past two years.

Less than one in 10 nurses (8%) said that staffing was at the right level for all of a patient’s needs to be met, while just over three quarters (76%) said that limited time and resources mean they regularly need to make “difficult decisions” about prioritising care.

One nurse working on a general acute ward in an NHS Scotland hospital said they have to deal with “multiple competing priorities” while on shift, with these including managing deteriorating patients, completing essential observations and giving out medication, along with responding to “urgent clinical changes” in patients’ conditions, answering phone calls and updating documentation.

“In this environment, nursing care becomes task-driven and reactive,” the nurse said.

“There is little opportunity for comprehensive assessment, preventative care, patient education, or meaningful interaction – all of which are fundamental components of safe and effective nursing practice.”

Another nurse said: “Working in a sustained high-stress environment where there is no capacity buffer is not a safe or sustainable model of care.

“It increases the likelihood of missed care, delayed interventions, and moral distress among staff who are unable to provide the standard of care they are trained to deliver.”

Mr Poolman said: “When NHS nursing staff in Scotland say there is a high risk of harm to patients because staffing is below what is needed, the government must act.

“Scotland’s population cannot afford for them to be complacent to rising, dangerously unmet levels of patient need.”

He added: “The continued gaps in the registered nurse workforce are always unsafe, but the risk is being compounded by the demands of delivering ever more complex care to an ageing, sicker population, with multiple conditions.

“It is the Scottish government’s first priority to keep its citizens safe, but our analysis and the testimony of nursing staff show ministers are too often failing in this most basic task.”

Mr Poolman said the RCN continued to “have significant concerns” that workforce planning tools used to determined the number of staff and skills mix needed to provide safe care were “unfit for purpose and underestimate the staffing establishment needed”.

He added: “Nursing staff cannot continue to deliver the care their patients deserve with increasing workload pressures and continued gaps in the workforce.

“Gaps in the workforce and the adverse effect on staff wellbeing undermines safe and effective care.

“Safe nurse staffing saves lives, protects exhausted staff and strengthens health and care services.”

Labour health spokesperson Dame Jackie Baillie urged SNP ministers to “listen to these stark warnings from the RCN”.

She said: “For too long nurses and other hardworking NHS staff have been asked to do the impossible by this incompetent SNP government.

“Staffing shortages pile pressure on services and put patients at risk – the SNP needs to produce a real workforce plan.”

SNP MSP Michelle Campbell said: “The SNP deeply value the incredible impact that all our hardworking nurses make in Scotland’s NHS and in social care settings every single day.

“Under the SNP, the number of nurses and midwives working in our NHS is up by over 21% and band 5 nurses in Scotland are the best paid anywhere in the UK.

“We established a new Nursing & Midwifery Taskforce to address recruitment and retention challenges and are fully committed to taking forward its actions to improve the profession and make nursing an attractive and rewarding career.

“The reality is our current social care system is under pressure because of Brexit and the recruitment issues that has presented – something that the Labour UK Government has made worse.”

She added: “Our social care system needs to work better for everyone and under John Swinney’s strong leadership we’ve seen what can be achieved within our NHS – long waits are down, GP numbers are up and thousands more operations are being performed.

“The new SNP government will apply that same focus to social care and through a fresh start of independence we can build a migration system that actually works for Scotland’s needs.”