Hi Sheila,

Is it acceptable for an agency nurse or a full time nurse on night shift to be responsible for giving medicines to 40 residents in one unit, and also attend to another unit with 18 residents, should any emergency occur?

Answered by Sheila Scott

Your question is challenging and complex and I sought advice from two colleagues here at Quality Compliance Systems.

This is what the first one said:

The Royal College of Nursing published guidance on Safe Staffing Levels in 2010. For all areas of practice, including Nursing Homes or Care homes depends on the roles and competencies of different staff groups, the complexity of the patient’s needs, the efficiency and effectiveness of processes used and when the care takes place i.e. day shifts or night shifts. Consideration of the local contractual requirements may also be required.

The Nursing Homes Regulation and Quality Improvement Authority (2009) offered the following guidelines for patient/staff ratios…

Proposed Nursing Home staffed so that over a 24-hour period there is an average of 35% registered nurses and 65% care assistants

• early shifts 1:5
• late shifts 1:6
• night 1:10

A qualified nurse should also always refer to the NMC Code in particular;

• Prioritise People – 1.4 make sure that any treatment assistance or care for which you are responsible is delivered without undue delay
• Preserve Safety – make sure that patient and public safety is protected, work within the limits of your competency, exercising your professional duty of candour and raising concerns immediately whenever you come across situations that put patients or public safety at risk.

A nurse must therefore take necessary action to deal with any concerns where appropriate. This preservation of safety also specifically refers to medication admin in the code.

The other colleague said this:

I am not a nurse, but I would have thought that one nurse supporting 58 people is unacceptable, and if CQC were to inspect I’m sure they would have an opinion that it is inappropriate.

CQC don’t determine staffing levels but will come to a judgement on whether there are enough staff to ensure the safety of people using services. They will also look at how the service has assessed the needs of the people using the service and whether the numbers defined are acceptable.

The question also mentions an agency nurse – this is even more risky as they may not know the service users. Medication may take longer and an understanding of the needs may be lacking.

I would also be concerned about the timing of the giving of medication. If one person is providing for 40 people, it will take a long time and it is unlikely that the timings will correspond closely with the timings defined by the GP. Also, if during a night shift then service user may be disturbed when asleep.

I agree with the comments of both my colleagues. I would advise you to discuss these issues with your manager. You must act in the interests of the people you are responsible for and you must also protect your own professional registration.

I am happy to discuss this with you personally if you wish. If you’d like, please get in touch with the QCS office and they will pass your contact details to me.

Sheila