STRIKE for mandatory minimums

This is the text of a leaflet produced by the 4:1 Campaign for the NHS pay strike on November 24th. Download the leaflet here for printing and distributing on NHS picket lines.

The government’s pay cut is part of a determined policy to slash our salaries and reduce the cost of nursing in the NHS.  It is part of the same strategy to marketise and privatise our priceless NHS.  It is clear the government sees nurses as a cost to the NHS and not as a clinical resource with direct positive effect on patient outcomes and quality of care.  NHS Trusts are chronically under-staffed all over the UK, thousands of vacancies are left unfilled and Trusts are replacing qualified nurses with health care assistants, all with the intention of reducing their costs at the expense of patient care and outcomes.

It is time we took action to stop the erosion of our salaries but it’s also time we took action against the chronic understaffing, the constant poor care scandals and the exhausting and demoralising conditions nurses are working in.  We have taken the blame for poor care standards and have put up with atrocious staffing conditions for too long.  We need minimum qualified nurse to patient ratios and we need them to be made law.

UNISON Head of Nursing Gail Adams stated “”It’s ironic really that only when nurses take strike action do employers want to agree minimum staffing levels. Employers don’t believe in minimum staffing on any other day.”   NHS managers do not understand what it is like to nurse 10-20 elderly medical patients for 12-13 hours a day.  Chief Executives and Trust Boards are prepared to work us to the bone, forcing use to care for 8, 10, 12, sometimes 14 or more patients per shift because the balance sheet is more important than the very safety of their staff and patients. This shows an utter disregard for the safety of patients, and the well being of NHS nurses.

There is a mountain of evidence that caring for more than 4 patients on a general medical or surgical ward increases the risk of patient injury and mortality, and increases the rate of nurse burnout. Other more specialist wards need even better nurse: patient ratios.

Nurses are joining together to campaign for mandatory minimums to provide a safe minimum standard across all wards. The 4:1 campaign was launched in 2013 to campaign for mandatory minimum staffing levels across the NHS. We involve members of the RCN, UNISON, UNITE, and have wide public support.

Enough is enough!  We have been blamed for all the failures of care. The reputation of nursing is at its lowest in history.  And our patients are suffering, and their families are suffering.  Nurses need to protest, campaign and raise our voices loud and clear. We need mandatory minimums for the sake of our patients and our profession. Without them we will see the care and compassion squeezed from our jobs, leaving little of what brought us into them.

Join our campaign and help build a movement for safe staffing which can protect and improve the NHS for all patients and staff.

Block the Beds – how to use the strike to enforce safe staffing

Nurses can use the strike to enforce safe staffing.  We should take a lead from Australian nurses, who have successfully campaigned for and won mandatory minimums across public hospitals.

The Australian Nursing and Midwifery Federation used the strategy of blocking hospital beds to prevent admissions of patients taking them over the ratio of 1:5.  How did they do it? Direct action. The nurses went physically removed the mattresses from every 5^th bed, hid it, locked it in a cupboard, or stuck it under a bed where it couldn’t be used.

They then put big “BED BLOCKED” signs on the beds to indicate they couldn’t be used. They refused to take any more non-emergency patients until their demands were met.  Beds were kept open in A&E for emergency cases, but their actions forced the hospitals to scale back or stop all their elective work in order to keep beds free for emergencies.

Nurses didn’t stop caring for patients, they just refused to let hospital management place patients in unsafe environments where there wasn’t enough nurses to look after them. This forced hospital management to re-prioritise their work and their admissions in the interest of patient safety.

How could this work in a British context? NICE has issued new staffing guidelines, which recommend that nurses should not care for more than 8 patients at a time. The guideline itself has little weight as it makes it clear it is up to individual Trusts to determine their own levels and 8 patients is still too many.  But it is a start.  It is therefore completely justifiable that nurses use the bed blocking strategy to enforce this new guideline when hospital management is unwilling to.

Union branches could support their nurse members to enforce the 1:8 ratio on their wards as part of their work to rule. Nurses can state they’re “working to rule” to the new NICE guidelines, and they won’t work on understaffed shifts, or care for unsafe numbers of patients, according to the new guidelines.  Petitions can be circulated for nurses to sign asking that they get the 1:8 ratio, and pledging not to work if they’re forced to care for more than 8 patients, an unsafe number according to NICE and all available nursing research.

On wards where nurses regularly care for 8 or more patients, whenever a patient is discharged nurses should block the bed(s), until the nurse-patient ratio on the ward is 1:8. Those beds then stay blocked until the hospital provides more staff and meets the ratio of 1:8 permanently.

Given that a survey of 526 nurses by the Nursing Times in February 2014 found 44% of nurses saying they regularly cared for 10 or more patients on their wards, and a UNISON survey of 3,000 nurses reporting 45% caring for more than 8 patients, tens of thousands of nurses could participate in this action. We can make our work to rule about enforcing patient safety in an NHS made unsafe by brutal cuts and austerity. We can make our action popular with the public, and reclaim our rightful place as champions for patient safety.