Study finds Scottish safe staffing act implementation, which specifies minimum nurse ratios, facing challenges

A recent study conducted by Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR), which was published in the Journal of Nursing Scholarship, has shed light on the challenges faced in implementing Scotland’s Health and Care Act 2019.

The Act, designed to ensure safe nurse staffing through specific guidelines, duties, and a standardized staffing method, is not consistently being adhered to according to frontline nurses. Unlike most regions that have set minimum ratios or staffing committees, Scotland’s approach to improving nurse staffing is unique, making the Act a subject worthy of investigation.

A collaborative research team from CHOPR and Edinburgh Napier University surveyed 1,870 nurses across Scotland to evaluate the initial stages of Act implementation in April 2024. The findings revealed that a small percentage of nurses believe that staffing levels are adequate to deliver safe, high-quality care during every shift (9%), or rated the quality of care as excellent (17%). The majority of nurses expressed that current staffing levels do not align with the Act’s guiding principles.

“These results indicate that the Act’s primary objective of ensuring safe staffing is not being achieved during the implementation phase,” stated lead-author Eileen T. Lake, Ph.D., RN, FAAN, the Edith Clemmer Steinbright Professor in Gerontology, Professor of Nursing and Sociology, and CHOPR Associate Director. “The complexity of the Act’s provisions may pose a significant barrier to its successful implementation.”

The study also highlighted that almost half of the surveyed nurses (45%) plan to remain in their current positions over the next year, while the other half are considering seeking alternative nursing roles, promotions, or even leaving the profession entirely. The researchers caution that this potential workforce shift, combined with the challenges in Act implementation, poses urgent questions for Scottish policymakers, nurse leaders, and researchers.

“While many nurses see nursing as a long-term career, the expected turnover in the workforce will necessitate robust retention strategies,” Lake emphasized. “It remains to be seen whether the Act’s intricate approach can truly achieve safe staffing and counteract the trend of nurses vacating their positions.”