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

A new study from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR), published in the Journal of Nursing Scholarship, has revealed that implementing Scotland’s Health and Care Act 2019 is facing significant challenges.

The Act, which aims to ensure safe nurse staffing through guiding principles, duties, and a common staffing method, is not being consistently followed, according to nurses on the frontlines. Scotland’s approach to improving nurse staffing differs from that of most countries or states, which have established minimum ratios or nurse staffing committees. This makes the Scotland Act a unique exemplar worthy of investigation.

A research team from CHOPR and Edinburgh Napier University surveyed 1,870 nurses across Scotland to assess the baseline of the Act’s implementation in April 2024. The study found that only a small minority of nurses believe that staffing is adequate to provide safe, high-quality care every shift (9%), or rated the quality of care as excellent (17%). A large majority of nurses indicated that current staffing levels did not meet the Act’s guiding principles.

“These findings indicate that the Act’s overarching goal of ensuring safe staffing is not being met at the point of implementation,” said 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 be a significant barrier to its successful implementation.”

The study also found that nearly half of the nurses surveyed (45%) intend to stay in their current job over the next year, while the other half plan to seek other nursing jobs, promotions, or leave the profession altogether. The researchers caution that this potential workforce disruption, combined with the challenges in implementing the Act, raises urgent questions for Scottish policymakers, nurse leaders, and researchers.

“While most nurses view nursing as a long-term career, the anticipated workforce turnover will require robust retention policies,” said Lake. “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.”

A new study from Penn Nursing’s Center for Health Outcomes and Policy Research (CHOPR), published in the Journal of Nursing Scholarship, has revealed that implementing Scotland’s Health and Care Act 2019 is facing significant challenges.

The Act, which aims to ensure safe nurse staffing through guiding principles, duties, and a common staffing method, is not being consistently followed, according to nurses on the frontlines. Scotland’s approach to improving nurse staffing differs from that of most countries or states, which have established minimum ratios or nurse staffing committees. This makes the Scotland Act a unique exemplar worthy of investigation.

A research team from CHOPR and Edinburgh Napier University surveyed 1,870 nurses across Scotland to assess the baseline of the Act’s implementation in April 2024. The study found that only a small minority of nurses believe that staffing is adequate to provide safe, high-quality care every shift (9%), or rated the quality of care as excellent (17%). A large majority of nurses indicated that current staffing levels did not meet the Act’s guiding principles.

“These findings indicate that the Act’s overarching goal of ensuring safe staffing is not being met at the point of implementation,” said 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 be a significant barrier to its successful implementation.”

The study also found that nearly half of the nurses surveyed (45%) intend to stay in their current job over the next year, while the other half plan to seek other nursing jobs, promotions, or leave the profession altogether. The researchers caution that this potential workforce disruption, combined with the challenges in implementing the Act, raises urgent questions for Scottish policymakers, nurse leaders, and researchers.

“While most nurses view nursing as a long-term career, the anticipated workforce turnover will require robust retention policies,” said Lake. “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.”