• Neonatology
• Nursing Care

Recognition of the importance of one-to-one nurse staffing ratios in neonatal intensive care (IC) is not new: since the 1990s, successive studies and quality standards—including the British Association of Perinatal Medicine Standards for Hospitals Providing Neonatal Intensive and High Dependency Care1—have stated unequivocally that the sickest babies require this level of nursing. Indeed, this is no different from the one-to-one nurse staffing ratios required in both paediatric and adult IC. In 2009, the Department of Health set this staffing ratio as the national standard for England, stating that “High-quality neonatal services…rely on having an adequate and appropriate workforce”. These same ratios also apply in Scotland2 and in Wales.3

Neonatal services, in common with many areas within the National Health Service, are under considerable pressure. Despite the development of a National Service Specification for Neonatal Critical Care, covering all levels of care delivered within neonatal units, it is clear that many neonatal services do not achieve recommended levels of nurse staffing. This is due to a number of factors including increased activity in addition to staff recruitment and retention issues. The extent of nursing staff shortfall in some areas has led to suggestions that current recommendations for staffing are unrealistic and that these should be reduced to an ‘achievable’ level. However, some hospital trusts that provide clearly structured development programmes for new nurses have been able to maintain consistent nursing establishments.

Previous studies on staffing levels have often focused on nurse activity during delivery of care rather than outcomes. The paper by Watson et al4 is, therefore, both a timely and welcome addition to an area where there is still a paucity of evidence supporting the value …