Challenges in Implementing Scotland's Safe Staffing Act: Impacts on Nursing Care Quality

A recent study by Penn Nursing's Center for Health Outcomes and Policy Research highlights significant hurdles in the implementation of Scotland's Health and Care Act 2019, which was designed to improve nurse staffing safety across healthcare settings. The Act sets forth guiding principles, duties, and a standardized staffing methodology aimed at ensuring adequate nurse-to-patient ratios and high-quality care. Unlike many other regions that have established explicit minimum nurse-to-patient ratios, Scotland's approach relies on guiding principles, making its implementation complex and variable.

In April 2024, a survey involving 1,870 nurses throughout Scotland revealed that only a small proportion (9%) believe staffing levels are sufficient for safe, high-quality care during every shift. Additionally, just 17% rated the overall quality of care as excellent. These findings suggest that many nurses feel current staffing does not meet the standards envisioned by the Act, and its comprehensive provisions may be challenging to realize effectively.

Lead researcher Eileen T. Lake emphasized that the intricacy of the Act's requirements could hinder its successful implementation, underscoring the need for ongoing assessment and policy adjustments. The study also uncovered workforce concerns, with 45% of nurses planning to stay in their current roles over the next year, while the remaining half considered leaving, seeking promotions, or shifting careers altogether. This potential staffing turnover could further complicate efforts to achieve the Act’s goals.

The findings raise critical questions about the feasibility of Scotland's unique approach to safe staffing, especially in the context of workforce stability and capacity for consistent implementation. Policymakers and nursing leaders are urged to address these challenges to ensure that safety and quality standards in nursing care are maintained.

For more details, the study is published in the Journal of Nursing Scholarship (2025). source: https://medicalxpress.com/news/2025-05-scottish-safe-staffing-minimum-nurse.html