Hospitals should collect information to help them check whether they have the right number of nursing staff. This information may be collected using a form for patients to fill in to give feedback about their experience while they were in hospital. It might include questions about pain control and how nursing staff talked to patients and explained about their care and treatment.

Hospitals should also keep records of the following:

  • any falls a patient has while in hospital

  • any pressure ulcers that develop or get worse after a patient has been admitted to hospital

  • care not being provided when it should be (see the box in Checking there are enough nursing staff available on the day or night)

  • how many registered nurses and healthcare assistants work on the wards every day, and how this compares with the amount of nursing care needed

  • how often nursing staff have to miss their breaks or work overtime to provide adequate care.

Hospital managers should regularly look at this information to see if there are any problems, and they should use it when they are doing their long-term planning.

NICE says that there isn't a fixed number of patients each registered nurse should care for. The nursing staff needed depends on how much nursing care the patients on the ward need.

There is some evidence that there is more chance of things going wrong for patients if a registered nurse is looking after more than 8 patients during the day shifts.

So if the monitoring shows that a ward has registered nurses who are caring for more than 8 patients each during the day shifts, hospital managers need to keep a particularly careful look out for signs that patients aren't getting the nursing care they need. It may not be a problem – there are some situations where registered nurses can safely care for more than 8 patients.