Scottish nurses’ perceptions of the new safe staffing law: qualitative findings from a national survey

BACKGROUND: The Health and Care (Staffing) (Scotland) Act 2019, which came into force on 1 April 2024, aims to address workforce challenges during a global nurse staffing crisis. This Act is innovative in that it does not specify staffing ratios; rather, it provides guiding principles, duties and a mandated common staffing method. AIM: To evaluate Scottish nurses' baseline perceptions of the Health and Care (Staffing) (Scotland) Act 2019 and to inform implementation efforts. METHOD: Data were taken from responses to a free-text question that was part of a survey conducted between May and July 2024. A total of 391 nurses and nursing support workers throughout Scotland provided free-text responses. The data were coded using thematic analysis. FINDINGS: Three themes were identified from the data: the implementation context; concerns and anxieties about the Act; and hopeful outlook about the Act. These themes highlighted the suboptimal context for implementation of the Act - consisting of inadequate staffing, low morale and a lack of attentive leadership - which undermined respondents' confidence in the ability of the Act to achieve its goals. Respondents also expressed hope that the Act would provide a foundation for legislation to address significant concerns, particularly around retention due to burnout and intention to leave the profession. CONCLUSION: The findings of this study indicate that many nurses are unsure if the goals of the Act can be achieved amid sustained staffing pressures. Therefore, the context should be an essential consideration when implementing legislation and organisational changes.