A third of nursing directors believe they regularly have too few nurses to ensure safe staffing levels on their wards, a survey of some of England’s most senior nurses suggests.

According to the poll by HSJ’s sister title Nursing Times, a fifth also have concerns about the skill mix, while 17 per cent said they had been put under pressure to sign off savings plans that included reductions in nursing staff.

The survey was completed by 47 directors of nursing − representing about 30 per cent of English acute and specialist hospitals. Although 69 per cent felt they had enough nurses “most of the time”, 27 per cent said they often struggled and 4 per cent said they “hardly ever” had enough staff. Not one nursing director said they were confident they had enough nurses to deliver high quality care “all the time”.

However, respondents were split over the need for a minimum nurse staffing level, with 48 per cent in favour and 37 per cent against.

Those against − who were also more likely as a group to say they had enough nurses “most of the time” − worried a minimum level would become the norm and could not account properly for the huge variation in patient acuity and staff skills and competencies.

Those in favour said it would give weight to their arguments with the board about staffing levels and “protect nursing from being the easy target for cost improvements”.

The vast majority of nursing directors felt nursing concerns were taken seriously by their trust’s board. However, 40 per cent wanted more control over the nursing budget. Many commented that they had to fight to get their voice heard at board level.

One said: “Directors of nursing usually have to prove their worth more than other executive roles in terms of being the authoritative voice on patient safety and patient experience issues. For new directors of nursing this can be a trial by fire.”

The survey also sought views on the wide range of policies and initiatives announced in the wake of this year’s Francis report into care failings at Mid Staffordshire Foundation Trust.

Nearly three quarters of respondents (73 per cent) said they did not support health secretary Jeremy Hunt’s proposal to make aspiring nurses work as healthcare assistants for up to a year in order to qualify for a place on a funded undergraduate nursing course.

Commenting on the government’s controversial proposal, one nursing director warned that “12 months as an HCA in the wrong culture” could “cause more damage” and “create the wrong values in the individual”.

Respondents were 4:1 in support of healthcare assistants being regulated, a move recommended by Robert Francis QC’s report in February but that the government continues to oppose.

Nursing directors were also critical about the lack of a powerful voice on the national stage during the past year, when the profession has faced widespread criticism in the national media following a succession of negative reports.

Several respondents said they felt the government’s splitting of the former chief nursing officer for England’s role into two − with a chief nurse at NHS England and director of nursing based at the Department of Health − had further weakened the national voice of the profession.

“With all the criticism of nursing from Francis and an ‘NHS-hostile’ media, there has been a deafening silence from any national leaders about all the brilliant care nurses give every day,” one respondent said.