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Shortages are compromising patient care, new report warns

RCN calls for review of staffing to ensure safe winter care

Jo Carlowe

Friday, 29 September 2017

Nursing staff levels must be reviewed to ensure patient safety this winter.

The warning comes from the Royal College of Nursing (RCN), in the report, Safe and Effective Staffing: Nursing Against the Odds, published today. The survey of staff, reveals more than half (55%) say shifts did not have the level of nurses planned, and that shortages were compromising patient care (some 53% took this view). 

The RCN is calling on the boards of health and social care providers across the UK to urgently review nurse staffing levels, give public assurances on patient safety and take action where standards are not met.

The survey of nursing staff in all four UK countries asked about staffing levels on their most recent shift and the quality of care provided. More than a third (36%) report having to leave elements of patient care undone due to a lack of time, while two thirds (65%) work an unpaid extra hour on average.

Seven in 10 nurses (71%) in England said their last daytime shift exceeded NICE guidelines, which states that more than eight patients to one nurse should act as a ‘red flag’. A quarter (26%) reported shifts with 14 or more patients per nurse.

Nursing staff working in hospitals rated the quality of care lower than those in community services such as district nursing. Accident and emergency departments had the lowest quality ratings of all hospital services, with one in seven (14%) A&E nurses rating care as poor or very poor.

Almost half of all respondents (44%) said no action was taken when they raised concerns about staffing levels.

Nursing staff rated the quality of care more highly when there are fewer patients for every one registered nurse, which supports recent research by Dr Jane Ball. The work, released last month, found a link between the number of registered nurses, patient care duties left undone and mortality levels.

The report also states that short-sighted measures designed to cut costs led to unregistered nursing staff making up a greater proportion of the staff on duty. The proportion of registered nurses on adult general wards has fallen to 48% this year, from 62% in 2009.

The survey was carried out in May and suggests that pressures previously associated with the winter months have become common throughout the year.

The respondents also reported that:

  • patients are no longer afforded enough dignity, even dying alone;
  • colleagues have burned out and have become sick themselves, unable to come to work;
  • staff leave work “sobbing” at the impact of shortages on patient care;
  • many question their future in nursing and contemplate leaving the profession;
  • they struggle to give their children and families enough support after shifts that can exceed 12 hours.

The RCN is calling on providers of health and care services to urgently provide assurance to their boards that they are providing safe services. 

In addition, the College says new legislation is needed across the UK that guarantees safe and effective nurse staffing.

Commenting, Janet Davies, chief executive and general secretary of the RCN, said: “When this many professionals blow the whistle, they cannot be overlooked. The nursing shortage is biting hard and needs the attention of ministers - this warning comes from the very people they cannot afford to lose.

“The findings in this report are a direct result of years of poor planning and cost-cutting - it was entirely predictable.”

She added: “Nursing staff are revealing desperately sad experiences and their honesty must drive forward the policy debate. We urgently need assurances from every health and care provider that services are safe for patients, and new laws on staffing should follow swiftly.”

Responding, Professor Jane Cummings, chief nursing Officer for England, said: "This report underlines the importance of responding to real workforce pressures, which is why the NHS is growing our workforce, opening up new routes into nursing, and helping people come back to practice after career or family breaks. It's an important reminder to us all of the pressures nurses face on a day to day basis.” 

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