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'Emotional' nurses tell hospital inspectors of low staffing fears

Nurses at a failing hospital trust have told inspectors how they are unable to care adequately for patients due to low staffing levels.

United Lincolnshire Hospitals Trust was heavily criticised by the Care Quality Commission in its latest inspection report.

The trust, one of 14 inspected as part of the recent review by NHS England medical director Sir Bruce Keogh, failed to meet seven essential standards set by the regulator. The CQC found a catalogue of failures and described how nurses became emotional talking about the stresses they faced.

In their report, the inspectors said: “We found a number of nurses became very emotional when discussing the stress of working short staffed. Many reported they were working longer hours, often missing breaks, going off duty late and undertaking overtime by doing extra shifts.

“We spoke with one nurse at 2.30pm; the nurse had been working since 7am and had not had a break, including a drink since starting duty.”

They added: “We were told because staff were rushing all the time sometimes patients were left longer on commodes; some patients received their medications late and hourly observations of patients’ conditions were not always completed. Nursing staff felt it was impossible to always keep up with paperwork and support the needs of the patients.”

Inspectors, who visited the trust on five occasions during June and July, witnessed call bells being ignored with “staff seen to walk by without checking whether the call was urgent or not”.

They also found the drugs trolley had been left open and unattended on a ward with a high number of confused patients. Their report also highlighted handover problems with nurses and doctors failing to communicate.

It stated: “We found all staff spoken with agreed there were staff shortages. Staff reported low staffing levels meant they could not care for their patients as they would wish to do.”

Inspectors carried out checks on patient charts across three wards and found on one ward that out of 21 hourly observation charts, nine had not been completed correctly. On a second ward, they found gaps in eight out of 25 hourly observation charts and on the third, six out of 23 hourly charts had gaps.

The CQC report highlighted a “confusing picture” on decisions not to attempt resuscitation, with poor documentation and one example of a patient being subject to a DNAR without their knowledge.

In addition, inspectors found only 56% of staff had completed mandatory training.

The report said there had been some improvements in staffing levels for nurses, but recruitment remained a challenge.

The trust’s board has recently agreed a £7m investment in additional nursing over two years and has closed 26 beds.

Trust chief executive Jane Lewington said: “It is our top priority to ensure that we provide patients with the best possible care. We are improving, but we know we have more to do.”

The CQC report said: “In the past three years, the Care Quality Commission has continued to raise its concerns about the quality of care provided by this trust. Improvements have not been sustained.

“We will continue to closely monitor the trust, inspecting as required and working with NHS England to review progress.”

As part of the special measures process, health secretary Jeremy Hunt announced this week that struggling trusts would be partnered with more successful organisations to help them improve.

Under the programme, United Lincolnshire has been partnered with Sheffield Teaching Hospitals Foundation Trust.

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Readers' comments (29)

  • michael stone

    I approve of the nurses telling the inspectors, and of the nurses being emotional (which I take to mean 'upset by the situation').

    Talking Truth Upwards, has to be facilitated somehow, to prevent systematised 'poor behaviour'.

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  • You have to be truthfull or elses things do not change. Well done that nurse.

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  • This report echoes everything I feel & see on a daily basis :(

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  • I can totally sympathise with the account that this nurse made. Unfortunately this is the norm within so many trusts and it's about time the clinical staffs concerns are taken seriously and action taken.

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  • "In their report, the inspectors said: “We found a number of nurses became very emotional when discussing the stress of working short staffed."

    At least this was included in the report and acknowledged by the inspectors, and which hopefully will come to the attention of all concerned.

    It should only be under exceptional circumstances rather than an apparent norm that employers put their employees in such a situation, and especially in healthcare where safety for patients and staff is paramount, or other jobs of equal or greater responsibility.

    showing emotions in this way is a result of coercion to carry out work under difficult conditions with insufficient resources leading to stress, over-tiredness and exhaustion as the workers struggle to cope until eventually their coping strategies, such as emotional control may gradually diminish as well as their physical and mental well-being which can manifest itself in many different ways for each individual according to their level of tolerance and resilience. Such a situation, if it remains unchecked, has the potential to become a more serious and difficult to treat health hazard where major depression and burnout can eventually ensue.

    Reducing trained staff as a cost-saving measure is not a very intelligent or satisfactory solution to a situation which can not only cause untold suffering to an individual and affect their livelihood, and that of their family, but also very short-sighted human resources planning with hours lost due to sickness, unbalance and disharmony in nursing teams and diminished efficiency and provision of high quality of care that most qualified nurses have been trained for and expect to deliver.

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  • why are charts not being filled in? simple... not enough staff. This is happening all over the country. WE NEED MORE STAFF NURSES!!!! Why keep pulling the nurses apart they are working to the best of their abilities with the resources they have or have not. I had a melt down last week, 11 patients to look after, one pt with progressive vascular dementia not eating or drinking and only 2 doctors looking after 34 patients. i was still writing my reports at 21.30hrs when i should have finished at 20.00hrs. Also our shifts were changed so we have 11hrs rest between shifts, does not happen when you are still at work at 22.00hr and due back in at 07.30am the next day. I still love my job.

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  • 'Tis a pity all that emotion is not channeled into appropriate and effective action by the nurses concerned. Their continued inaction is in part responsible for their situation. Nothing will ever be gained by wringing their hands, gnashing their teeth and working without breaks. That really doesn't help the patients. A properly galvanised and organised workforce, prepared to stand up, in a united manner, now that would bring about change.

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  • Anonymous | 23-Sep-2013 1:10 pm

    Thank you for working so long and so well

    I LOVE YOU

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  • Struggling trust partnered with more successful organisations to help them improve is not always a good thing.
    Some times this causes a downward pull on the successful hospital and does not always give a solution to the failing hospital.
    What would be more helpfull would be to find out what the problems are then apply the corrections.
    As a nurse who has been in the system for more than twenty years I strongly feel the problems are poor staffing level and weak management.
    Now if that is surely the case and this hospital is partnered with a successful hospital then, would they be lending staff to the failing hospital? If they do that, then the successful hospital will also go down.
    Would it not be easier to add more staff and ensure management is in good order.
    This remind me of a story in the Bible.
    The story of the ten virgins and the oil.

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  • Too many non clinical manages making clinical decisions without involving and listening to the nursing team. It's not rocket science - we just need more trained nurses on the shifts then just maybe quality of nursing care would improve.

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  • Totally agree with the above post... not rocket science. So where is the difficulty?

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  • Anonymous | 23-Sep-2013 3:49 pm
    Anonymous | 23-Sep-2013 4:02 pm

    You have a meek, subservient workforce prepared to work through breaks, remain behind after 12 hour shifts (for hours on end, apparently) and say nothing in protest beyond muttering among themselves. Why would you be stupid enough to pay more people to do the same job, when the mugs will do it for free? These same people will claim that without THEIR efforts, the patients won't survive the day (you should see their faces when they are made redundant and it is no longer their concern anyway).

    It isn't rocket science. Wake up nurses, stop propping up the failing system and open your mouths!!!!

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  • Are they going on about the hourly rounding forms not completely filled in ? If so it's pathetic because it does not mean that the patient has been checked or not. A patient will not die if hourly rounding forms aren't filled in but a patient who has deteriorated and needs the nurses attention more than paper work may.

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  • This mirrors what as been going on in the NHS for many many years, the difference is the can of worms is now well and truly open as a result of structured governance. Trouble is Organisation with a memory over 10 years ago touched on all the safety issues, where are we though now in 2013...... An organisation without a memory. Money for target chasers, golden pockets when the proverbial hits but the fan and they need an exit, why don't we ever learn and plan for the future rather than fire fight the hear and now? nurses & midwives don't stand up for for what we know is right because we are knackered!

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  • yep, this report just about sums up nursing today. what is being done to improve the situation apart from 'twinning' - how many more staff will be employed, how many beds will be cut until it's safe?
    as usual nothing will be done.

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  • So what are you all going to do about it?

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  • Says a lot that we are all wishing to stay anonymous on the subject.

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  • Anon 8:06pm that is a good question.

    I think for starters, a good idea is for the nurses from United Lincolnshire Hospital to sort a protest march infront of their hospital to get this problem of understaffing more noticed.

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  • Anonymous | 23-Sep-2013 8:58 pm
    Trolls follow you around if you don't post anonymously.

    Anonymous | 23-Sep-2013 9:22 pm
    Bang on. Your colleagues at every hospital with similar issues (that'll be just about every hospital in the UK), should all be out marching.

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  • having just come home again, an hour and a half late ,it is just so depressing to read all the above. it seems that the NHS is in a real mess................. too many managers, too many meetings, too much paper work...........

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