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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


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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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