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Nurses struggling to provide care on stretched wards

Nurses are struggling to deliver safe patient care due to chronic understaffing and a heavy burden of bureaucracy, according to two major union surveys.

Both Unison and the Royal College of Nursing have unveiled a bleak picture of the pressures currently faced by nurses ahead of key conferences taking place this week.

Nearly two-thirds of nurses, midwives and healthcare assistants surveyed by Unison said they did not have enough time to deliver safe, dignified and compassionate patient care.

Respondents gave examples including not being able to help with feeding, toileting, patient mobility and accurate record keeping.

The survey results, published on Friday, also revealed that 45% of the 1,500 respondents were looking after eight or more patients. One nurse said: “My ward will end up killing someone. That’s how bad it is and how unsafe.”

Unison head of health Christina McAnea said: “The hidden voice in the survey must surely be that of the patient who is not getting the level of care they are entitled to expect.

“Introducing minimum nurse to patient ratios would provide a safety net of care, restore public confidence and show nursing staff they are respected and valued,” she said.

Meanwhile, on Sunday the RCN revealed the findings from a survey of more than 6,300 nurses, which it said showed nurses were “drowning in a sea of paperwork”.

Most of those surveyed, 86%, said non-essential paperwork had increased over the past two years, with 55% saying it had increased dramatically. More than four out of five nurses said paperwork prevented them from giving care to patients.

The college estimates nurses are spending a total of 2.5 million hours a week on paperwork – equivalent to 17.3% of all the hours worked by NHS nurses in the UK.

RCN chief executive Peter Carter said: “Some paperwork is essential and nurses will continue to do this, but patients want their nurses by their bedside, not ticking boxes.”

The NHS Confederation is to carry out a review of the bureaucracy burden in the NHS. It is due to report on its findings and make recommendations in September. Confederation chief executive Mike Farrar said: “It is clear we need to do more to free staff from the shackles of unnecessary form filling.”

  • RCN Congress is taking place in Liverpool this week, while Unison’s health conference is in Glasgow. Keep up-to-date with news from both events at

Readers' comments (19)

  • B***dy h*ll! No s**t Sherlock!?! I never would have guessed!

    Finally caught up with the times then eh? Finally figured out what Nurses have been screaming down your collective earholes for a decade? It would be laughable if it wasn't so serious! Never mind, only 8 or 9 years behind eh Carter?

    It isn't just paperwork though is it? Although that is a massive burden. It's the fact that we have to do med rounds for too many patients, too many PEG feeds/IV's/wound care/dressing changes, etc etc etc etc. (Note for idiot managers, it isn't nurses time management that is the problem but the sheer amount of patients they have to do things for).

    And why is it always basic care (washing dressing etc) that gets noted for not being done? At least there are HCA's for that. How many times is CLINICAL care not done or not done fully because there aren't enough nurses?

    "The survey results, published on Friday, also revealed that 45% of the 1,500 respondents were looking after eight or more patients. One nurse said: “My ward will end up killing someone. That’s how bad it is and how unsafe.”

    What a joke! If you are going to publish a survey don't fudge the results. The accurate number is at least double that! When I was working the number was always 1 nurse for 18 - 20 patients on an ACUTE EMERGENCY ward!!!!!! I KNOW people died because we couldn't keep up with the clinical care for that many patients!


    It isn't rocket science!

    I am so glad I am out of nursing now.

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  • Minimum staffing levels is a poor idea, because that will become the level that the managers will work at, and as anyone with any knowledge of working on the wards or in the community settings will tell you every setting is different and can alter drastically in a short space of time.

    There is of course the nmc who as part of the code of conduct state that nurses must report dangerous situations such as understaffing, but have continually failed to address any complaint as they state it is nothing to do with them.

    Since its inception the idea of having a majority of its members being lay members appointed by the government has meant that it is a quango which does not act in any way that might upset the government in any way, and as such has failed in its duty of care to patients clients, as it is not ensuring that no harm is done. Indeed it sees no problem in Nurses working for Atos Healthcare and denying incapacitated and disabled claimants the help they need based on assessments made on idiot sheets, without ever seeing the claimant or completing a nursing assessment based on that interview.

    It seems to think these very highly paid individuals promote professionalism in nursing. I wonder if they would take the same view if a staff nurse at the local hospital just handed out an idiot sheet to a patient and based all care on the outcome of that.

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  • i've got a great idea....lets get rid of some more posts!!!!

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  • when we do report short staffing or inadequate skill mix nothing gets done.

    we regularly TRY and look after 14 patients per RN.

    same old story, different headline.

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  • When completing a return to practice course 2 1/2years ago we were repeatedly told by uni tutor that she didn't want to hear 'shortage of staff' cited as a reason for what we experienced on wards. Everyone colluding!

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  • not surprised by these findings, same in my trust, my ward is demoralised and fed up, not a nice place to be for over a year now, time to get off this sinking ship for my health and family, i wish i had looked sooner but wanted to help steer the ship around, unfortunately the system kept drilling holes through the hull :(

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  • Yes But

    Anonymous | 22-Apr-2013 9:07 am

    You are right that lay members have to be properly independent - but remember that it was relatives, not professionals, who did most to expose the scandalous situation at Mid Staffs. Professionals appointed by goverment, seem to me even less likely to criticise goverment policy!

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  • I was in an Essex hospital last year. Staffing levels seemed OK most of the time, but once or twice they might be one or two down and then seriously stretched to keep us all alive let alone fed and watered.

    What was a giggle was that if anyone said "You a bit short today?", the only reply was "We're not allowed to tell you!" - as if we couldn't see for ourselves!

    Sister finally confided that they were on a disciplinary if they dared even acknowledge the problem. Not exactly full transparency!

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  • Savvy Trusts are finding a middle ground

    The recent report from the Royal College of Nursing unfortunately highlights an issue we are seeing in Trusts across the country. Existing administrative policies have led to a spiralling amount of paperwork that is preventing healthcare workers from being able to provide the optimum care to patients.

    The Prime Minister and Health Secretary announced late last year that £100 million will be offered to the NHS for nurses and midwives to spend on new technology that will free up time for patient care, with digital pens being highlighted as a good starting point.

    The use of digital writing is a middle ground that savvy Trusts have been turning to with great success. Digital writing puts the power back in the hands of nurses, and through saving on the unnecessary multiple form filling and data input that the Royal College of Nursing report highlighted as a cause for concern, nurses are empowered and able to provide the optimum time interacting with patients and less being metaphorically chained to their desks under a mountain of paperwork.

    Virginia Carpenter, Marketing VP, Anoto

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  • "Minimum staffing levels is a poor idea, because that will become the level that the managers will work at..."

    This is the same wonky reasoning coming out of the DoH. Right now there is nothing compelling a certain level of staffing other than local decision making, the reasons a ward might be better staffed than any proposed minimum ratio don't disappear once minimum ratios hit the statute book. All that would happen would be establishing a baseline beyond which we can readily say staffing would become unsafe. Even at 8:1 that would be a huge benefit to millions of patients every week, you'd be driving standards *up* to a minimum, not down.

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  • We need an intelligent tool for
    measuring the number of staff on a ward not just a minimum nurse patient ratio.
    For example I had eight patients to look after, none of whom could have a wee or a poo without help. Think about how often in a day one would need to do this on average & multiply that by 8. Time for medication, only one of them could actually be safe to take their own medication when it is put infront them.
    Think of all the other jobs now, lets make a list with the average time it takes.
    Lets work out an equation to find the solution or employ a mathematian to do that. This tool is really important for us.

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  • It will mean every ward will run on minimum staffing levels. I doubt that will be enough staff to give adequate care, but not good effective care as Anonymous | 22-Apr-2013 9:07 am points out. Isn't that the levels that staff we are working at now?
    There will be no flexibility to support areas that have a sudden crisis, which is unpredictable, and happens daily. There's nothing so sure as something needs to happen to improve staffing levels, but what?

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  • Haven't other countries like Australia developed good working tools to calculate staffing levels? These are now bound by law and we could learn by their example.

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  • there have been studies and 'tools' used many times over the years to work out safe nurse-patient ratios.

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  • A huge amount of work has already been done on nurse staffing which includes looking at patient acuity and dependency in different care situations. See: and also and the review by the NHSIII and

    Also check out the work done by Keith Hurst which informed much of the SNCT development and the "Guidance on Safe Nurse Staffing Levels in the UK" (RCN, 2010) and "Setting Appropriate Ward Nurse Staffing Levels in NHS ACute Trusts" (RCN, 2006) documents on the RCN web site.

    What I find worrying is that the NHSIII has closed and the site will be discontinued in a few months (at the end of June). Searches of the NHS Commissioning Board site and NICE have failed to provide little if any information on plans to progress/develop tools for establishing nurse staffing levels. The whole issue seems to have had a veil drawn over it with a reduction in transparency about what is happening.

    There is no lack of work, tools or evidence and there appears to be a smoke and mirrors game being played by those who run the NHS in England.

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  • the DOh will do everything in its power to prevent a minimum staffing ratio, because currently that would involve employing a hell of a lot more nurses than we have at the moment and would drive standards up,

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  • there is no reason why wards should be stretched and nursing staff should be put in such a position when patients' health and lives depend on their skills and expertise.

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  • I recently had the pleasure of being asked why I had not completed an individuals paperwork for their personal care, I advised because I had not yet completed their personal care. What the manager failed to notice as she was so intent on checking the PAPERWORK IN THE ROOM was that the individual had vomited over herself. As a student nurse trying to do my best, I have to ask when paperwork took priority over an individuals care. There was only myself and 1 other care assistant and we were both dealing with another patient. Too much focus on paperwork with too few staff.

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  • Anonymous | 18-Sep-2013 1:03 pm

    if it was obvious how busy you were, the person scrutinising the paper work could have shown their compassion and gone to the aid of the patient who was vomiting!

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