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Nurses warned to record concerns about workload risks

Nurses have been warned to document their concerns on workload and workforce shortages in the wake of “worrying” results from a major union survey.

Less than 10% of nursing staff believe they can deliver “safe, dignified, compassionate care” all of the time with their current workload, according to the Unison annual nursing and midwifery family survey of more than 3,000 people.

The results were presented last week by Unison head of nursing Gail Adams at a seminar in Birmingham.

Ms Adams said: “I’m profoundly worried and concerned about how many [nursing staff] feel they cannot deliver safe, compassionate dignified care on their shifts.”

She told delegates they must “document and articulate” their concerns, as not doing so could potentially mean they were breaching the Nursing and Midwifery Council code of conduct.

“If you don’t have that audit trail of demonstrating you clearly articulated your concerns – and subsequently a complaint is made about the level of care – it’s very difficult…. to demonstrate you did everything you could to raise concerns.

“If we do not document when we are concerned about patient safety, if we don’t say ‘it’s wrong’, we almost become complicit and that sadly is what happened at Mid Staffordshire [Foundation Trust].”

The survey also revealed that a third of respondents thought the level of care quality they were delivering had worsened since this time last year.

In addition, the majority of respondents thought staffing levels had decreased since this March, which Ms Adams described as a “bad picture” that was “worsening”.

Meanwhile, only 44% of nurses felt their role was “respected”. Ms Adams suggested this was largely down to negative media coverage from cases such as Winterbourne View.

“Every time that there is an outcry in regards to standards of care it has a detrimental impact on the way the profession feels,” she said.

Readers' comments (15)

  • oh right so it will be the nurses fault AGAIN.

    I have spoken to my ward manager, senior managers, put in incident forms and nothing has changed. We carry out pointless audits that look at pressure sores, falls, HAIs - all of which happen more when there are not enough staff.

    We have minimum qualified staff on duty, how dare anyone suggest that if I cannot offer safe and dignified care that I am in any way complicit.

    Why don't the regulatory bodies and the unions actually come to the wards, look at the staffing levels, make their recommendations then insist the trusts take responsibility when problems arise.

    This is why nurses go to the media because no-one else ever takes them seriously. Survey after survey is carried out, doesn't that tell people that staffing levels are atrocious.

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  • Margaret Hayward reported her concerns and she got struck off. Every time there is a 'scandal' there is always evidence to show that nurses concerns have been raised and ignored.

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  • despite what the papers say, nurses don't want to see their patients lying in wet beds, not be given a hot drink when they ask, have to wait for painkillers, not get their bells answered.

    I am now getting patients and visitors commenting on how busy and short-staffed we are. Patients apologise for wanting help to go to the bathroom, they know that we can only one thing at a time.

    What do our critics suggest we do when buzzers are going off,a couple of confused patients are trying to get out of bed, one patient has fallen on the floor, three admissions have all arrived at the same time,the drug-round is due and there are only 2 of us there?

    I would love to see patients, visitors, patient groups, the daily mail support us by reporting what it is really like on the wards.

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  • Myself and all the nurses at the facility I work in, all recieved disciplinary letters from the district manager regarding the voicing of our concerns. One colleague told me she would use it as toilet paper, I said I would be holding on to it, as evidence, because there will be a day someone will walk into the facility and hold me accountable, I will be able to demonstrate I have voiced my concerns over and over again.Interestingly the company's new values of honesty and transparency which we have been told to embrace -and which we all thought to be great, prove to be worthless, they tell us to be open and honest - until they dont like what we say - which is with the minimum staffing levels we are working with, we are unable to safely render quality BASIC care. This is another reason I am working towards another profession, to get out of nursing.

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  • I work in a large district general hospital on a very busy ward, and when some of our staff submitted incident forms regarding severe staffing shortages on their shifts, they were told to stop keeping on doing incident forms. Management clearly didn't like it being highlighted because they then couldn't ignore it. Some staff then said it was pointless doing them, but I stated that it wasn't pointless, and that we should continue to do them even if they are unwelcome. We have to protect our patients, and protect ourselves too, or we might find we are the scapegoat when things go horribly wrong.

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  • Send your incident forms to the Chief Nurse (or what ever other fancy title he/she has invented)

    If possible copy your forms to your professional organization/trade union rep and always keep a copy for yourself.

    If no attempts are made to acknowledge your concern or worse to improve your situation request your professional organization/trade union to write to the Chief Nurse stating a belief that they are in breach of the NMC's code of conduct and that unless improvements are are rapidly implemented a referral will be made to the NMC requesting a "fitness to practise" investigation take place. The letter should be copied to the Trust Chairman, CEO and the CQC.

    Dont continue to allow yourselves to be mistreated !

    By taking the initiative you can improve working life and as a result give better care to your patients

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  • tinkerbell

    many years ago i was told to stop using 'inflammatory language' on reporting low staffing levels on incident forms, the word that was regarded as inflammatory was 'dangerously' low staffing levels. These managers must be told by higher management not to encourage staff to complain about staffing levels, otherwise how could they get away with it?

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  • chief nurses are in breach of their nmc code if they continue to ignore nurses concerns.

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  • tinkerbell

    I can well imagine that some elements of management do not enjoy receiving reports about low/dangerous staffing levels.


    Because such reports expose managements total disregard for patient safety or staff well being

    That is why I suggest any reports about poor staffing are addressed to the head of your local nursing management structure.

    By doing this opportunities for the junior management weasels to loose, miss-file or just ignore alerts about staffing.

    It is however, important to keep your staff side reps informed. If management bullying occurs then clearly an immediate grievance should be lodged.

    Keeping wards and depts. short of staff is. I believe, akin to professional negligence.

    Those responsible must face the ultimate sanction of being removed from the register.

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  • money, money, money. that's all they care about, saving money. robbing peter to pay paul. they don't care about the staff and they certainly don't care about the patients, if they did they would ensure that there were always enough staff to look after people properly and not have staff thinking that a good day is when no-one has fallen or gone missing.

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  • I agree with all of the comments above, but most of all with the money money money. Maybe that could be used to make good/ safe staffing levels an incentive. As if the CQC did regular unannounced visits just to check on staffing levels, And if found to be below a set standard level, then the trust gets fined, yes this doesnt sound good that money is being taken in this way, BUT in the long run these ignorent managers may wake up and realise the money would be better spent on more staff and improved care and better standards for staff and patients.

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  • CQC came in last year to our facility and spoke to staff about staffing.The staff that discussed staffing levels with them, were taken into the managers office and told off. The CQC were happy that we staff to the minimum staffing guidelines, regardless of the dependancy of the residents - so management feel that they have the green light to continue with 1 nurse and 2 carers to highly dependant residents, all but twoo require hoisting for all transfers, 2 of whom are on 02, 1 on Bi pap, 5 who require feeding, 3 at high risk of choking, 4 bedbaths, and 12 needing full assistance with washing and dressing etc etc. Yet we are not understaffed. Add to that nursing duties of medication rounds, observations, ordering meds, charting on a minium of 7 problems on all 17 wonder I am leaving this profession.
    All of the nurses in our facility have highlighted that we are UNABLE to give quality holistic care. I am fed up of hearing the words budget....I am about to invite the district manager to bring her mother in for a weeks care, without special priviledges, lets see what she has to say about the care, and bloody budget then!
    However I suspect I will be on the recieving end of another telling off!

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  • You can highlight and document unsafe and dangerous staffing levels until you are blue in the face but it doesn't make any difference.

    What it does do is raise the issue formally, and when something goes wrong, you can prove that you had brought it to the notice of senior staff/management, but you must do it in writing, and KEEP A COPY.

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  • i work on a acute surgical ward in a large hospital, we are now treated as a day case unit, we have limited staff and are under pressure to discharge as quickly as possible, so we can fill up with emergency admissions, we often do not have break, and if we work a long day 14 hours, often do not have a break during this time, incident forms are done on the computer, and after a busy 14 hour shift, all the staff want to do is go home, our manager is concerned, but the CSM and matron do not seem interested, this is not why i became a nurse

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  • I spent two years working on the Bank at a facility where I regularly made complaints about being the only qualified person covering the shift.Mistakes (although minor and not life-threatening) were made due to workload pressure and lack of support.
    They stopped using me, now I am looking for work again and with no hope of a reference either.

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