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Some wards have one nurse overnight, RCN report shows

There is just one nurse on some NHS wards all night, data obtained by the Royal College of Nursing suggests.

The information obtained via a freedom of information request also found a large reliance on temporary workers to hold the fort overnight.

Acute hospital trusts in the east of England were asked by the RCN for staffing information on a randomly chosen night, January 14, after it was informally told about issues in the area.

The resulting report said five hospitals, from three of the region’s 18 trusts, had wards with only one registered nurse on duty that night “compared to their establishment that they have two registered nurses and one healthcare assistant”.

The RCN said there were 573 agency, bank or locum staff working night shifts on that date across all the trusts.

It has signed up to the Safe Staffing Alliance, which wants no more than eight patients for each nurse. That’s based on a study that found hospitals with a greater ratio of patients to registered nurses would see about 20 more deaths a year than those with more staff. Southampton University used general acute wards during the day to come up with the figure.

The RCN said at first, two places refused the freedom of information request - West Hertfordshire Hospitals Trust and Colchester Hospital University Foundation Trust, with the later currently under investigation by police over allegedly falsified waiting times for cancer patients.

The report said having only one nurse on duty would “result in delays for patients receiving pain relief and intravenous fluids” and outcomes for patients on such wards should have been recorded as “near-miss clinical incidents”.

It said the investigation was sparked by anecdotal evidence from members of the public who said nurses in some hospitals “were looking after wards single-handedly with only a healthcare assistant in support” and “covering at night to support inexperienced junior doctors” because there was not enough senior-level supervision.

It said the data compiled showed some wards had only one registered nurse and “all hospitals were struggling to cover night shifts”, with a resulting reliance on temporary staff.

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Readers' comments (7)

  • Not only England but Scotland also and even in the day time

    Potentially Scotland has similar problems not yet revealed

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  • We didn't need the RCN to point this out. That's why some of us argue that a minimum qualified nurse to patient ratio even of 1:12 at night would be much better than what some of us have to put up with now.

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  • yes . needs sorting NHS and private. Also care homes . I know govt say they are not responsible for private sector. Does not matter does it?
    No all pts not asleep all night. could have 30pts- 8 tube feeds, 2 passing away etc and if nurse or ca sick and u cannot get cover- well!
    But hca number also needs addressing or else- they will drop them and have 2 nurses!!

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  • Earlier this year the Chief Nurse decided that we all need three qualified staff at night on the ward as a minimum. It meant that we were rotating on to nights every other week. Well when we sort out our staffing the ward manager goes home then the Lead Nurse comes around.
    She then moves the qualified nurses about to cover other wards leaving us with the bare minimum across the unit.

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  • 6.27

    I feel your pain. I definitely think we would be better off if the government or NMC or special think tank said something like: on a general surgical ward, at night, you must have a minimum of 1 qualified to 12 patients with no more than 6 patients per member off staff on duty - as an example.

    I think there has been quite a bit of 'I'm alright, Jack' going on, where staff who work in areas with better staffing whinge when those of us are regularly shat on (and often end up working alone) think that mandatory minimum levels would ensue enough staff to physically care for patients.

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  • One trained nurse at night is dangerous. Such a nurse can only, at best, spend very short periods with individual patients, with the high dependency clinical load taking priority. Managers who allow this have their heads in the clouds if they think such practice is safe. The NHS is in real trouble not due to the hard working front line staff but as a result of the poor performance of managers who run the service. Who is disciplining the poor performance managers?

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  • One trained nurse at night is unacceptable. As for staff being moved this often happens when staff call in sick at short notice for nights, (usually Friday or Saturday) and as you say we cant leave a ward withn one trained so we have to get moved. We cant have it all ways, perhaps a more robust sickness absence policy would help.

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