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Survey: low staff levels threaten care


Seven out of 10 nurses believe that staffing levels in their ward or care setting are inadequate to deliver “safe, dignified, compassionate care”, a snaphot survey has revealed.

The overwhelming majority of respondents also supported the introduction of minimum patient to nurse ratios, the research by Unison found.

The union carried out a snapshot survey on 6 March, asking UK nurses working shifts during a 24 hour period to record information on staffing and workload as well as their views on the situation that day.

Initial findings from the research, covering the views of nearly 1,600 nurses and healthcare assistants, have been published in a report today. It was presented at Unison’s healthcare conference in Brighton.

The report – titled Care in the Balance (attached, right) – said 73% of respondents felt they were too understaffed to provide safe, dignified and compassionate care and 91% said they were in favour of the introduction of minimum nurse to patient ratios.

One nurse said she was upset after four patients were left in wet beds for too long. She said: “This is unacceptable and upsetting seeing standards of care drop because of staffing levels, or should I say lack of staffing levels.”

Another respondent said: “Crisis has become the norm.”

In addition, many respondents reported being unable to take breaks or meals due to what the report said was “unreasonably high workloads”.

Another major concern of staff highlighted by the survey was the repeated use of agency or bank staff, who were viewed as not having the same workplace knowledge as regular staff and were not always able to work at the same speed or standard.

Nurses also said they felt they would be held accountable if anything went wrong regardless of factors such as understaffing.

The survey also found almost two thirds of staff, 62%, reported working some overtime on 6 March with only one in 13 receiving any payment for it.

The findings chime with a Nursing Times survey last year which found more than 75% of nurses feared for their patients’ safety due to inadequate staffing levels, poor ward layout and the bad attitudes of colleagues.

The Unison survey results will fuel the debate over whether mandatory minimum staffing levels should be imposed.

Such ratios have already been introduced in California and parts of Australia, and are favoured by UK healthcare unions and some academics.

However, patient ratios remain a controversial issue for the profession with some nurses feeling it would be too complex to account for factors such as variations in patient acuity or staff sickness absence. Others have warned that setting a minimum could actually lead to employers viewing a minimum ratio as the maximum level of staffing they need to be safe.  

Chief nursing officer for England Dame Christine Beasley told the Mid Staffordshire Inquiry in the risk was “instead of becoming the floor, they become the ceiling”.

Unison head of nursing Gail Adams said: “I understand the complexity and people’s apprehension about it becoming the norm and it becoming a ceiling. But the reality is from what nurses are telling us is that we are already there. I think very much that nurses feel we’re already at the bare bones.”

She told Nursing Times the finding that “surprised me and actually worried me most significantly” was the high percentage of respondents concerned about inadequate staffing levels on the day of the survey, which she said was not a “bad day” in terms of general demand.

“We didn’t have seasonal weather affecting staffing, we didn’t have high episodes of flu; it wasn’t a Monday where there had been loads of emergency admissions over the weekend. On that bog standard day about 70% of respondents said their staffing levels weren’t adequate to deliver effective, compassionate care.

“That we didn’t expect. We expected some people to say it but not the overwhelming majority of respondents, so that for me indicates we are at the bottom level.”

The Department of Health and NHS Employers, which represents trusts, have so far rejected calls for the introduction of ratios.

NHS Employers director Dean Royles said: “We believe employers should continue to take advice from their own chief nurses and professional advisors as their main guide on staffing levels. National guidance to employers can be helpful but crude national ratios could be too rigid and limit the NHS’ ability to plan its workforce according to local needs.”

But Unison said it would seek to campaign for national legislation on staff to patient ratios and would be using the survey to discuss stafing levels with trusts.

Ms Adams said: “We’re not advocating a single nurse to patient ratio level, universal across every single service. What we are advocating is that we need to work collaboratively with others to identify minimum sets of staffing levels across different services to make sure they are appropriate.”

She said more detailed research on the patient to nurse ratios identified in the survey are set to be published later in the year, following external scrutiny by academics.


Readers' comments (18)

  • I am wondering if pts are scored on a daily basis to determine their acuity. It would seem that scoring indicators would help determine staffing levels.

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  • "She said more detailed research on the patient to nurse ratios identified in the survey are set to be published later in the year, following external scrutiny by academics."

    Has anybody carried out a meta-literature search on the patient to nurse ratios as there already seems to be a vast body of literature on this going back a great number of years and based on informed professional opinion.

    What is the point of waiting until later in the year for another report on a survey when all is needed is to heed the repeated evidence from nurses working on the front line and reports in the media, including the daily press, that there is a shortage of staff which impacts on patient safety and quality of care.

    Urgent action is now needed on the substantial evidence already available and not waiting for the generation of further research and reports.

    There was a report on CNN news last night 23.04.12 citing that the serious nursing shortage in the UK and that nurses are being recruited from Portugal to fill a shortage at the Queen Elizabeth Hospital in King's Lynn, Norfolk. I was unable to find a written copy of this report and in the video it appears that a large recruitment drive took place by the head of nursing in 2011 so it seems rather strange that last night (1) they were reporting this shortage now and (2) in view of the numbers of nurses now out of work in the UK and newly qualified nurses seeking employment.

    video of last night's CNN report of nurses fleeing Portugal to work in the UK

    Spanish and Portuguese nurses fill the gaps in the NHS

    Nurses are quitting crisis-hit Spain and Portugal for the UK, in search of better jobs and training opportunities

    • Michael Howie
    •, Tuesday 20 December 2011 17.00 GMT
    • Article history

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  • No wonder nurses find it so hard to stay compassionate in their work - minimum staffing ratios may well help them to remember why they came into the job in the first place!

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  • It doesn't help when Mr Lansley seems to imply quality of care is not increased by having more staff.

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  • reduce red tape and paperwork and quality of care will improve.

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  • I couldnt agree more with the above comment about excessive red tape and paperwork.

    I work as a bank nurse. I often have a very brief handover and have to rely on prewritten handover notes to look after a patient. If I need further information, trawling through copius notes and rambling care plans in the file isn't often an option due to time constraints.

    We really do need to get away from the tick box mentality that so prevails and invest that time in real patient care.

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  • Anonymous | 24-Apr-2012 8:04 pm

    isn't that an issue to be put to the new Nursing Quality Forum?

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  • this topic has gone on and on, and no-one is listening!! Why - it costs money.

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  • "Survey: low staff levels threaten care"
    Talk about stating the Bl***ing obvious.

    It isn't threatening care it is already affecting care!

    a nurse working finishing a 12 hour shift was told by the duty manager that she had to continue working to cover the night shift until a nurse was found. She was told that if she refused, she would be disciplined. She then had to work a further 5 hours.
    Managers do not care as long as they do not go over their budget.

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  • Anonymous | 25-Apr-2012 9:01 am

    surely she had the right to refuse and there must be some legal protection for employees - even nurses!

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