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Three quarters of nurses fear for their patients' safety

More than 75% of nurses fear for their patients’ safety due to inadequate staffing levels, poor ward layout and the bad attitudes of colleagues, a Nursing Times survey has found.

Just over 600 respondents from every level of the nursing profession replied to our Patient Safety Week survey asking about concerns, confidence in reporting incidents and harm to patients.

Less than a quarter were confident their patients were safe on the ward or other care setting all of the time. Inadequate staffing levels some of the time was the top cause for concern, followed by poor attitude of colleagues, poor skill mix and bad ward layout.

Worryingly, a quarter of respondents also said they never had enough staff to be confident patients would be safe.

Unison’s head of nursing Gail Adams told Nursing Times staff shortage was becoming systemic and urged nurses to report their concerns to the Nursing and Midwifery Council or their union.

“In the past you would get occasions where, for example, it’s a weekend and a couple of people were off but now it’s happening all of the time and people are worried.”

She said the fact that 41% of respondents were concerned for patient safety due to the attitude of their colleagues was “surprising”, but said it could be a result of the stress nurses are under.

“When you’re pulled every way trying to care for patients, your patience and tolerance can be affected,” she said.

A report by the Care Quality Commission published last week identified safety concerns with almost half of hospitals and care homes, with risk management one of the areas organisations were most likely to fall down on.

Asked what their biggest patient safety concern was, 24% of survey respondents highlighted the identification of deteriorating patients, followed by drug errors, slips, trips and falls and insufficient nutrition and hydration.

Concerns over identifying the deteriorating patient echo previous Nursing Times research, which found one if five nurses lacked confidence in colleagues on this issue (news, page 2, 25 January).

Only 4% worried about patients receiving the wrong treatment due to misidentification; however it was the second most common cause of patient harm seen by survey respondents.

Misidentification is one of 25 “never events” which, according to the Department of Health, should never happen if relevant procedures and guidance has been followed. Only 43% of respondents were aware of the list.

Nursing Times asked respondents about the prevalence of seven never events which nursing care could have the greatest impact on.

Failure to monitor and respond to oxygen saturation was seen as the most common, reported 131 times in our survey, followed by misidentification reported 77 times. Respondents reported 52 instances of patients getting trapped in bedrails, 50 occasions of misplaced enteral feeding tubes, 49 maladministration of insulin and eight instances of severe scalding.

On average, about half of respondents were confident they knew what procedures should be followed to prevent harm as a result of these seven never events.

In contrast, the survey revealed the majority of nurses were confident about reporting patient safety incidents. However, only half said they expected to be treated fairly if they reported an incident and a quarter were worried they would get into trouble or be bullied by management.

In total, 82% of nurses said they had reported an incident in the past and 86% said they would report a near miss, even if they were involved in it.

Nurse and National Patient Safety Agency director of patient safety Suzette Woodward told Nursing Times the results of the survey showed the importance being placed on patient safety by the nursing community.

“Identifying patient safety incidents and ensuring they are reported in an open and transparent manner is at the heart of reducing risk in healthcare,” she said.

Figures released by the NPSA last week showed an 8.5% increase in the number of incidents being reported between October 2010 and March 2011.

Full results of the survey can be accessed at nursingtimes.net

Readers' comments (6)

  • If reported to the NMC would they come and visit the wards to see for themselves?

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  • Ive been nursing for over 25 yrs and it has now become very sad to see the staff per patient ratio rising again and again more nurses having to take on more jobs within their role as nurse, at the expense of the patient. There is only so more a nurse can do at one time, even if super human there will come a time when patients suffer, its not a nice proffession to be in at present, dont get me wrong I love my job but feel that most managers only worry about their budgets more than there actual patients.
    When is it going to be better for patients? maybe when all nurses stand together and fight for what is right!!! I never thought that nursing would ever be a profession that people take for granted and value nothing but expect everything for nothing. Its sad, the government should take heed they may need us in the future and there will be no nurses to look after them thats a fact.

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  • If things are this bad, and I have no doubt they are, why are more nurses and midwives not complying with the professional Code and their duty of care by raising concerns?

    Alternatively if they are raising such concerns, why are their management not taking more notice.

    In either case why are their management not making a priority of creating a culture where raising of concerns is encouraged and acted upon ratherth than frowned upon or punished?

    Have no lessons been learnt from Mid Staffs and Maidstone?

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  • "urged nurses to report their concerns to the Nursing and Midwifery Council or their union."

    Hahahahahahahahahaha!!!! WHAT THE HELL DO YOU THINK WE HAVE BEEN DOING?!?!?!

    It doesn't make a damn bit of difference how much or how loudly we shout if the unions ignore us and the management pretend it isn't happening so they can collect their cushy paypackets!

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  • These comments are all valid and undoubtedly there are problems with patient safety and deficiencies in care standards. We must continue to raise the issues and never accept that poor quality standards are acceptable. Yes we have to continue working in the system but it doesn't mean we have to accept poor care. We need to shout about it to anyone and everyone who will listen. Also we need to look at ourselves and ensure that we are a competent and caring workforce - staff not up to scratch should be dealt with, regards DH

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  • michael stone

    Interesting that whenever the CQC or PA or whoever, reports 'unsatisfactory care' the typical response on NT is to say 'flawed report' - yet when nurses are saying the same thing, nobody seems to be calling those nurses 'liars' ?

    Just a 'philosophical observation'.

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