Ward staffing pressures leave vital care undone
A “staggering” amount of necessary care is left undone by nurses at the end of shifts because of staffing pressures, according to latest findings from a landmark nursing study.
The study authors said there was also a “clear relationship” between the number of tasks left incomplete and the number of registered nurses per patient.
The latest subset of interim results from the RN4CAST study into Europe’s nursing workforce was presented last week at the Royal College of Nursing international research conference in London.
Previous findings from the study, published in the BMJ in March, showed nurses in England were second only to Greece in considering themselves burnt out.
The new data is focused on nurse staffing levels in England and their impact on care. Researchers from the National Nursing Research Unit at King’s College London and the University of Southampton surveyed nearly 3,000 nurses working on around 400 general medical and surgical wards at 31 acute trusts.
Nurses were asked how many staff were on duty on their last shift. The average registered nurse to patient ratio was nearly 1:9, ranging from 1:8 during the day to 1:11 at night. There was also significant variation between trusts, from five registered nurses per patient at the best to 11 at the worst.
Nurses were also asked whether necessary tasks had not been completed due to lack of time and which out of a list of 13 activities had not been done. Overall 87% of respondents said at least one necessary activity was left undone.
Two thirds of nurses said they had not had sufficient time to “comfort or talk” with all patients who needed it and half had not been able to spend sufficient time educating patients and family. In only one area – pain management – did less than 10% of respondents report finishing their shift having left a task incomplete (see below).
NNRU deputy director Jane Ball, who presented the results, described them as “staggering”.
“Nurses are reporting significant amounts of care that is being left undone due to lack of time,” she said. “This is a significant volume across a wide range of care that is being reported as left undone.”
The researchers also found the number of necessary tasks left undone was linked to the nurse to patient ratio.
Ms Ball said: “There is a definite relationship. In the best staffed areas nurses reported an average of three aspects of care left undone, where on the worst areas, it’s more like four or more.”
The findings add to growing evidence of the importance of staffing levels in ensuring quality of care, at a time when NHS managers are increasingly seeking to cut nurse posts in order to make savings.
As reported by Nursing Times last week, Unison carried out a snapshot survey of nearly 1,600 nurses on 6 March. It found 70% believed staffing levels in their ward or care setting was too low to deliver “safe, dignified, compassionate care” and 91% backed minimum ratios.
A Nursing Times survey carried out in February found a similar percentage of nurses believed staffing levels had regularly dipped below safe levels over the last year and 72% wanted mandatory ratios introduced.
The RCN also supports mandatory nurse staffing levels. Delegates at RCN congress last April voted overwhelmingly in favour of their introduction.
RCN director of communications Fiona Johnson, who chaired the conference session, called on the profession to “bang the drum” about the new findings and use all its “networks and opportunities” to highlight them.
Jill Maben, the director of the NNRU who was recently appointed as an expert advisor to the Nursing and Care Quality Forum, said she would give the data to the forum’s “time to care” workstream.
She said: “We have an opportunity at the moment in that we have the Nursing and Care Quality Forum. I’ll be making sure this evidence gets to the group.”
However, the topic of nurse to patient ratios remains open to debate, with some in the profession believing that differing patient acuity levels make it too complex to set ratios, and others warning the minimum ratio could end up being viewed by managers as a maximum level of staffing they need to be safe.
|Snapshot reveals levels of incomplete care|
|Task:||Percentage of nurses who said task was left undone at end of shift:|
|Comfort/talk with patients||66%|
|Educating patients and family||52%|
|Develop/update nursing care plans||47%|
|Adequate patient surveillance||34%|
|Adequately document nursing care||33%|
|Frequent changing of patient position||28%|
|Administer medications on time||23%|
|Prepare patients and families for discharge||20%|
|Treatments and procedures||11%|
|Source: RN4CAST study|