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Exclusive: Specialists called onto wards as pressure mounts for safe staffing

Specialist nurses are being made to abandon their caseloads to work on wards to bulk up staffing numbers, Nursing Times has been told.

The revelation comes amid intense pressure on trusts to publish “safe staffing” data to the public, as part of the government’s response to the Mid Staffordshire Foundation Trust public inquiry.

“About a third of people in a room of 70 said they had been asked to work on wards and that meant abandoning their caseloads”

Alison Leary

Last year, health secretary Jeremy Hunt said all NHS hospitals would have to display the planned and actual number of nurses on each shift on each ward by the end of June at the latest. This data would then be collected by NHS England and published on the NHS Choices website.

Trusts were given until 10 June to submit information on nurse staffing on their wards during May to NHS England.

Many organisations are reported to have worked “flat out” to meet the deadlines, with a national shortage of nurses adding to their difficulties in filling shifts. Nursing Times has learned the pressure on trusts has led some to ask specialist nurses to work on the wards.

Alison Leary, an independent healthcare consultant who has researched specialist nursing, said she was getting “four to five emails a day” from specialist nurses concerned about being deployed to hospital wards to make up the numbers.

Alison Leary

Alison Leary

“At a recent conference on long-term conditions, I did a straw poll and about a third of people in a room of 70 said they had been asked to work on wards and that meant abandoning their caseloads,” she told Nursing Times.

While this has been an ongoing problem, Ms Leary said she had seen a sharp increase in complaints over the past six months as the deadline to publish staffing information approached. This was fuelling concern trusts might be tempted to “game the system” to look good to patients and commissioners, she said.

Unison’s head of nursing, Gail Adams, confirmed members and branches had reported “specialist nurses being told they had got to be on a ward on a certain day”. “It’s robbing Peter to pay Paul,” she added.

Gail Adams

The data on nurse staffing is due to go live on the NHS Choices website on 24 June. While there is widespread support for increased transparency on staffing levels, there has been growing concern about how this data will be used at a national level to make comparisons between organisations.

NHS England originally told trusts that when the information was put on the site they would receive a red, amber or green rating for safe staffing, based on the fill rate of shifts over a month.

However, Nursing Times has learnt that trusts will not now be rated in this way when the data is first published.

“If it’s not a true reflection of the number needed, then it could give the public a false sense of security”

Howard Catton

The drive to make every NHS provider publish ward-level staffing data was inspired by work at Salford Royal Foundation Trust.

Chief nurse Elaine Inglesby-Burke said uploading the data to NHS Choices was “absolutely the right thing to do”.

However, she warned organisations that set a high staffing standard but didn’t always achieve it could end up looking worse than those that had set lower standards.

Elaine Inglesby-Burke

Elaine Inglesby-Burke

“Unless we identify a national standard, I don’t know how you can compare across organisations,” she said.

Royal College of Nursing director of policy Howard Catton stressed the publication of staffing data was “a good first step” but added there were potential “weaknesses”.

“We’ll get to see planned versus actual numbers so the supposition is the planned number is the right number,” he said. “But if it’s not a true reflection of the number needed, then it could give the public a false sense of security.”

However, former nursing director Elaine Maxwell, a non-executive director at Basildon and Thurrock University Hospitals Foundation Trust, said trusts were more than capable of dealing with potential negatives.

“If you have an establishment with a very rich number and skill mix and then are not able to achieve it and you are rated amber or red then it’s up to you to communicate to the local community why that is. We saw with mortality rates that trust with high rates were able to explain those and it did not stop people from coming,” she said.

“Publishing the data might help improve staffing levels in the same way that publishing mortality rates for surgeons led to improved outcomes”

Anne Marie Rafferty

Anne Marie Rafferty, professor of nursing policy at King’s College London, described the initiative as “a huge experiment”.

While a single figure could not reflect the complexity and variables involved in ensuring safe staffing, she said publishing the data might help improve staffing levels in the same way that publishing mortality rates for surgeons led to improved outcomes.

Anne Marie Rafferty

“Identifying variations between similar units is a starting point for asking questions,” she said.

A spokesman for NHS England said work was continuing to refine how the data would be presented on 24 June to ensure it was “easy to understand and meaningful” for the public.

He said if a specialist nurse was vital to the needs of patients on a ward, they should be part of the complement of that ward’s staff.

“This is not about ‘gaming the system’. It is about ensuring openness and transparency of data to give the public confidence in hospital services,” he said.

NHS England said staffing should be determined using an evidence-based approach and should be reviewed regularly.


What do you think?

We’re going to be discussing this story and its implications on twitter at 1pm Wednesday 11 June.

To join in, search for #NTtwitchat and use this hashtag in all your tweets.

Readers' comments (39)

  • michael stone

    'Specialist nurses are being made to abandon their caseloads to work on wards to bulk up staffing numbers, Nursing Times has been told.'

    Does anyone else, keep seeing this 'domino effect' whereby 'solving one problem is the [inevitable] cause of the next problem down the line' all over the place, is it just me ?

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  • michael stone

    very similar trolling style to IgonikonJack!

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  • Pointing out the impact of one decision on another sphere of activity is not trolling.

    Posting unsubstantiated stuff about trolling stye however is trolling.

    Oh no.... I just fed the troll!!!

    Or did I?

    On another note, there must be a cost/benefit analysis carried out alongside a risk assessment of such a process. Anyone who doesn't do that shouldn't be in a management role.

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  • Anonymous | 11-Jun-2014 11:50 am

    it was a general message for the attention of MS and applies across all of its comments and not particularly this one.

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  • Using specialist nurses in ward areas will enhance the numbers but what about the skill mix?
    As a specialist nurse myself I would say my skills have become quite specific; there are many competancies required on a general ward that I now longer am up to date with.
    It is a knee kerk instant 'fix' reaction with little consideration for other important factors.

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  • tinkerbell

    fire fighting, robbing peter to pay paul, are these the only strategies on offer by managers on the titanic. Incompetent managers have got us in this complete mess by allowing the whole profession to become a pushmepull me profession, jack of all trades and master of none. Shame on them! Shame on us for putting up with it!

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  • Nothing new here then. When wards are short staffed i.e. winter pressures - specialist nurses have always been called upon to do shifts to cover. What exactly did Jeremy Hunt/government expect Trusts to do - they have no money! The NHS is required to save up to £20 billion by 2015, an average of 5% per year, the biggest efficiency challenge it has faced. Will this data show the skill mix of staff? I suspect there will be an increase in the HCA ratio to RN's. Whilst this would provide more 'hands on deck' you still need a certain 'number' of RN's on duty for the safety of patients. After all, HCA work is delegated from the RN who ultimately is responsible for the level of care given.

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  • about time specialist nurses see how hard ward based nurses work..... we dont get the recognition as much with the patients as we dont have time to sit and talk

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  • I agree with my learned colleagues. This is a 'sticky - plaster' situation that just patches over the underlying problem without solving or healing what is underneath.
    This is not new and has been going on for years!
    As for the culture of blame.
    I feel that there are very few managers that have voices that are heard these days and that they are terrified of loosing their own jobs. Lets 'not rock the boat' syndrome is a song that is long on-going!
    Nurses are historically, 'wingers' , so lets wake up everyone and stand up for what we believe in; 'better staffing levels to provide better quality and compassionate care and time for nursing staff to be objective and pro-active about what they are doing'!

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  • what do they mean by 'specialist' nurses, is it clinical nurse specialists or those who teach and don't work in clinical areas any more?

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  • When I was a specialist nurse, this has happened to me.
    I was asked by email at 22.47 (at night) to go to a ward on another site the following day as they were so short staffed and shifts has not been filled by bank or by agency. I did go at very short notice, and spent about 5hrs on the ward (I had to leave the ward at that time as I had pre-arranged appointments). So, I was only able to cover the ward for part of a day shift! At the time, the staff were kind to me and extremely grateful for me going, but had a grumble about me leaving, presumbly as this left them short again.

    Two weeks later I received another SOS email, but on that occasion I could not go.

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  • Anonymous | 11-Jun-2014 12:35 pm

    about time specialist nurses see how hard ward based nurses work........

    The above is a learned colleague's contribution to this discussion, the very element that jeopardizes nurses' and nursing's progress to be recognised as one of serious dedicated intellectual care givers - divisiveness and mediocrity.

    I must point out that this is not the time for bickering and stating who does the hard work and who doesn't.

    The commentator couldn't be more wrong about their perception of "specialists" nurses.

    The issue of specialist nurses appears to present another topic for later discussion!

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  • anon 2.04 - what was your specialist role? happy to hear you enjoyed working on a ward, maybe it's good to have a break from routine ocasionally. Are nurse managers, lecturers and 'trainers' going to be asked to help out on the wards as well.

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  • The fact is that if a nurse is not competent to do the work of a ward nurse then he/she should not be doing it! There is no such thing as a generic "do it all" nurse who can move between disciplines/depts at the drop of a hat. Would you want to be nursed by someone who had not stepped foot on a ward for 10 years (for example)? I know I wouldn't...
    Would the nurse on a general medical ward be able to go out into the community and be Specialist Heart Failure nurse/a community nurses/a Diabetic nurse at short notice. I think not, and neither would they be expected to.

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  • Anonymous | 11-Jun-2014 7:41 pm

    that was the vision of some managers - to have general nurses who could work on all general medical and surgical and other wards except the very few which are highly specialised such as A&E, ICU and pediatrics and anesthetics where they still required specialist training.

    The wanted something like a giant pool so instead of having ward teams nurses would be sent to any part of the 1000-bedded university hospital spread over a large area in several buildings where they were needed each day according to the work load.

    How they proposed to manage this or whether they ever put it into practice I never discovered as i left the hospital after 20 happy years and shortly after the introduction of general management who came in and almost overnight 'bulldozed' the whole previously excellent clinical structure of the organisation. Change for the sake of change and in the name of economy.

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  • I was asked along with other CNS's to work on the wards about 5 years ago. We contacted our RCN rep and she told us on no account should we do so. So we refused as we pointed out that our skills in general wards had lapsed in all sorts of aspects and our own patient case loads and clinics would suffer, not to mention the doctors we work with. We have never been asked again I am glad to say but watch this space...

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  • we dont need costly time wasting exercises to obtain data about safe staffing, hospital wards are understaffed and have been for a very long time. I am a HCA and have been doing 2 peoples jobs for years, 2 hca' and 2 nurses for 32 patients, most needing all care, is not enough, any fool knows that, its just ignored. I wonder if i will be able to claim back 2 peoples pay for the times i ran myself ragged, was unable to have a break and finished late when the new minimum staffing levels come to bear

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  • michael stone

    Anonymous | 11-Jun-2014 11:15 am

    Dear Anonymous,

    I have had a thought.

    You are trying to stop me from posting, by telling me to stop posting – this will not be successful.

    But you keep posting AFTER my posts: perhaps you should post your ‘don’t post MS’ messages in every topic, BEFORE I post anything. As I don’t read or post in many topics, although your posts won’t actually do anything, you will have the satisfaction of [falsely] concluding that if you told me to not post in something I never intended to post in, that you finally succeeded in stopping me from posting.

    A win-win: you can believe you achieved your objective, even with no effort/restraint on my part.

    Anonymous | 11-Jun-2014 11:50 am

    Trolls are a growth sector - expect Tesco to start selling packaged Troll Food anytime soon.

    I think Michael Thomas almost had it right with his 'sticking plaster' comment. But it isn't quite that: if 'specialist nurses' are doing some necessary task, and are stopped from doing that by being used to prop-up a different area of nursing (presumably 'ward nursing' normally), it is more like taking some of the screws out of the table, and putting them into a wobbly chair. Do that too often, and the chair doesn't collapse, but the table collapses instead.

    There is, of course, a lot of 'knee-jerk reaction' to 'bad press' in this: good or bad, without things like the media campaigns and Francis, etc, it seems certain that this type of NHS reaction wouldn't have happened.

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  • Our Trust tries to enforce this all the time, Specialist Nurses are supposed to do a fixed number of ward shifts every year - it doesn't work! What happens is the specialist nurse then ends up with a backlog of her own patients which invariably has a negative or even harmful impact. For example lots of specialist nurses are seeing suspected cancers, if their appointments are delayed then so is their diagnosis - unacceptable.

    Trusts just need to accept ward Nurses are best for ward patients, and stop looking for ways to massage the figures!

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  • Michael Stone

    "Trolls are a growth sector - expect Tesco to start selling packaged Troll Food anytime soon."

    Do they eat haggis?

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