More than half of nurses believe their ward or unit remains dangerously understaffed one year after a seminal report drew attention to the dangers of staff shortages, according to our latest survey, which suggests little has changed at the NHS frontline.
Robert Francis QC published his report on the high profile care failings at Mid Staffordshire Foundation Trust on 6 February 2013, setting out a raft of recommendations focused on improving care and patient safety.
Six months later the government unveiled its full response to the report, outlining measures requiring trusts to regularly publish details of staffing levels and encouraging the adoption of ideas like hourly rounding and supervisory status for ward managers.
Nursing Times wanted to gauge if the report has had an impact, for better or worse, on nurses working on the frontline and its legacy for nursing.
Our survey of 526 nurses, carried out last month, found that 42% of respondents thought the Francis report would improve things in the long term for the NHS and nursing, and 6% said they were already seeing positive changes as a result.
But 28% said it would make no difference and 24% warned that it had led to unfair criticism of the profession and the NHS in the national media and from politicians.
One respondent said: “The Francis report could lead to positive change – but so far budgeting concerns and political agendas seem to have undermined positive recommendations.”
Another added: “The focus of criticism from the media has been on nurses, whereas doctors were also criticised in the report but this has been ignored. All the good and hard work nurses do daily seems to be virtually invisible.”
Latest workforce figures, published last month, show hospitals were employing 2,400 more acute, older people’s and general nurses in October than they were in February.
But our survey reveals that the situation varies for nurses, with 39% of respondents warning that staffing levels have worsened where they work over the last 12 months and 37% that they have stayed the same – only 22% reported an improvement.
Our survey also suggests trusts need to recruit many more nurses if they are to reduce pressures faced by staff. Half of respondents warned that their ward or unit was “sometimes” dangerously understaffed and 7% that this was “always” the case. More than a third – 37% – said the average number of patients per nurse was 10 or more.
One respondent noted: “Although my organisation has been recruiting more nursing staff they have been inexperienced and have had to be supervised, so in some cases have made matters harder.”
Another said: “There just aren’t the number of nurses out there to recruit and I believe this will only get worse.”
The results suggest only marginal improvements since January last year, when we surveyed nurses on similar issues. Then, 11% said they were “always” dangerously understaffed and 44% said there were 10 or more patients per nurse on their ward.
Worryingly, a third – 33% – of respondents said patient safety had got worse over the past 12 months. This compares to 19% who said patient safety had got better and 48% who said there had been “no change”.
However, the survey suggests a slightly better story for care standards in general. Two-thirds – 65% – of respondents said they had witnessed “poor care” in their ward or unit over the past months, but this compares favourably to 76% in our survey last January.
Mid Staffordshire was criticised for putting financial targets ahead of patient safety. Asked to describe how they perceived the strategic focus of their trust, nearly half – 49% – said it was focused on financial targets more than quality of care. However, this does represent an improvement on the 65% in our survey last year.
On a more positive note, a third of respondents said they were encouraged to raise concerns about care or poor practice and felt they were listened to by managers. But this was tempered by 19% who said they were not encouraged to raise concerns and felt ignored if they did and 11% who felt they were actively discouraged from raising concerns.
Despite warnings in the Francis report about divergent skill mix ratios between registered nurses and unregulated healthcare support workers, this year’s survey suggested little improvement and in some places a worsening of the situation.
Around one in five respondents – 22% – said there had been an increase in HCAs compared to registered nurses on their ward or unit over the past 12 months, compared with 69% who said it had stayed the same and 9% who said there had been an increase in nurses versus HCAs.
Rounding and supervisory status
Nursing Times asked nurses about three nurse-focused ideas in particular that were recommended by Francis.
More than a third said their organisation counted ward or nursing team managers as supervisory or supernumerary to the ward or team’s nursing provision – something the Care Quality Commission has been asked to look for in its inspections. Of these 12% said their trust had introduced the measure over the last 12 months.
A further 10% said their trust had indicated it intended to introduce supervisory status in future, but 39% said it had not been mentioned.
Around 20% said hourly rounding by nurses had been introduced on all wards, while 12% said it was in place on most wards and the same percentage on a few wards. But a third said the initiative was still not used at their trust.
The situation was worse still for Schwartz rounds – monthly meetings where staff discuss specific patient cases or a set of circumstances they may face. Just 15% said Schwartz rounds were used and more than half – 54% – said their trust had not mentioned their introduction.
Two third of survey respondents said they worked in hospital trusts, with the majority – 42% – describing themselves as staff nurses. A further 20% described themselves as ward managers and a similar percentage as specialists.
|Read some of the comments made by nurses in response to the survey:|
“I returned to practice full of hope but am left with nothing but utter despair. The NHS is a shambles, unfortunately it is being run by the very people the whistleblowers tried to expose years ago.”
“The dependency of patients is much greater now and the staffing levels have not changed to accommodate this. We are classed as not short staffed but do not have enough staff to give patients the time and care they need and deserve.”
“Everyone is working hard and management take advantage of caring nurses who don’t complain and work 45-50 hours a week for no extra money… Burn out is a massive issue”
“Conscientious staff are doing as much as possible for as many as possible in as little time as possible – whilst at the same time ‘carrying’ less conscientious staff.”
“What can I say , I still love being a nurse but am sick of the way we are being treated by our employers, by the government and by the press.”
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