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Wards dangerously understaffed, warn more than half of nurses

More than half of nurses believe their ward or unit is dangerously understaffed, according to the results of a Nursing Times survey.

Nursing Times conducted an online poll ahead of the publication of the report of the Mid Staffordshire Foundation Trust public inquiry on Wednesday.

Chairman Robert Francis QC’s report will consider why chronic failures of care at the trust were not picked up by regulators for so long.

A decision to slash nursing posts in a bid to save money and achieve foundation trust status has previously been blamed for many of the failures.

Of around 600 nurses who responded to Nursing Times online poll last week, 57% described their ward or unit as sometimes or always “dangerously understaffed”.

In addition, 76% said they had witnessed what they considered to be “poor” care in their ward or unit over the past 12 months – of which nearly 30% said they seen it happen regularly.

One respondent said: “It is becoming more and more stressful for a nurse to nurse. Safety is always at the forefront of my mind but it is becoming increasingly difficult to ensure that all patients are kept safe while in my care.”

More than half, 55%, of respondents thought nursing was facing unfair criticism over standards as a result of previous well publicised failings at Mid Staffs. But most thought that while the Francis report would have a negative effect initially, generating more criticism, it would lead to positive changes in the long run – leading to better staffing and regulation.

Nursing Times asked about a number of issues raised during the inquiry such as staffing, patient safety and culture.

Overall, 73% of respondents said they had completed an incident form over the past 12 months because an adverse incident, or risk of one, had occurred. Worryingly, 76% said they had not received feedback or a response after submitting the form. This reflects evidence heard by the inquiry that incident forms filled out by nurses at Mid Staffs concerned about staffing levels ended up in the bin.

Of nurses working on general medical wards, 85% said the average ratio of patients per registered nurse was eight or more – of these just under half said the ratio was 10 or more patients per nurse.

The Royal College of Nursing has said a ratio of eight or more patients per registered nurse is associated with patient care regularly being compromised.

In addition, 43% of those who worked on general medical wards said the ratio of registered nurses to healthcare assistants was either 50:50 or worse. The RCN recommends a ratio of 65:35 in favour of registered staff.

More than 80% of respondents believed there were more “Mid Staffs” out there while, around a third were not confident they could rule out similar failings happening at their trust. More specifically, 23% said they were “at risk” of a similar situation occurring at their trust and 12% that it was already happening at their trust – either in isolated parts of the organisation or right across it. 

One survey respondent said: “Cutting staff numbers will mean poor care as simple as that. Most hospitals are heading the Mid Staffs way due to these cuts.”

Another added: “Acute care in the NHS is in crisis. There are examples of poor care in every trust. Changing the culture within nursing is the only way to secure and reverse the deteriorating situation.”

Unison head of nursing Gail Adams said: “Sadly the Nursing Times survey chimes with Unison’s own findings last year. At the time less than 10% of nurses said they could deliver safe, dignified, compassionate care all of the time.

“It is time for the government to listen to staff and reverse its dangerous cuts to nursing staff.”

A spokesman for the NHS Commissioning Board was unable to comment on the survey findings, but highlighted that the importance of locally determined safe staffing levels was included in the new national nursing strategy, Compassion in Practice.

Readers' comments (68)

  • Just seen this as first headline on BBC News this morning. Good timing before the Francis report and Jenni Middleton spoke well on camera.

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  • Susan Markham

    Well done Jenni Middleton and thank you NT for doing something positive at last!

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  • This just about sums up the way nurses feel now. Hopefully the Francis Report will make positive changes, what a shame it had to come to this. Nurses have been saying for a long time that care will be compromised, why wouldn't anyone listen to us.

    I wonder why Cornwall are not listening, if they are replacing RNs with 'senior care assistants' - surely a disaster in the making.

    If we are understaffed and the skillmix is wrong we need more staff but they need to be experienced and have the right skills otherwise they are really just numbers for management to play around with.

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  • My own trust seems to think it is ok to have 2 RN's on duty on a very busy 26 bedded ward. We are so busy, and inevitably things get missed, and then the finger of blame points to the nurses on the ground rather than the managers who bring this about. You can do incident reports until they come out your ears, but they don't get acted upon.

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  • Anonymous | 3-Feb-2013 10:10 am
    "Nurses have been saying for a long time that care will be compromised, why wouldn't anyone listen to us."

    I genuinely believe that it is because we haven't done enough to be heard. There are probably understandable reasons for this. After all,we don't come into nursing to be politicians or 'activists'. We come into nursing expecting to direct all our time and energy looking after our patients. Sadly, the time is long past for that way of thinking. We are now working in what, for many, are intolerable conditions which are at best, uncomfortable, and at worst, downright dangerous. Using the right medium to be heard, is a start. Some of the Nurses who read NT took the time to complete a survey and it is now headline news for a while anyway. We need to build on this. Get onto the unions and professional organisations, our colleagues in other disciplines and get the media involved in putting our message front and centre. Personally, I think we should be on the streets marching and shouting that very loudly.

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  • Anonymous | 3-Feb-2013 10:10 am

    "You can do incident reports until they come out your ears, but they don't get acted upon."

    If you looked at the incident reporting stats for NHS Trusts, the amount of reporting is minimal. Nurses, in the main, simply don't submit them.

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  • nurses DO submit incident forms, this is one thing found in the Francis Report - they submitted them but they were ignored. we put them in daily, never get feedback, never see improvements.

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  • I am a nursing student and find the the state of some of the wards makes me feel nervous about becoming a nurse. They are always overworked and tired. Mistakes will be made. Can the people in authority not realise that they have an obligation to look after staff and patients and not just think of the cost. The death or injury of a loved one is a high price to pay. Maybe they should ask themselves, what if it was their loved ones in that bed. Are the facilities good enough.

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  • Anonymous | 3-Feb-2013 11:22 am
    Anonymous | 3-Feb-2013 10:47 am

    I understand your frustration. But I think that we don't know how to complain effectively. Again, we didn't come into nursing thinking that this would be a part of the job.

    The latest NHS Incident Reporting data published in September 2012 shows the following: The most common types of incidents reported were: patient accidents– slips, trips and falls (26 per cent); medication incidents (11 per cent); incidents relating to treatment and/or procedures (11 per cent).
    68% of incidents resulted in no harm to the patient
    25% resulted in low harm
    6% resulted in moderate harm
    1% resulted in severe harm or death

    The data also shows an increase in no and low reporting organisations, with a total of 101 organisations classed as no or low reporters for the current round of reports. This is compared with 66 organisations in the last report.

    There are important factors as to why incidents are under-reported. e.g.
    Usability of reporting system; Lack of training or refresher training on incident reporting; Fear of consequences; Level of feedback; Lack of anonymity. We all know this to be true and none of these factors should be understimated.

    When it comes to root cause analysis, ask your manager, in writing, to identify the methodologies used by your organistaion to identify:
    What happened?
    Why it happened?
    How it happened?
    RCA usually involves a multidisciplinary group of staff, not all of which were involved in the incident. The group will work through a series of questions and processes to identify the underlying causes of incidents as well as immediate causes. These findings are supposed to lead to the development of solutions or preventative measures. If this is not happening in your trust, then they are not acting in line with good Clinical Governance. You should be receiving feedback as a result of the submission of incident forms. If not, you have every right to challenge this and make that challenge a part of the event. This is not time-consuming. It takes 2 minutes to fire off an email asking for an incident update to your manager, copying in your union, the trust CEO. Get your colleagues to do the same.

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  • michael stone

    Well done NT - this was mentioned in the morning news headlines on both Radio 4 and Radio 5 this morning.

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  • tinkerbell

    Well Done Jenni.

    Hoping some positive, lasting change & good will come out of all this tragedy and those patients who have suffered and ended up as a 'statistic' in the metallic heart bean counters equations will be highlighted as individuals rather than numbers.

    I hope Robert Francis QC gives those responsible a metaphorical damn good thrashing and a bloody nose.

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    Its time nurses started to fight back and ask for support from the management also they NEED and i do believe i will cause trouble here They NEED to go back to Nurse training . stuff this nurse education in Universities .Go back to Nursing school attached to Hospitals. Bring back bedside nursing Have three levels, Nursing Assistant ,SEN,SRN. and if you must have specialist nurses to assist the junior doctors. Pay Nursing Students a living wage not a bursary .How can they be expected to work full time, study and pass exams,whilst trying to live on such a meager income. I believe in progress ,but this certainly is not it.

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  • tinkerbell

    Unison head of nursing Gail Adams said: “Sadly the Nursing Times survey chimes with Unison’s own findings last year. At the time less than 10% of nurses said they could deliver safe, dignified, compassionate care all of the time.

    Unison did a survey too then? What about the RCN? Did the RCN do one who supposedly represent nurses.

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  • My wife puts in, on average one, untoward incident report a month, usually due to poor staffing. She never gets feed back or any action on any of them, despite, at fist, asking for it (she's given up asking now). A couple of months ago a relative made a complaint about her. Guess what, she was contacted within 24 hours to explain herself. Nothing came of the complaint thankfully. I would love to know what the difference is in her complaint and the relatives. She now feels unsupported

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  • Anonymous | 3-Feb-2013 12:11 pm

    Good points about incident reporting. But nurses mustn't think that this is the only action to be taken. | 3-Feb-2013 12:55 pm

    I'm sorry, but I cannot agree with you. The old system produced the subservient doctors hand-maids, whose lack of action over the years has brought us to where we are today. What has happened to nursing didn't happen overnight. There has been a complete lack of nurse leadership, because too many senior nurses trained at a time when nurses were expected to make the doctor's tea and thought that was their place. The result being that nurses have been a meek workforce, easily ignored by successive governments. There is a lot wrong with current nurse education that needs to be sorted, but the solution does not lie in going back in time. Probably, the answer lies somewhere between. We need a better educated, confident and strong profession to advocate for itself and the patient.
    I say this as a nurse who trained in 1980 under the old system, then subsequently gained further qualifications and did my degree. Loved it, but I don't make the mistake of ignoring the shortcomings.

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  • In the far west my service is under review and I have been informed that a nurse is not required. Obviously nurses are not part of the rehabilitation process only physios. I set up this service developed inter professional working reducing and eliminating referrals to other teams, provided quality effective care saved approx 100K this year alone. I

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  • I hope our chief nurse will take note of this. How does it fit in with her simplistic "6 C's". As they nurses in the report said, they cannot give good care whilst being chronically understaffed, they do not feel good about this but cant work miracles. Its time for the chief nurse to leave la la land and speak to nurses in the ward to find out what goes on in the real world. She needs to focus on the causes of poor care and campaign for staffing improvements, not offer simplistic, back of a postage stamp sound bites. What exactly is her role, apart from being a government poodle?

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  • Nursing numbers have been gradually deteriorating now for around 20 years or thereabouts, so it isn't a new phenomenon.

    No true interest has been shown in this fact by any organisation from Government right through to Nurses representative organisations; despite incident reporting, tragic accidents or events reported in the media or political grovelling by hand wringing Government Ministers promising things will be investigated and changes made.

    I'll believe conditions have changed when budgets are directed at where they should be, patient safety, increasing front line staff numbers not managerial posts, bonus payouts, golden handshakes or IT updates.

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  • I've put in loads of incident reports, and rarely get an answer, but at least I do them, and no one can say I didn't raise concerns when the s--t hits the fan as it undoubtedly does.

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  • "Care standards

    Prime Minister David Cameron has acknowledged the government still has a long way to go to raise standards across the NHS.

    Mr Cameron encouraged the idea of nurses checking on patients every hour, as part of a package of nursing measures in January.

    Some 31% of nurses on general wards in the survey said they were not aware of this being introduced where they worked."


    "3 February 2013 Last updated at 09:36 GMT

    Wards dangerously understaffed, say nurses in survey"

    Surely the ideas of what is needed for safe and high quality patient care should be coming from nurses and not from Mr. Cameron. What does he know about the needs of patients and the running of wards and resources required by the staff to carry out their work apart from what he has repeatedly been warned about a dangerously low drop in staffing levels. Cameron and his 'ideas' defy all common sense. Anybody can come foward with an idea but they must be realistic, practical and of benefit to the patients and their safety and to the well being of the staff to enable them to perform their skills with competence, 'Compassion' if you will, and pride.

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