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Stroke care study backs more nursing staff

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A “very powerful message” about the link between nurse staffing levels and high quality stroke care has been highlighted in figures shared exclusively with Nursing Times.

A Royal College of Physicians analysis carried out for Nursing Times revealed that nurse to bed ratios in trusts providing the highest standards of stroke care were almost twice those of trusts whose care had been assessed as having the lowest standards.

This is a very powerful message that if you fiddle with the numbers of staff, quality is very likely to go down

Trusts meeting fewer than three out of seven stroke quality standards had on average 5.5 whole time equivalent qualified nurses for every 10 beds, compared with 10.2 among those meeting all the standards.

The figures, based on an audit of every acute trust in England, come to light as unions warn that thousands of nurses’ jobs are at risk from cuts, particularly those in specialist roles.

RCP stroke programme director Tony Rudd said: “This is a very powerful message that if you fiddle with the numbers of staff, quality is very likely to go down.”

The correlation between higher nurse staffing levels and better care was “striking”, he said, although he added there were likely to be other factors affecting units’ performance as well.

The unpublished statistics were extracted from last year’s RCP national sentinel audit, which found there were seven nurses per 10 beds on average.

The National Stroke Nursing Forum has called for trusts to employ at least 12.5 whole time equivalent nurses for every 10 beds.

Some parts of the country, such as London, have introduced region-wide staff to bed ratio standards for stroke units. However, Professor Rudd warned that such initiatives were at risk, as the coalition government “hasn’t got an appetite” for centralised decision making.

Guy’s and St Thomas’ Foundation Trust stroke specialist nurse Gill Cluckie said having more nurses allowed staff to manage problems such as dehydration and constipation properly, which helped reduce rates of infection and mortality.

She said: “The work’s quite time intensive. If we’re trying to avoid catheterisation, you need enough staff to ensure patients are appropriately managed.

“That takes a lot more nurses than if you have patients who are catheterised.”

She also recommended that Agenda for Change band 7 should be the minimum level of seniority for nurse leaders on stroke units, because of the level of experience and skills required.

However, in the RCP audit, 21 hospital stroke units had no senior nurses above band 7, and only a few had nurses above the lowest tier of band 8.

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Readers' comments (2)

  • This is hardly shocking news. How many more of these studies are needed before the idiots in charge realise that MORE NURSES EQUALS BETTER CLINICAL CARE!!!!! Job freezes and threatened redundancies are not the way forward, and with this research and a whole backlog of research like it we have a powerful tool in any fight against them! We should be using them!

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  • Quality stroke training is needed too. It can be hard to faciltate than to do for, and managers find it hard to adopt that notion. There is a national need, backed by research, for direct admissions to stroke units (SU). So much 'damage' is done for these patients if direct admissions to SUs does not happen. Short term measures of putting a catheter, for instance, to save on nursing working time is so detrimental to long term recovery. Please think about your nursing practices with this group of patients, the long term outcomes depend on the care they receive in the short term...and it could happen to your patients and family.

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