Clinical nurse specialists are being sent back to the wards to perform duties outside of their specialist remit and expertise
An investigation by Nursing Times has found hospital trusts across the country are requiring their clinical nurse specialists to undertake general ward duties, away from their specialist work.
[The trust] has decimated the wards and reduced the staffing budget year on year. Trained staff are being replaced with healthcare assistants and clinical nurse specialists are being used instead of bank nurses
The move has sparked alarm among the nurses who work with patients with long term conditions such as diabetes and cancer. They fear for patient safety as they could be called on to perform duties such as using intravenous lines which they have not done for a number of years.
Clinical nurse specialists suspect trusts are making the change in a bid to save on expensive agency staff.
A spokeswoman for University Hospitals Leicester Trust said its clinical nurse specialists had been asked to work on the wards for “a minimum of three to five hours a month, subject to the needs of the service”.
A source at the trust said the requirement was translating into one day a week because of understaffing on wards. The trust’s spokeswoman conceded that could be the case.
The change was first implemented late last year due to “winter pressures” but by the end of April it had become routine.
The source said: “[The trust] has decimated the wards and reduced the staffing budget year on year. Trained staff are being replaced with healthcare assistants and clinical nurse specialists are being used instead of bank nurses to supplement poor staffing.”
Clinical nurse specialists at County Durham and Darlington Foundation Trust have also been asked to do at least two shifts a month on the wards, following a year long review of their role. Nursing Times has been told similar changes are under discussion at Newcastle upon Tyne Hospitals Foundation Trust.
At Gloucestershire Hospitals Foundation Trust clinical nurse specialists have been told to work one planned shift on the wards a month for the last year. Nursing Times understands that is also the case at University Hospitals Bristol.
Unison head of health for the South West region Tanya Palmer said clinical nurse specialists had been sent back to the wards across the region.
“Foisting specialists into ward settings to do one shift a week is something that is happening more and more. Trusts will use whatever available resource they can find [to save costs] and if that means using a specialist nurse as a healthcare assistant they will do it.”
A snapshot survey of lung cancer nurse specialists carried out by the Lung Cancer Nurses Forum last week and shared exclusively with Nursing Times found that of the 50 respondents, almost half had been asked to undertake ward shifts.
One respondent said: “The expectation is to cover a shift that would otherwise be covered by a bank nurse, therefore saving funds. My anxiety is that I don’t feel skilled enough to work on the ward and feel I am a liability.”
Another said: “It wasn’t really successful as many [specialist] nurses needed additional training in order to be able to work on the wards. In the end we were used as very expensive healthcare assistants.”
John White, forum chair and Macmillan lung cancer nurse specialist at Leeds Teaching Hospitals Trust, said the proportion of skilled nurse specialists being asked to undertake general ward duties was “quite staggering”.
He said the potential impact on patient care was “very worrying”.
“Clinical nurse specialists prevent a lot of hospital admissions. If they have to go and work on the wards, the quality of care their patients receive would decrease, acute admissions would probably rise and [patient] length of stay would increase.”
Alison Leary, visiting lecturer at King’s College London and former lead nurse for lung cancer at Imperial College Healthcare Trust, said the move was a “false economy”.
“There is an implicit agenda here and the sense that I get is that it is all economic,” she said. “It is not around management of crisis at all because it is so common.”
But County Durham and Darlington Foundation Trust director of nursing Laura Robson said spending two days a month on the ward would help clinical nurse specialists “maintain their frontline skills”.
“This also means that the trust will have additional capacity to call upon in the event of surges in activity or a major incident,” she said.
A Gloucestershire Hospitals Foundation Trust spokeswoman said ward shifts enable specialist nurses to “keep up competencies and clinical practice” and provide an opportunity for them to “share their expert knowledge and skills” with ward based clinical staff.
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