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Alarm as nurse specialists used to plug gaps on general wards


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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Readers' comments (37)

  • Hello RCN?

    No reply......

    I suspect more and more nurses will leave the profession and look for less stressfull work. Nursing really is a poor career choice for any person nowadays.

    Students if you read this think long and hard about nursing. . . .you can do a lot better believe me.

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  • When the specialist nurses come to my ward they cannot cope. They work with the healthcare assistants and leave the RN doing all drugs, care planning, ward rounding, assessments and dealing with the emergiences for the entire ward. "I am too out of practice" they say.

    When they do have to take over as the lead RN for a group of patients all hell breaks lose. Before they take this on they moan and complain about the ward nurses. Once they walk a few miles in the ward nurse's shoes they see the light and never come back. The specialist nurses cry and sob about how "impossible" it is to be the RN on a ward these days. You come on duty after one of these people and the place is a mess and the specialist nurse is sitting at the station sobbing.

    Funny that, as these specialists actually trained in the "good old days".

    But education of nurses isn't the problem on the wards. Poor RN staffing is the problem.

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  • John Howes

    Forgive the tongue in cheek.. I am 65 years old.. I work in a 23 bed ICU. We have experienced our nurses being used on the general wards when many have not worked outside ICU in 15+ years. None raises an eyebrow. Touch the Specialist nurse and the world is dismayed. This is yet another indicator of the new breed of management who play the numbers game. Ask senior managers when they last used patient deopendency profiles to plan their staffing. Most of the new ones will never have heard of it, preferring to use the 'benchmarks' provided by the majopr accountancy firms. Nursing is measured in large parts by lipservice, at least it's General Election time with all those heady promises of power to the nurse, after 47 years in nursing I've heard it so many times, it's always been jam tomorrow. But for all that it's still the best job in the world.

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  • To the comment above, it sounds like your CNS's end up sobbing at the desk due to your lack of support. As a CNS myself i do find it a concern we are having to work on the wards as it does mean services suffer. But in the current financial climate it is better than redundancies. I qualified 8 years ago and do not fit into your branded 'trained in the old days' group. Maybe if you tried to support the CNS's covering ward shifts they would pick up the routine and not make 'the place a mess'. As nurses we should be working together to provide a high standard of care not wasting time bad mouthing each other.

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  • A Clinical specialist, like any other nurse, should be able to deal with any task involving mainstream nursing. A Lot of clinical specialists and academics here in Australia spend a few days per month as study leave maintaining clinical skills. Wake Up over there. Less moaning and more doing!!

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  • Almost on a weekly basis nurses from the ward are asked to go and work in other areas where they do not have experience and despite of their objection they are warned that if they refuse action will be taken against them. Sometimes non-ITU/HDU trained nurses are moved to ITU/HDU or they are even booked by the "Hospital Bank" to work in areas where they are not specialized in to save paying extra specialist rate or sometimes because bank staff choose not to work in particular ward because it is always short of staff, busy and stressful and if something goes wrong; the bank nurse will be blamed and be accountable for her actions....

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  • I think you have a good system in Australia Carol. Nurses of all specialties and levels, should maintain basic clinical skills, and your system facilitates that. However, I also think you have misunderstood the issue here. It is not about the action, it is the motive. The Clinical Specialists here have not been deployed to the wards in order to brush up their basic clinical skills. It would be commendable if it were so. The Trusts just do not want to employ more nurses.

    However, as a proactive strategy, maybe the Trusts should adopt Carol's system. This serves a lot of purposes. Firtstly, it keeps the CNS up to date on basic clinical skills. Secondly, the CNS feel less 'used' when deployed to the wards, as it is a practice requirement. On a sarcastic note, the Trusts might even save money for pet projects like inpractical and hideous uniforms, and a few more medical directors.

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  • As a CNS from one of the Trusts named in this article I felt I had to respond. I am more than happy to keep my clinical skills up to date, however, being told you are doing this and there is no discussion worries me. Many CNS have been out of a clinical ward setting for a significant period of time and basically will end up as a very expensive HCA. All staff have the right under the NMC coed of conduct to refuse to carry out anything which they do not feel capabel of and I suspect many CNS will do this.
    As stated above it is not the fact that about going onto a ward that is worry but the way it has been handled and lack of skills updating we will be getting before going back onto a ward. It seems false economy to me paying Band 6/7 wages when many will be completing a Band 3/4 Role.

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  • Although I totally agree with the above, I think everybody is missing the point of who does our job when we are on the wards? I realise that the vast majority of management (although they all employed us!) do not understand our role and think we sit in an office doing very little but those people need to speak to our patients who truly understand our role as they are at the receiving end. Who is picking up their problems when we are on the wards? No one I think!!

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  • Clinical Nurse Specialists should not be grumbling when re-deployed to the wards. I am an RGN/RMN who has arrived (often for the first time) at hospitals, nursing homes, various departments and clinics and been told "you are in charge" and I have had to be confident and deliver a quality service. It is unprofessional when asked to do just 1 shift a month on the ward then start making patients and colleagues suffer by refusing to carry out drug rounds, admissions or basic RGN duties. It is not that you can't do it, you just want to moan and have disgusting self-pity. Most CNS are educated to degree or Master's level and have years of experience on the ward. Those who refuse to comply should be reported and disciplined. After all they are being paid nearly twice as much as ward nurses.

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