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Nurses say patients at risk under working time rules


The European working time directive is leading to advances in nursing practice but is putting some patients in danger, a Nursing Times survey has revealed.

Restricting junior doctors’ hours to 48 hours a week from 1 August has led to the development of advanced nursing roles, according to 60 per cent of the 548 respondents.

More than half – 56 per cent – said they were more inclined to challenge medical staff as a result of the change.

But half of those surveyed said patients were being put in danger due to the directive, compared with 39 per cent who said they were not.

And 71 per cent said the additional work had left them with less time to carry out basic nursing duties, while 70 per cent said it had led to gaps in medical cover.

Nearly two thirds (64 per cent) said it had led to greater pressure and expectations on nurses to make clinical decisions.

The most common extra responsibility was deciding if and when to call in specialists or transfer patients to higher dependency units or intensive care.

This was followed by venepuncture, cannulation and ordering X rays, scans and blood tests. Other respondents mentioned chronic disease management, wound care and electrocardiograms.

London South Bank University principle lecturer in advanced nursing practice Katrina MacLaine said nurses should practise procedures such as cannulation on pigs’ trotters and simulator before moving onto real patients, under supervision.

She said: “Sometimes the pressure of the need to meet the requirements of the directive have meant that the preparation hasn’t always been in place to make sure they’re competent and confident.”

A third (34 per cent) of nurses said they had not had sufficient training for tasks they were carrying out as a result of the directive. And 41 per cent said they were uncomfortable with the level of responsibility they had taken on.

More than a third (34 per cent) had witnessed more clinical errors since 1 August, the majority (67 per cent) of which were by nurses.

The findings support those of a previous survey carried out by Nursing Times in May ahead of the deadline for the directive’s full implementation (news, p8, 2 June).  

Association of Advanced Nursing Practice Educators chair David Barton said: “The biggest problem is that we have no national standards for advanced nursing practice in the UK. Anybody who’s a nurse can come along and slap a badge on and say ‘I’m an advanced nurse practitioner.”

The Department of Health and devolved governments are still in the process of developing a set of competencies for advanced practitioners.

Overall, only 11 per cent of those taking part in the survey said their organisation had taken action to reduce the pressure on nurses, compared with 73 per cent who said it had not.

One nurse commented: “It takes the most experienced and skilled nurses away from nursing roles and leaves my area short in relation to skill mix.”

Another claimed junior doctors were passing advanced tasks over to nurses who may not have been trained to carry them out.

The nurse said: “I am routinely completing request forms or making clinical decisions about results and feel way out of my depth.”

Royal College of Nursing head of policy Howard Catton said research had shown that advanced nursing roles improve patient outcomes, but nurses needed to be properly trained.

He said: “We’ve had a lot of feedback from people who say that they’re picking up the work [from doctors] and it isn’t properly managed.”

Workforce planners needed to consider the impact on nurses of changes to the medical profession, he said.


Readers' comments (4)

  • "... half of those surveyed said patients were being put in danger due to the directive". The Directive is intended to protect the health and safety of workers. Surely, if anything is putting patients in danger it is under-staffing; the wrong staff mix; a lack of training; or lack of preparedness for the changes. It also takes time for new ways of working to become established - and it's a time when everyone has to pull "above their weight".

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  • Anon (13 Jan 9:57am) writes:
    "The Directive is intended to protect the health and safety of workers. Surely, if anything is putting patients in danger it is under-staffing".

    So right! The directive promotes the safe working of medical staff and so promotes the wellbeing and safety of patients.

    The survey reports that "More than half – 56 per cent [of 548 respondents] – said they were more inclined to challenge medical staff as a result of the change."

    That's sound interprofessional working - another plank to support the wellbeing and safety of patients.


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  • I'm curious about the lack of clarity of what these advanced tasks mentioned in this piece actually are. Do people feel insufficiently trained, supported or lack confidence despite training or are people directly or indirectly pressured to perform tasks they have little or no training in? What has the training been and was it adequate or not to be held against the expert if you end up in court?
    I'm partly interested as I'm not on the wards at the moment and haven't been for a few years but I am training to be an Advanced Practitioner in primary care and I'm finding the training woolly combination of 'facilitated learning' and self directed study which so far has consisted of little or no teaching in a structured way, resulting in a staggering lack of clarity with respect to boundaries of competence and knowledge. We're being told that we will be able to function at the level of the junior doctors (HO/SHO) but without the medical training foundation. In primary care it will be in place of GP's particularly in the out of hours care if things continue the way they are going.
    Any thoughts anyone?

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  • Anonymous | 13-Jan-2010 12:20 pm

    Mate. Nurse training in the U.K. as far as I underwent is a joke - but not the funny kind. I had the fortune to have done a B.Sc in Physiology before doing my nurse training. I'm happy to have Problem Based Learning when it's taught by people who actually know something about the subject they teach. Understanding the core knowledge of a subject enables the subject to be taught rather than soaked up through the the drip drip osmosis of text books. I really wonder why nurses have taken up the government's agenda so willingly in dumbing down medicine when nurse education is so lacking in medicine.

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