More than nine in 10 of the 50 largest NHS hospital trusts in England are not staffed with nurses to the level planned by their own management, according to the Royal College of Nursing.
Despite their best efforts to fill shifts with bank and agency staff, acute trusts were still falling short of filling their nursing rotas, warned the college, following analysis of data published on the NHS Choices website.
“Patients stand a better chance of survival and recovery when there are more of them on the ward”
It found 91% of the 50 largest trusts in England failed to have the number of registered nurses they had planned to have on wards, during the day, on 150 individual hospital sites.
Since 2014, all hospitals in England have released information on their nurse staffing levels to NHS Choices. The college said its analysis of the current data on the NHS Choices website confirmed that acute trusts were putting more unregistered support staff on shift to cope with the shortage of registered nurses.
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More than half of the largest hospitals (55%) brought more unregistered support staff onto the shifts, according to the RCN’s analysis.
The over-reliance on support staff was worse at night, it said, with 67% of hospital trusts increasing numbers on night shifts compared to what they planned due to the registered nurse shortage.
The practice of substitution raised questions about safety, noted the RCN. Research has shown that mortality rates rise significantly when the ratio of registered nurses to healthcare assistants is lowest.
A study, in the journal BMJ Open, found that where registered nurses had six or fewer patients to care for, the death rate on medical wards was 20% lower than where they had more than 10.
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Hospitals with more unregistered nursing support workers may have had higher death rates, noted the RCN.
The RCN said its analysis of the data supported recent research highlighting that there were 40,000 nurse vacancies across the NHS in England.
Janet Davies, chief executive and general secretary of the RCN, described the figures as “startling” and said they showed “our largest hospitals still do not have enough nurses”.
“They are resorting to filling wards with unregistered healthcare assistants, especially at night, just to cope with the shortage,” she warned.
“Nurses have degrees and expert training and, to be blunt, the evidence shows patients stand a better chance of survival and recovery when there are more of them on the ward,” she said.
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“It is unfair on the healthcare assistant too – they should not be left in a situation they have not been trained to handle,” she said the RCN leader.
She called on the government to “redouble its efforts” to train and recruit more nurses and “stop haemorrhaging” experienced ones, who she said were “fed up, undervalued and burning out fast”.
She added that ministers were still failing to reassure overseas nurses from the European Union of their right to remain, warning that the NHS “would go under if they drifted away”.
“All nursing staff, regardless of where they trained, should go to work confident that there will be enough trained nurses to give safe care and feel valued with fair pay for their work,” said Ms Davies.