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Nursing ‘on the brink’ because of staff shortages, warns RCN report


Basic nursing care like helping people go to the toilet, providing pain relief and preventing pressure ulcers is not getting done, because of staffing shortages, warn nurses.

Nursing staff have also revealed that workforce shortages are having a damaging impact on their own physical and mental health in a new report by the Royal College of Nursing.

“Staff described patients having to wait for treatment and care, including having access to toilet”

RCN report

The Nursing on the Brink report, published to coincide with the start of the RCN’s annual congress, paints a stark picture of the impact staffing shortages are having on both the wellbeing of patients and nurses.

Based on analysis of thousands of comments submitted last year by nurses and healthcare assistants for the RCN’s safe staffing survey, it sets out evidence to back the college’s call for UK-wide safe staffing legislation.

More than 30,000 nursing staff took part in the 2017 survey, with 55% reporting a staffing shortfall on the last shift they worked, increasing to 58% among those working in the NHS.

“We are significantly bottom heavy in terms of skill mix”

RCN member

Almost 18,000 comments – explored in this latest report – were related to the impact of staffing shortages on patients and staff.

Among six key themes that emerged were concerns that basic patient care was not being done due to lack of time.

“Due to lack of time created by workforce shortages, staff described patients having to wait for treatment and care, including having access to toilet and washing, pain relief, and care such as action to prevent bed sores, ulcers and infections,” said the report.

Meanwhile, it added that “the observation of patients and their condition and recording of vital signs is not being carried out to the level required”.

Other key concerns included not having enough time to spend supporting families and carers, with too much time spent on non-nursing duties.

“My concerns for my registration and mental health have been higher than at any other time in my career”

RCN member

Many nurses also expressed concern about skill mix and reported that there were too few registered nurses in proportion to support staff

“We are significantly bottom heavy in terms of skill mix, which means these junior colleagues are getting pushed into progressing before they are ready, which is destroying them as people,” said one RCN member employed in an NHS hospital.

“These nurses then leave and our staffing becomes worse and worse,” the member noted.

Meanwhile, nursing staff consistently reported that their concerns about staffing levels were not acknowledged, listened to or addressed by employers.

“I constantly raise concerns each morning about staffing levels, risks to clients. It falls on deaf ears. The manager does not listen or care,” said one RCN member who works in a care home.

“I fill in regular incident reports for unsafe staffing levels, none of which I’ve ever been spoken to about,” said another, who works in a hospital and said they were planning on leaving nursing.

“Vital medication was missed during this shift as I had too much on my mind, I missed breaks and I went home feeling hungry, tired and like a failure,” they warned, regarding one incident.

“Sometimes my brain is like a messy filing cabinet, which in itself is exhausting”

Senior charge nurse

The comments show staffing shortages put pressure on nurses at all levels, the RCN highlighted.

“Newly-qualified staff often cry during shifts due to stress and fear of compromising patient care,” said one RCN member who works in an NHS hospital.

Senior nurses also feel the strain. “As senior charge nurse, I feel I have to be the strong person for everyone and can go above and beyond the call of duty when staffing is below safety levels to ensure staff on duty are supported and patient care is maintained,” said one survey participant.

“This often means you are firefighting with your other managerial duties. Sometimes my brain is like a messy filing cabinet, which in itself is exhausting,” they said.

In addition, the survey comments showed that nurses said they felt at risk professionally.

“At times, patient care has been compromised and my concerns for my registration and mental health have been higher than at any other time in my career,” said one RCN member who works in a hospital.

Meanwhile, a public poll conducted on behalf of the RCN shows concerns about staffing levels extends beyond the profession into the wider community.

The survey of more than 1,600 adults carried out at the start of May by YouGov found nearly three quarters – 74% – think there are currently not enough nurses to care safely for patients in the NHS.

The main worry linked to this staffing shortfall was that they or their family might not get care when they needed it – a concern voiced by 27% of those who took part.

The second biggest concern – highlighted by 17% of respondents – was that the care they received might not be safe.

The report comes ahead of a new RCN campaign to push for safe staffing levels to be enshrined in law in England and Northern Ireland, an issue it has been pursuing for a while.

In 2016, Wales became the first UK nation – and the first country in Europe – to introduce safe staffing laws, placing a legal duty on health boards to employ enough nurses.

Scotland is expected to unveil draft safe staffing legislation in coming months, but there do not appear to be any plans to follow suit in England or Northern Ireland.

The RCN report sets out five principles for safe staffing, including the need for clear lines of accountability for ensuring there are enough nurses, a clear workforce strategy at national, regional and local level and robust commissioning arrangements for pre- and post-registration training.

“Financial resources and expenditure must be in place to fully fund and support the delivery of workforce plans and the provision of nurse staffing for safe and effective care,” said the document.

“The reason we have so many vacancies is because of short-sighted cost-cutting in past years”

Janet Davies

In her keynote speech at congress today, RCN chief executive and general secretary Janet Davies will tell the 4,000 or so nursing staff attending the conference in Belfast, that the current high level of vacancies could have been avoided.

“The reason we have so many vacancies is because of short-sighted cost-cutting in past years, and ineffective workforce planning driven by finance and not the needs of patients. We warned this would happen, but were called scaremongers,” she will say.

She will add: “This is a failure of politicians and policymakers – with an inability to recognise the value of nursing, an unwillingness to listen to those of you who are working in the service, and a lack of political will to address it.”

Royal College of Nursing

RCN Congress 2017

Janet Davies

The RCN campaign, which will be launched in the autumn, will demand that safe staffing levels and accountability be set in law for every part of the UK.

“The current shortages are not only dangerous but a vicious circle too,” Ms Davies will say.

“Poor staffing levels are the number one reason for working-age nurses leaving the NMC register. Good nurses do not want to do a bad job. We must stop this,” she will say.


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Readers' comments (6)

  • Stop the corrupt IELTS as so many are failing and it’s stopping good nurses coming to the UK. Wake-up NMC get rid of this corrupt system.
    Bring the IELTS into our Hospitals not giving it to money making colleges. That also includes the OSCE stop feeding colleges and Universities with NHS money.

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  • I saw this all coming in the 1980s with nursing process overthinking basic skills and P2K. This is no surprise to me or many of my nursing generation. Trying to fix a really good training system and putting it in the hands of academics and universities, pushing a degree for a hands on service was a huge mistake. I see a place for a degree but as a post registration requirement once the basics are established. Teach that nurse to crawl, help her to walk towards a degree. You would have a home grown well trained motivated work force. If that degree had to be paid for, that nurse would be working and could afford it! It’s not rocket science!
    Throughout my certificate career I learned enough to make the Diploma a doddle. I never felt the need to chase a degree. Sadly my advanced hands on skills equal to those gained by degree nurses were looked down on. Many of my colleagues felt we had been redesignated as ENs as only wee rolled up our sleeves when the going got tough

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  • Review the IELTS as it is only a money spinner for colleges as I know many people that speak write read English 100% and they are failing this Corrupt IELTS

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  • Shut down all hospitals in UK. Make them private.

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  • Nursing has gone over the brink and is hanging on by its fingernails.

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  • IELTS requirement is good. Especially now, you can bring even two certificates to proof the combined, required 7.0 If you cannot achieve even that, you shouldn't work with the patients.

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