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RCN survey highlights 'moral distress' of nurses


Nurses are being left in ‘moral distress’ because they are too short-staffed to treat patients properly, the RCN has claimed following a major survey.

Nearly half of the 4,845 nurses responding to the RCN’s biennial employment survey said patient care was compromised once or twice every week by short staffing. Of those, one in four said this was true on most or every shift.

RCN head of employment relations Josie Irwin said: “It’s about not having [time to have] that conversation with a patient who’s having an operation the next day. Or district nurses not having a conversation with an elderly person about their foot care or the management of a long term condition.

“If they’re not able to do that, it becomes a type of moral distress, there’s a sense of dereliction [of duties],” she said.

While the average number of nursing staff on wards has changed little since 2007, skill mix changes mean only 60 per cent of nursing staff on duty during the day are registered nurses, compared with 66 per cent two years ago.

Additionally the average number of patients per nurse has risen from 6.9 to 7.9 in the day and 9.1 to 10.6 at night. Paediatric nurses look after an average of 4.6 patients, compared with nurses on elderly care wards who are responsible for 11.3 patients.

Ms Irwin said some trusts were involving nurses in decisions about skill mix, but others were using it as an excuse to save money. The latter were likely to have higher rates of problems such as bullying, she said.

The RCN has published a manifesto to coincide with the survey, setting out the priorities it would like politicians to focus on ahead of the next election.


RCN manifesto priorities
Standing up for staff who speak out
Safer staffing levels
Give nurses the time to train
Protect the nation’s health
Improve care for those with long-term conditions
Sustain healthcare investment

Heavy workloads

The survey also found that, because 200,000 expected to retire in the next ten years with fewer entering the profession, the number of trained nurses available in the UK may fall.

RCN general secretary Dr Peter Carter is calling for a pledge from all political parties that they would guarantee safe staffing levels for all nursing shifts. He said: “Policymakers must look at the workforce in conjunction with its ability to deliver high-quality and safe care. As we’ve seen too often, where there are not enough nurses, patient care suffers.”

A Department of Health spokesman said: “The local NHS must ensure it has the appropriate number of staff to deliver services for patients. It is important that it helps staff to use innovation and new technology to drive up the quality of care and deliver value for money.”


Readers' comments (4)

  • On a ward recently and needed to discuss a patient but could see that the staff were run off their feet. The nurse in charge apologised and explained that they had held a ward meeting with one of the modern matrons to discuss their concerns re. staff numbers. The response from the matron was for her to point at the door and comment that if the staff didn't like it they knew what they could do. I spoke to the staff eventually and suggested that as a body of nurses perhaps they could use the Code of Conduct to influence the management or perhaps a plethora of incident forms when the ward was unsafe might highlight the problem. Unfortunately, they didn't feel they had the strength or the energy to fight and informed me that incident forms had been filled in and never seen or commented on again.
    Worryingly, a few of the newer staff didn't know what the Code of Conduct was or what it referred to. Time was when every ward/workplace had a large laminated copy of the Conduct on the wall for all to see and abide by. Funny you don't see it anymore?
    I get the feeling that no matter how loud we shout, how many whistles we blow, how many forms we fill in, there is nobody listening. As the saying goes, 'there's none so deaf as them that won't hear'.

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  • I left my first nursing job because i couldn't give the patients the care i thought they deserved.

    I was a newly qualified nurse on a hectic medical admissions unit. The final straw was leaving a heavily soiled patient for over an hour because of a crash to attend to as well as assisting a dr with a lumbar puncture. . . no HCA to assist and also covering for another nurse off sick as well as a patient who had just been told she had an inoperable brain tumor. I left that shift in tears. It wasn't was something else and it wasn't for me.

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  • I've said it before and I'll say it again, the only way to make the government and the 'deaf', bullying, or just plain incompetent managers to listen is for ALL of us to act as a cohesive whole and STRIKE!!!!

    Strikes do work. It is an extreme last resort yes, but it is sorely needed and long past the time when we should have done it already. Indeed most other professions have gone on strike for a lot less.

    Yes we will be striking for better pay and more staffing levels to make it better for ourselves, but for those emotional blackmailers who want to stop us, ultimately this will lead to better conditions for our PATIENTS! To ensure that conditions like the one above never happen again.

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  • I whole heartedly agree with above comments. I work on a chronic long term medical conditions ward and swear its a fluck we get to the end of my shifts and nothing major occured with serious consequences. There are time when you feel the working environment feels dangerous and when you speak out your told nothing can be done about it complete an incident form. So we do (with great difficulty physicallyfinding time to sit at a computer and complete a long drawn out form to submit) only for the same circumstances to continue to arise. Quote the code of conduct at any of our managers and your viewed as obstructive and being difficult so in the end you do loose the energy and inclination to fight. Patients often say to me your short staffed again today arnt you your so busy and I find myself answering No actually we're all here today, this is the quota of staff managers dictate is adequate to cover the ward. On a day shift I have 12 patients and nite 15 - 17 with a HCA. How anybody can conclude that ratio is remotely sufficient to deliver all patient care needs, along with a significant degree of dependacy numbers, is beyond me. The manifesto priorities are just that PRIORITIES and should be viewed as crucial issue needing urgent attention and actioning. Why is it the top and middle of the ladder dont seem to register that when the very basics at the bottom of the ladder are dealt with properly the way they should be they wouldnt have half the clinical problems like infection control issues, patient complaints nutritional issues, extended stays due to hospital aquired infection/tissue viability issues just to name a few! all it needs is adequate number of nurses to enable us to be nurses and do the job we want to with sence of achievement and making that difference and most of all with compassion somthing theres little room for in the present culture. The manifesto needs to be screamed from the roof tops with a megaphone persistantly so someone has to listern!!!!

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