Nursing staff burnout due to heavy workloads and inadequate skills mix is affecting patient care and safety at a hospital trust in Herefordshire, board papers have revealed.
Particular concerns have been identified about staffing levels and skills mix on an acute admissions and gastroenterology ward where band 4 staff were being used to fill in for registered nurses, show the papers from a management meeting held earlier this month.
“The ward has had recent incident reports submitted for suboptimal care for patients regarding fluid management and medication administration,” said the board report on Wye Valley NHS Trust.
“Staff morale is affected due to lack of skill mix and additional workload, resulting now in staff “burnout”, which is affecting patient safety and care,” it stated.
The recommended nurse staffing ratios for acute admissions units is 1:6. However, the report shows registered nurses have been dealing with ratios more like 1:14, because band 4 staff are unable to do certain tasks, including administering medicine and fluid management.
“Staff morale is affected due to lack of skill mix and additional workload”
The report also revealed that pressures on Frome ward have been exacerbated by nursing staff vacancies, but showed that, even if all posts were filled, “the risk would still remain” due to lack of funding for qualified nurses.
“There is an insufficient band 5 budget (excluding vacancies) to allocate sufficient band 5 nurses to each shift,” said the report, which showed the staffing fill rate was consistently less than 70% for registered nurses even when bank or agency nurses and band 4s were used to plug rota gaps.
In addition, the report showed the situation had prompted some staff to leave the ward, while others were concerned about meeting professional requirements.
“Recent exit interviews with staff evidence that staff are leaving the ward due to skill mix,” noted the board document.
“Medication incident reflective accounts state that staff have an increasing concern for individuals to be able to meet their Nursing and Midwifery Council requirements within the existing skill mix,” it said, adding that some had sought professional advice from the Royal College of Nursing.
“Nursing appointments since October 2016 have predominantly been newly qualified nurses who do not have extended competencies for IV [intravenous] therapies,” continued the report. “This is the same for the high proportion of agency nurses allocated to the ward.”
“The safety of patients is the Trust’s priority”
There are regularly more than 20 acutely ill patients on the ward, who need increased input from registered nurses, it said.
The papers show the trust is struggling generally with increased spending on agency nurses and is trying to bring both the nursing vacancy rate and turnover down.
Efforts have included a review of the process for managing staffing day to day and the introduction of new shift patterns from January next year.
“This new way of working will aid the effective deployment of nursing staff and support a reduction in agency spending whilst also supporting recruitment and retention initiatives,” said the papers.
They stated that a recruitment campaign focused on nurse vacancies at community hospitals has already taken place.
Meanwhile, the report shows human resources, education and nursing teams have come up with a detailed plan, with support from NHS Improvement, designed to reduce the turnover rate among registered nurses to 10%.
The trust was placed in “special measures” in 2014 following a negative inspection report by the Care Quality Commission.
However, it was deemed to have improved sufficiently enough to leave the support scheme for struggling providers this time last year.
- Wye Valley Trust placed in special measures after poor inspection
- Wye Valley to remain in ‘special measures’ after 15 months
- Herefordshire hospital trust leaves ‘special measures’
Lucy Flanagan, the trust’s director of nursing, said in a statement for Nursing Times that the safety of patients was the organisation’s “priority”. “We provide patient-centred services and pride ourselves on the high quality care delivered by our professional and compassionate staff,” she said.
“Frome Ward is a 35-bedded unit with 20 acute admission beds and 15 gastroenterology/general medical beds,” she said. “The ward had an agreed staffing level of five registered nurses per shift – 24 hours a day for 35 patients – a ratio of 1:7. Following a risk assessment, an additional registered nurse per shift was added bringing the ratio to 1:6.
Report reveals safety concerns on ward hit by nurse ‘burnout’
“Further to this, we have also addressed the way the team on the ward organises its nurses and allocates work to ensure our patients receive the best care possible,” she said. “Importantly, the establishment review undertaken earlier this year did not identify an establishment shortfall.
“Since August this year, the fill rate for registered nurses has consistently been above 100% – returns prior to that time showed low fill rates due to data collection errors,” noted Ms Flanagan.
She added: “As a mark of the commitment the trust has to ensure safe staffing ratios, it is among the first wave of trusts being supported by NHS Improvement focusing on recruitment and retention. In addition, the trust has recently introduced a new master vend arrangement for agency provision, introduced new shift patterns and has in place a revised flexible working policy.”
Research published earlier this week observed that burnout among nursing staff significantly affected job performance, as reported by Nursing Times.