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Research reveals workforce pressures facing respiratory nurses

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Many respiratory nursing teams across the NHS are short-staffed with around half of nurses reporting they are unable to spend as much time with patients as needed, according to a new study.

The research, by the British Thoracic Society, found the vast majority of respiratory nurses – 91% – worked additional unpaid hours every week, with some working more than 12 extra hours.

“The workload is increasing dramatically but we do not have enough respiratory specialist nurses in place”

Respiratory nurse

Meanwhile, more than half of the current respiratory nurse workforce were planning, or were eligible, to retire within the next decade with urgent action needed to ensure teams could meet future demand, warned the study authors.

The findings, published in BMJ Open Respiratory Research, are based on responses to two surveys – one for individual respiratory nurses and the other for NHS employers.

The survey of more than 450 nurses, based in hospital and community settings, found only around half – 53.6% – felt they were able to spend as much time with patients as needed.

More than a quarter – 25.3% – disagreed or strongly disagreed they had enough patient contact.

The main areas of care respiratory nurses did not feel they were able to provide due to lack of time were patient education and support for enhanced self-management.

“I worry that my role as mainly preventative upstream work will be lost to the firefighting seen in hospital consequently denying my patients the opportunity to embrace and develop their self-management skills,” said one nurse. “This will increase the workload in secondary care. Again that quality care will be lost.”

“One clear task is to invest in administrative support to alleviate some of the strain on nursing teams”

Janelle Yorke

When asked if they had the necessary resources and clinical support to deliver high quality care, 36% of nurses said they did but 32% reported a lack of resources getting in the way of quality care.

Both the survey of nurses and survey of NHS organisations also revealed a lack of administrative support.

Of more than 140 organisations who took part, around a quarter said their respiratory nursing team had administrative support but about a quarter said they did not.

Of the 40 or so organisations who identified exactly who was responsible for admin duties, 72 said they were done by the nursing team, 14% said respiratory nurse specialists were responsible, while 14% said medical secretaries helped.

One organisation reported that their service was “currently a single-handed respiratory nursing service, with no admin support, holiday, unplanned absence cover”.

The research also found respiratory nursing teams typically delivered a wide range of services, with the majority of teams providing combined outpatient and inpatient care.

More than half of services also reported providing support to patients at home, including support with oxygen therapy, early discharge or work to avoid hospital admissions.

“I worry that my role as mainly preventative upstream work will be lost to the firefighting”

Respiratory nurse

On average, respiratory nurse specialists cared for patients across three different conditions, most commonly chronic obstructive pulmonary disease, asthma and bronchiectasis.

However, respiratory nurses said they were often expected to cover services and attend to patient care not directly linked to their role.

“Some respiratory nurses commented that their services were overstretched; there was the perception that staff are overworked due to an unrealistic expectation that the respiratory nursing team had the capacity to cover everything, including patient care on hospital wards,” said the paper.

In all, 91% of nurses who took part in the survey reported working extra hours above what they were contracted to do.

Nearly three quarters – 72% – said they worked up to six hours unpaid each week, while 18% reported working up to 12 hours unpaid and 5% said they worked more than 12 extra unpaid hours.

“I have been fully supported over the years,” said one nurse. “However, the workload is increasing dramatically but we do not have enough respiratory specialist nurses in place to cope with the demand. The hospital seems to be reluctant to approve any nurse specialist posts due to financial pressures.”

“It suggests that a large proportion of this sample would remain a nurse until retirement”

Study paper

In addition, the research highlighted a “pressing need for succession planning to ensure a viable respiratory nurse workforce in the future”, with more than half the survey sample planning to retire or eligible to retire by 2026.

“This is particularly important as the prevalence of chronic respiratory conditions is only set to increase as a result of our ageing population; the financial and staff strain of which will be endured primarily by the NHS,” stated the paper.

However, when retirement was taken out of the equation, the survey found few nurses planned to leave the profession within the next five years.

“This is a promising finding, as it suggests that a large proportion of this sample would remain a nurse until retirement,” noted the paper.

“The finding that most respiratory nurses are usually employed in a band 7 position suggests that a respiratory nurse position offers good career opportunities,” it said. “However, further investment in leadership roles at band 8 above is needed to support and encourage career progression.”

University of Manchester and The Christie NHS Foundation Trust/British Thoracic Society

Research reveals workforce pressures facing respiratory nurses

Janelle Yorke

Professor Janelle Yorke, chair of the British Thoracic Society’s nurse advisory group and a leader in the field of respiratory research, said the study showed that respiratory teams needed more support.

“Our survey study highlights how we must ensure that nurses in the specialty are given sufficient time and resource to provide the best care for patients,” she said.

“One clear task is to invest in administrative support to alleviate some of the strain on nursing teams, freeing up more time for patient contact,” she said. “This would enable a more efficient and cost-effective use of specialist nursing skills.”

She warned that there was also a need to “future-proof” the profession by recruiting and retaining enough nurses.

“The role of respiratory nurses will only become more important in the future as the number of people with longer-term lung conditions increases,” she said.

“We hope the results of this study will help inform future NHS commissioning in providing targeted support within the sector – to safeguard patient care,” she added.

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