The health service continues to suffer from “chronic understaffing”, according to a snapshot survey of nurses across the UK, with the union behind it claiming patients’ lives are being put at risk.
Almost two-thirds (63%) of nurses who responded to the survey said that wards were so understaffed that nurses could not ensure safe, dignified and compassionate care.
“Too few staff are still looking after too many patients”
Unison’s latest annual survey of nurses, indicates that the NHS staffing situation has not improved over the last 12 months.
Similarly, in last year’s survey, 63% of respondents also felt the numbers of staff on the wards were not adequate enough to ensure safe, dignified and compassionate care.
Patient-to-nurse ratios were worst on wards for the acutely ill or injured, said Unison, based on its latest survey.
It suggested 41% of nurses were caring for eight or more people, the point at which patient safety is at risk according to official guidance.
Guidance for acute wards from the National Institute for Health and Care Excellence said one nurse to more than eight patients was a “red flag” for increased risk of harm to patients during day shifts
The Unison findings are based on responses from 2,704 nursing staff who completed an online questionnaire about their shift on the Tuesday 7 February 2017.
It revealed that nurses cared for an average of 13 patients but the nurse-to-patient ratio differed significantly between departments, with six the average for acute wards and 62 for community nurses.
“It’s time the government showed it cared by introducing minimum nurse to patient ratios”
In addition, 60% of respondents said slips, trips or falls happened on their shift, 49% said pressure ulcers occurred, and 44% said errors were made in administering medication.
Missed care was another safe staffing concern identified in the survey. Over two-thirds (69%) of respondents said developing or updating care plans was more likely to be rushed, unfinished, not done to an acceptable standard – or even missed entirely.
Responses were similar for educating patients and family (66%), and comforting or talking to patients (63%).
Meanwhile, 58% had raised concerns about unsafe staffing levels during their shift. But a significant number of these (65%) said their worries had not been listened to, acted upon swiftly, or addressed.
The findings from the sixth annual Unison survey into safe staffing are contained in a report – titled Ratios Not Rationing – and published to mark the start of its health conference in Liverpool.
The report indicated a shortage of nurses was affecting care, with 63% saying they were so busy they either had no time at all or were rushed when trying to comfort or talk to patients and relatives.
Half had to work through their breaks to make up for the lack of colleagues, and 41% worked more than their contracted hours.
This situation was leading to exhaustion and burnout, with 54% of respondents saying they would leave their current job if they could. One in 10 said they wanted to leave nursing altogether.
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The union repeated its long-running call for “acceptable nurse-to-patient ratios” to be set. It said ratios would improve recruitment and encourage nurses to stay in the NHS, and also help to make nursing more attractive to future students.
Unison head of health Christina McAnea said: “Too few staff are still looking after too many patients, especially on wards where people are seriously ill. This is putting lives at risk.
“Nurses aren’t getting enough time to care properly because they’re so overstretched,” she said. “The result is patients are ending up with pressure sores and suffering falls.
“It’s yet another worrying example of the pressures facing the NHS. Safe staffing should be a priority issue in the coming general election campaign,” she said.
She added: “It’s time the government showed it cared by introducing minimum nurse to patient ratios. Then nurses wouldn’t have to ration their time, and patients would get the care they deserve.”
However, minimum ratios are at odds with the approach favoured by senior nurses at government arm’s length bodies, who prefer the use of workforce tools.
NICE’s work on safe nurse staffing across a range of settings was controversially suspended in 2015 by NHS England and the Department of Health, after it had published only two sets of guidance – for adult wards and midwifery.
It was on the brink of publishing documents recommending minimum nurse ratios in accident and emergency departments.
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A new programme of safe staffing guidance is currently being developed by NHS Improvement that will eventually supersede the work done by NICE.
Draft versions of its new guidance for adult general wards have said the 1:8 ratio can still be used but more heavily promote the adoption of evidence-based tools to calculate staffing.
Meanwhile, another draft document on community staffing did not recommend ratios of district nurses to patients, citing a lack of evidence.
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Previous Unison annual survey results, as reported by Nursing Times
- 2016 – Halting of NICE staffing guidance sparks safety fears for nurses
- 2015 – ‘No improvement over safe staffing’, indicates nurse survey
- 2014 – Half of nurses fear another Mid Staffs, finds snapshot survey
- 2013 – Minimum nurse-patient ratios urged by Unison
- 2012 – Survey: low staff levels threaten care