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Risk remains from chronic lack of nurses, warns union


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”

Christina McAnea

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”

Christina McAnea

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.


Unions welcome Francis proposals on whistleblowing

Christina McAnea

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.

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.


Readers' comments (7)

  • Nurse staffing is not just about wards what about district nurses . This too is understaffed with nurses with constant over full caseloads of patients with added ones from hospital discharges. Mistakes will be made and nurses will get blame when they are going under as work loads are not safe and no one is listening. More nurses leave the profession as our job is just not achievable anymore just making situation worse. Degree nursing also does not help as puts decent nurses off applying .

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  • And on top of all this we have a list of items which require cleaning such a the nurses station, commodes and drug trolleys etc eye -all this is to be done and ticket off on yet another piece of paper on a clip board - Yes this occurred on a busy acute ward I was nursing on 2 weeks ago when I had 9 elderly confused falls risks ladies to care for - the whole system is a joke -you have matrons and sisters sitting in their offices auditing or whatever they do knowing full well of the chaotic situation on the ward and not once have they donned apron and gloves and mucked in with the rest of us and they have the audacity to spout about what nursing excellence is !

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  • Always nurses this nurses that!! What about the HCAs or the underrated slaves of the wards!! I did a bank shift on A&E the other day and basically my job was to wheel patients on their trolley (some of them very heavy) to x rays and back on A&E and nobody to help as the porters do not want to do it because they only wheel patients if they go on a ward after x rays but not if they go back on A&E!!!! Disgraceful! As a result I'm not gonna accept shifts on A&E ever again! I'm an HCA not a porter!

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  • Patient wants to be taken cared of, look after, listened to, offered emotional support and maybe chat for a joke; nurse - patient ratio has to be limited to and not to exceed above 1:4. It can still be challenging but patient will be safer as well as nurses will feel motivated to function as a nurse. Unlike the current working environment, nurses are running like headless chicken, jumping like a donkey to fit the alloted shift finishing the allotted patients but sadly demoralised for the mere fact that care being rendered are all rushed to be completed.

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  • I completely agree with all the above comments. I recently took a shift on a busy acute surgical ward. I was allocated 11 patients as the ward was short of one staff nurse.
    I refused to take on the extra patients as it was not safe. Secondly, it was physically and mentally too much. I insisted and stood my ground. I informed the coordinator that I will not be forced to and if they insist, then I will rather cancel the shift and go home.The Matron threatened to report me to NMC. Thank God I have read the Code and know what to do in situations like this!
    Finally, a nurse was sent to help. I cancelled all future shifts, and will not go back to work in that directorate ever again! Nurses are under so much pressure and at the end of the day, we have nothing to show for.
    What with salary caps. The NHS keep loosing excellent nurses daily. Two of my colleagues have left and there are more in the pipeline.
    Its about time those above sit up and really analyse the situation.

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  • It's a big sinking ship! Nurses are leaving at such a high rate, experienced, caring nurses, ones that are overworked and dissullusioned by it all.
    I have been a nurse for almost 40 years and can't wait to retire, but more importantly I'm a service user and worried about what the future is for our NHS.
    In the hospital I work there are far too many layers of management, this is what needs to be looked at to save money, as well as highly expensive locum doctors and agency nurses. This is what's breaking the NHS and the crisis will just get worse.

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  • I have retired
    At the end of 35 years nursing I was referred to the NMC.
    It took 9 months for it to be decided I had nothing to answer.
    It should have taken 9 minutes.
    I hold nurse management and the NMC in disgusted contempt.
    My response has been to talk out of nursing anyone who is thinking of taking it up.Why spend 4 years of indebted study for it to be destroyed by those disgusting legalist creatures in the NMC working in cooperation with bullying pathological rotten managers.
    I have now talked 14 young people out of it and will continue to do so.
    The day nursing collapses completely will be a happy one for me.
    Yes my dealings with the NMC and managers have achieved this attitude of mind.
    Please remember Amin Abdullah.

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