Service providers must “urgently” examine whether they have enough nursing staff to provide safe patient care this winter, the Royal College of Nursing has said in the wake of worrying new survey findings.
In a survey of 30,000 frontline staff, 55% said shifts did not have the level of nurses planned and 53% warned that the shortage was compromising the care given to patients.
“The nursing shortage is biting hard and needs the attention of ministers”
As a result, the RCN is calling on health and social care providers to urgently review nurse staffing levels, give public assurances on patient safety and take action where standards are not met.
The survey of nursing staff in all four UK countries asked about staffing levels on their most recent shift and the quality of care provided.
The RCN said 36% of respondents reported having to leave elements of patient care undone due to a lack of time, while 65% worked an unpaid extra hour on average.
In addition, 71% of nurses surveyed in England said their last daytime shift exceeded levels set in 2014 National Institute for Health and Care Excellence guidelines for adult inpatient wards.
The NICE guidance – one of a set from a planned programme that was controversially cancelled – stated that more than eight patients to one nurse should act as a safety “red flag” that needed investigating.
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According to the RCN survey, 26% of nurses on acute adult wards reported shifts with 14 or more patients per nurse.
The survey also found that nursing staff working in hospitals rated the quality of care lower than those in community services such as district nursing.
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Accident and emergency departments had the lowest quality ratings of all hospital services, with 14% A&E nurses rating care as “poor” or “very poor”.
Meanwhile, 44% of all respondents to the survey, regardless of setting, said no action was taken when they raised concerns about staffing levels.
Nursing staff rated the quality of care more highly when there are fewer patients for every one registered nurse, which supports recent research by Southampton University’s Dr Jane Ball.
The work, released last month, highlighted a link between the number of registered nurses, patient care duties left undone and mortality levels.
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The RCN survey findings have been published today in a report – titled Safe and Effective Staffing: Nursing Against the Odds – that also stated that “short-sighted” measures designed to cut costs had led to unregistered nursing staff making up a greater proportion of the staff on duty.
The proportion of registered nurses on adult general wards has fallen to 48% this year, from 62% in 2009, said the college.
Its survey was carried out in May and suggested that pressures normally associated with the winter months have become common throughout the year – as previously indicated by other warnings, including those made by senior nurses at last year’s Nursing Times’ Deputies Congress.
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Some survey respondents reported that colleagues had burned out and become sick themselves, leaving them unable to come to work, while other staff left work “sobbing” at the impact of shortages on patient care.
Many said they questioned their future in nursing and had contemplated leaving the profession, noted the RCN.
The findings come after the Nursing and Midwifery Council warned the nursing profession was shrinking as more people were now leaving than joining its register.
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In the wake of its findings, the RCN is calling on providers of health and care services to urgently provide assurance to their boards that they are providing safe services.
In addition, the college is calling for new UK-wide legislation that guarantees safe and effective nurse staffing. Wales and Scotland are already in the process of introducing their own safe staffing laws.
Such legislation would give clear accountability and responsibility for workforce strategy, policy and planning, which the RCN said must lie at ministerial level, rather than with arm’s-length bodies.
The college also repeated its previous call for increased funding for health and care services to meet the patient demand.
Janet Davies, RCN chief executive and general secretary, said: “The nursing shortage is biting hard and needs the attention of ministers – this warning comes from the very people they cannot afford to lose.
“The findings in this report are a direct result of years of poor planning and cost-cutting – it was entirely predictable,” she said.
“Nursing staff are revealing desperately sad experiences and their honesty must drive forward the policy debate,” noted Ms Davies.
“We urgently need assurances from every health and care provider that services are safe for patients, and new laws on staffing should follow swiftly,” she added.
Commenting on the findings, NHS Providers chief executive Chris Hopson said: “This report is a powerful reminder of the relentless pressures faced by frontline staff, whatever the time of year.
“As demand continues to grow, it is becoming increasing difficult for staff to provide the safe, high quality care that patients deserve, even though many are routinely working longer than recommended hours, often in very challenging circumstances,” he said.
Mr Hopson said trusts were “doing all they can” to sustain safe staffing levels “under the most difficult circumstances”.
“They need national support, including a plan to tackle current workforce gaps based on realistic training timetables and a credible long term workforce strategy to ensure the NHS has the right number of staff with the right skills in the right place,” he said.
Nigel Edwards, chief executive of the Nuffield Trust think-tank, said: “This report reveals what was sadly all too predictable: NHS staff and their patients are bearing the brunt of an abject and long-term failure to plan the nursing workforce.
“Successive governments have not equipped the NHS to meet the changing needs of patients, instead allowing the size and make-up of the future workforce to be determined by drives to hold down health budgets,” he said.
“As well as tackling workforce shortages through attracting nurses to the profession, it is vital to hang on to the committed and talented staff we already have,” noted Mr Edwards.
“Nurses are the largest professional group in the NHS, but that is not an excuse for treating them as interchangeable units,” he said. “Yet the report reveals a worrying disregard for the existing nursing workforce, making it likely – and understandable – that many nurses will vote with their feet.”
Danny Mortimer, chief executive of NHS Employers, said: “NHS services are under levels of pressure and demand not seen since for 20 years. Nurses and other clinical staff feel this pressure acutely.
“Employers are committed to supporting our nursing teams; we look forward to the government rapidly resolving the uncertainty facing EU nationals so that we can return to recruiting staff to fill the additional posts created in recent years,” he added.
In response, Department of Health spokeswoman said: “We are helping the NHS to make sure it has the right staff, in the right place, at the right time, to provide safe care – that’s why there are over 29,600 more professionally-qualified clinical staff, including over 11,300 more nurses on our wards since May 2010.
“We have also committed to funding an extra 10,000 places for nurses, midwives and allied health professionals by 2020 to ensure the NHS has the staff it needs both now and in the future,” she said.