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Nurses already feeling pressure - before winter sets in

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Staff shortages and high bed occupancy levels are increasing the pressure on services across the NHS to unexpected levels, a Nursing Times investigation has found.

An exclusive survey of more than 1,000 visitors to the Nursing Times website suggests nurses are feeling the strain in acute and primary care settings - even before the onset of cold weather that normally heralds the NHS’s busiest period.

Around three quarters - 72 per cent of hospital nurses and 77 per cent of acute nurses - say the service they work in is under greater pressure than this time last year. Sixty per cent of hospital nurses say this pressure is greater than planned for.

Staff shortages because of recruitment freezes or difficulties are given as the main reason for the additional pressure in both sectors, suggesting straitened economic conditions are already having a tangible effect on the front line.  

One respondent from the acute sector said: “Pressure on beds to meet emergency and elective targets seems far worse this year due to community health and social services having reduced capacity.”

“Workload has increased and there is a large amount of pressure from senior managers. Therefore departmental stress is very high at this time,” said another.

More than 60 per cent of community nurses said they did not have sufficient staff in their practice or team to cope with the demands on their services. One described the pressure as “overwhelming”.

Forty five per cent of acute staff said they had been asked to work additional hours this autumn because services are so busy. 

One acute nurse said: ”[There is a] shortage of staff due to the ward being overspent on its budget. Some weekends the ward is run on three staff nurses and one HCA to care for 27 acutely unwell patients.”

A community nurse added: “The staffing freeze due to the debt that the PCT has incurred has resulted in dangerously low staffing levels. Management disregard any attempt by the ‘coal face staff’ to alert them to the unsafe situation.” 

Additionally, 60 per cent of acute staff report that bed occupancy rates in their ward were higher than usual – with more than one in 10 nurses warning that levels were “unsustainable”.

This hike in bed occupancy appears to be the result of emergency admissions – possibly as a result of efforts to meet the four-hour A&E target – because community nurses said they had not noticed a significant increase in GP referrals.  

The survey results also suggest that the high bed occupancy rates are having a knock-on effect on discharge, as hospitals attempt to make space.

More than 40 per cent of community nurses said that in their opinion more patients were being discharged before they were fit to go home – risking readmission. This finding is supported by analysis of separate figures from hospitals by NHS data specialists CHKS.

Some nurses said they feared what would happen over the winter. “I feel the worst is yet to come. Flu numbers are low for us so far – I expect things to worsen,” one said.

“The majority of the year has been one huge pressure – making us dread any extra over the winter,” another said.

Appearing to confirm their fears, national director of NHS flu resilience Ian Dalton warned in a letter to NHS managers last week that worse was to come.

He said: “We are…beginning to see increased pressure within the system, particularly on A&E and ambulance services. We are well placed to manage them due to the plans we have in place, but we are reminded of the need to continue to remain prepared for what will potentially be a tough winter for the NHS.”

  • 3 Comments

Readers' comments (3)

  • As an A and E nurse we have noticed a large increase of patients unable to get past the receptionist at the GP. This is impacting greatly on the capicity problems every A and E faces all year round, we do however as i am sure all A and E's do; do our upmost to advoid addmissions unecessarly regarless of breach times!

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  • As an A/E nurse we have a large proportion of GP referrals or patients who feel that there condition has not been investigated properly or they try and get their booked scan early, part of the new pressure is of course swine flu but this is not helped when patients ignore the advice or are told by the help line etc NHS Direct included to come to hospital. The Trust I am working for are opening a third medical admissions unit and a new surgical review area in a hurry, but this misses the point of where do those patients go once they are seen, the sole focus is on meeting the four hour target and the number of patients who were only discharged 48-72 hrs previously seems to be on the increase, coincidence I think not!, the pressure is always on the nursing staff though not the doctors, see patients faster get decisions made but it's not the senior medical staff pushing the SHO's it seems to become our job which put's a strain on the team, can't wait for the change over in the next week, just see those figures get worse! and it will all be the nurses fault, not the reduced bed capacity, new transport system that thinks it's ok to leave the elderly to wait for 8 hrs for an ambulance or 6 hrs to be transferred to our other hospital for further treatment, or lack of community beds, but hey Christmas is round the corner all those drunks and assaults can't wait!!!

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  • Working on an acute surgical ward, we are regularly making do with 3 trained nurses and 2 auxiliary nurses managing 28 patients on a day to day basis which is far too busy and downright dangerous. I am so exhausted when I get home I fall asleep on the sofa and I worry about the level of care I have been able to give.

    As we work 12.5 hour shifts, getting up to do the same again the next day is a real challenge. It's high time proper staffing levels are addressed to prevent unnecessary deaths of patients, staff being so run into the ground that they can't come to work as they're ill, and consequently the vicious cycle you just can't break out of. With the increased winter workload we are expecting, working conditions could become unbearable.

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