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How do staffing issues affect patient experience?

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Fenella’s experience as both an in- and out-patient varied considerably depending on staffing levels and the number of regular staff employed

When it comes to safe staffing there are several issues I feel very strongly about and wish to share my views as a patient.

Safe staffing has been written about in the professional health press and talked about extensively on social media, but few patients and carers, outside of formal enquiries, have said much about the impact low staffing levels have on the patient experience, from patient safety to continuity of care.

Late last year I was unfortunate to develop severe pneumonia. I was blue-lighted to A&E as my Sp02 had dropped to 66. The paramedics came quickly and the care I received was excellent including in ITU and the respiratory care ward.

”I noticed some days and at night/weekends the qualified staff were a minimum number”

The staffing in A&E and ITU was very good. On the respiratory care ward the staffing and care overall was good but I noticed some days and at night/weekends the qualified staff were a minimum number.

This did not increase when patients came from ITU who still needed high dependency nursing. At night there would be a senior staff nurse in charge on the ward with two other nurses and two HCAs. The HCAs would do the obs and answer the call bells.

This was frustrating at times when I needed something like pain relief as I had to wait for a qualified nurse and was often told “he/she is busy”. The wait on several occasions was more than half an hour.

”One several occasions I noticed how the HCA was missing because another bay had ‘borrowed’ her”

I noticed at weekends in a bay of four patients, a nurse would struggle if one patient took up too much time, for example if they had a surgical wound that needed dressing. On several occasions I noticed how the HCA was missing because another bay had ‘borrowed’ her so one staff nurse at the weekend was left to manage for several hours before being relieved so they could take a break.

During the week however there were often two or three ward sisters on (one the ward manager) and overall staffing seemed very adequate. At these times the safe staffing notice on the wall showed the quota of nursing seemed good.

”The agency nurses in my own experience were not confident”

The hospital had recently recruited nurses from the Philippines and Filipino nurses were working on the ward as HCAs while they awaited their PINs. The agency nurses in my own experience were not confident and on several occasions made mistakes with my care that prompted me to ask for them not to return to my care for that shift. I did wonder at times, at night especially, that if I or another frail patient had a fall how long we would be left before someone came to help.

The staff worked as a whole team including the medical staff and this was impressive as the continuity was very good. The ward manager was very hands-on and efficient.

In addition to being on an acute ward for a month, which gave me a good perspective, I was also under the district nursing service for wound care.

”Over the period of six months many permanent nurses left the team”

Over the period of six months many permanent nurses left the team and more and more agency nurses were being used at weekends as were mature nurses working part time on the staff bank. The regular nurses were stretched and it was hard for me as the continuity of care was lacking on some days.

The difficulties mainly lay in the agency and bank nurses not knowing my wound care plan that well, if at all, and how I preferred my dressing for example how much mefix to use or how tight the bandage. Not having a built rapport meant on a difficult day I couldn’t express my concerns or anxieties relating to the wound or discuss an out patient appointment. Now and then a bank or agency nurse put an open primary dressing back in the dressing box. The managers dealt with this swiftly but it was noticeable that some staff were out of date - thankfully this was an exception.

Overall the service was good and responsive but I had some concerns, which came down to lack of regular staff. 

Fenella Lemonsky


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