As new roles are established to fill nursing shortages, how do we ensure we have the right nursing skill mix on each shift to maintain high standards of care and prevent burnout of qualified staff?
Arriving on my ward for an early shift, I went to speak to the night staff to find out how the shift had gone. The nurse in charge commented that she was worn out as there had not been enough qualified staff on duty.
On paper, with the number of patients who had been discharged the previous week or who were on weekend leave, the staffing numbers should have been sufficient.
When I mentioned this to her and she said: “It’s not the number of staff but the skill mix”.
”Skill mix needs to be matched with patient decency”
She had been the only nurse with respiratory skills on duty and one patient had repeatedly desaturated overnight due to his high-level spinal cord injury, and needed a great deal of chest physiotherapy.
As she told me about the shift, she looked tired – but who doesn’t after a night shift? She also looked defeated.
Skill mix needs to be matched with patient dependency to avoid situations like this, but who is best-placed to do this, and how do the new nursing roles fit in?
There is evidence both in support of and against the establishment of new, unqualified nursing roles.
I realise that the profession must address the shortages of registered nurses, the number of vacant posts and the diminishing numbers of people wanting to enter our profession, but we still need to make sure the skill mix on each shift is appropriate to care for patients safely, effectively, professionally and compassionately.
”Inadequate skill mix could lead to compassion fatigue and burnout”
My ward recently developed the role of senior healthcare assistant to help our registered nurses and they do help very much, but my registered nurses still want to wash patients and have that contact, not just stand behind the drug trolley or complete patients’ notes.
It is by looking at and talking to patients that you get a good idea of how they are before recording their observations.
I am lucky to work with a brilliant team of unqualified and qualified nurses in a specialist spinal cord injury rehabilitation centre. They work through a detailed competency document when they begin their job, so they gain a sound knowledge of spinal cord injury and can provide the specialist care our patients need.
But inadequate skill mix could lead to compassion fatigue and burnout, which will then have a negative effect on patients, nurses and the profession as a whole.
As an overstretched workforce, we cannot afford to lose any more nurses. It is crucial to keep us, as well as our patients, as happy and healthy as possible.
Sian Rodger is health coaching nurse facilitator at the London Spinal Cord Injury Centre