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Hospitals struggling to hit own targets for nurse staffing levels

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The ability of NHS acute trusts to employ sufficient numbers of nurses on hospital wards has worsened this year compared with 2014, despite record levels of recruitment.

Despite the recruitment drive, there are still not enough trained nurses to fill shifts according to safe staffing guidance, nursing directors have said.

“The recruitment of nurses is most certainly a national issue and the availability of registered nurses isn’t what it once was”

Carolyn Fox

Analysis of staffing levels at 135 acute trusts showed 83% failed to meet their own planned levels for registered nurses during both day and night shifts in April in at least one of their hospitals. This compared with 76% of trusts for the same month in 2014.

According to the figures, published on the NHS Choices website last month, all 135 acute trusts that reported staffing data failed to hit their target for nurses working during the day in at least one hospital in April, compared to 86% last year.

 

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A total of 114 trusts did not meet planned staffing levels for nurses working at night in at least one site.

Each acute trust has a planned target for nurse staffing hours across day and night. They are required to publish monthly data showing the average fill rate across their hospital sites on NHS Choices.

Out of 227 hospital sites reporting data, 198 missed their target for nurses working during the day – almost nine out of 10 hospitals in England – according to the analysis by Nursing Times’ sister title Health Service Journal. Meanwhile, 159 hospitals, or 70%, missed the target for nurses working at night.

More than two-thirds of hospitals failed to have sufficient numbers of nurses across day and night shifts. Forty-two hospitals had one in 10 daytime nursing shifts unfilled, and 16 had a daytime fill rate of less than 85%.

Many trusts where nurse staffing levels were below target had responded by filling gaps with healthcare assistants. More than 120 trusts were overstaffing on HCAs by up to 140%.

“It is extremely challenging times at the moment – the nurses just aren’t there”

Barbara Stuttle

The decline in performance follows the publication last year of staffing guidance for acute wards by the National Institute for Health and Care Excellence, which led some trusts to plan to have more nurses on shifts.

The situation was exacerbated by a national shortage of qualified nurses, with trusts recruiting more nurses from overseas in response to the 2013 Francis report. Since then, the number of whole-time equivalent qualified nursing, midwifery and health visitor staff has increased by more than 12,000, according to the Health and Social Care Information Centre.

Northampton General Hospital had the lowest fill rate for nurses during the day at 79%. Director of nursing Carolyn Fox said the trust planned to recruit 173 nurses by February next year, with 63 already in place.

She said: “The recruitment of nurses is most certainly a national issue and the availability of registered nurses isn’t what it once was.

“The NICE guidance is not necessarily a bad thing because it has increased the requirement of registered nurses,” she said. “It will have a fantastic impact on patient care in the future.”

Barbara Stuttle, chief nurse at Colchester General Hospital, which filled only 81% of its nursing day shifts, said the trust was recruiting nurses from overseas to fill gaps. It has recruited 95 extra nurses since January and plans to recruit 90 more this year.

She said: “It is extremely challenging times at the moment – the nurses just aren’t there. A few years ago [nurse training places reduced nationally] and this is the consequence of that.

“The NICE guidance around staffing levels has helped but in some areas it has increased the requirement for registered nurses, which is a good thing,” she added.

“The NHS continues to work… to support the recruitment of new and returning nurses, to retain nurses already in post, and to help hospitals reach their planned staffing levels”

NHS England

In many trusts where nurse staffing levels were below target, they have turned to unqualified healthcare assistants to fill gaps. More than 120 trusts were overstaffing on HCAs by up to 140%.

Royal College of Nursing policy director Howard Catton said he was “shocked” by “the gap between where we are and what trusts have determined we need”.

An NHS England spokeswoman said: “The NHS continues to work with partners including Health Education England to support the recruitment of new and returning nurses, to retain nurses already in post, and to help hospitals reach their planned staffing levels.”

A Department of Health spokeswoman said the government was “fully committed to making more staff available”.

She added: “If individual hospitals do not have enough staff to deliver safe care, the chief inspector [of hospitals Sir Mike Richards] will step in and take action.”

Five hospitals did not report data to NHS Choices – Essex County Hospital, Queen Elizabeth Hospital in Hertfordshire, Heatherwood Hospital, New Cross Hospital in Wolverhampton, and Queen Elizabeth Hospital in Birmingham.

  • 8 Comments

Readers' comments (8)

  • ===
    A Department of Health spokeswoman said the government was “fully committed to making more staff available”.
    ---
    Right! In 3 or 4 years time - and the extra planned won't even replace the numbers that will have left, through retirement or disgust, by then.

    Meantime, immigrant nurses will have to leave the country and EU nurse recruitment will slow right down with the ludicrously high language requirement.

    ===
    She added: “If individual hospitals do not have enough staff to deliver safe care, the chief inspector [of hospitals Sir Mike Richards] will step in and take action.”
    ---
    What action, exactly?

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  • Plenty of people in the country, so I'm sure you can find enough people to train. Stop using labour on the cheap, to the detriment of other countries. If not a wage, give student nurses a non-means tested grant similar to the dipHEs had, and put in place that the graduate has to remain in the UK for 5-yrs, or else pay a proportion of the cost of training, reducing incrementally.

    We have a racially diverse indigenous population, and those who have lived here for most of their early life. Start with what you've got, and stop thinking it doesn't matter when you take people from less wealthy countries and don't pay for their training. Work with those closer to retirement rather than making them feel like they cannot wait to go. It matter what policy-makers do, and it matters how people are made to feel.

    Do any of these comments really matter, though? Is it just a safe place to sigh, and then it goes in the cyber-pile?

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  • "Meantime, immigrant nurses will have to leave the country and EU nurse recruitment will slow right down with the ludicrously high language requirement." As a nurse who has held management and recruitment positions, as well as being a seriously ill patient....I for one, hope that the "ludicrously high" language requirement is maintained......I am fed up of having to listen to overseas staff trying to make themselves understood to patients who are sick, elderly or hard of hearing. Being sick is bloody hard work, to have to be dependent on someone who can not speak English fluently is extrememe distressing. Not being able to make yourself understood when you are very ill, takes effort, and it is not fair to patients!

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  • it will be even worse when nurses have to pay for their own training. taking what is an essential necessity and turning it into a luxury, which the government must think it is if they want trainees to pay for it, will make the numbers of new nurses nose dive. Hey ho, Hey ho its off to privatisation we go.

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  • can't we get rid of this target culture and focus on what is important?

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  • early retirement here I come. I don't care about a reduced pension

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  • I wish I had gone on to be a doctor instead of a nurse. I just did not have the money to take me to medical school, but I had the advanced levels. On hindsight I could have borrowed the money and by now I would have paid it back and still have much more money and respect than I have now. After twenty seven years as a nurse (I would have been a consultant by now) instead my pay is like crumbs that fall off the table of a consultant.
    My workload is getting bigger stress level is rising and I am getting older doing the same job with no promotion in sight.

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  • No explanation as to why Peter Carter seemed so against getting Nurses who have left the profession to raise families, back to a profession that is so short of staff.

    Why is the profession so against helping people get their registrations back. Teachers don't need to re register ?.....what is this all about ?.

    Now there is change at the top, lets hope this subject is looked at more seriously.

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