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Meeting patient expectations is 'biggest problem' facing nursing


More than half of nurses say patient and carers’ expectation of services that cannot be met with existing resources is the “biggest problem” currently facing nursing.

According to a survey of nurse opinion, 55% of respondents highlighted this issue as their biggest concern.

Meanwhile 52% said cuts to the nursing workforce, both registered and non-registered, was the main concern facing the profession. A further 42% highlighted cuts to the registered nurse workforce and 41% inadequate care of older patients, such as issues of dignity and nutrition, in the NHS.

Lack of support for staff who raise concerns about the quality of care was cited by 35% of respondents and 27% thought the biggest problem was either lack of compassion in some nursing staff; inadequate care of older patients in the care sector; and pressure and lack of support for ward and community managers.

Nursing Times also asked nurses which issues facing the profession they found most concerning on a personal level.

The majority, 70%, highlighted staffing cuts that in their view endangered patient safety and 59% identified staffing cuts that significantly increased their workload.

Meanwhile, 56% said the inability to provide adequate care to their patients or government proposals to change NHS pension scheme and retirement age.

A further 43% highlighted concerns about changes to the NHS caused by the government’s health bill being passed, and 38% cited attempts by trusts to reband nursing staff to a lower pay level.

One respondent said: “Nursing and quality care cannot be achieved in the same breath as cuts to staffing levels, downgrading of nurses, frozen posts etc. Why are nurses always the easy target for budget cuts when the NHS is a flood with managers many who will never encounter a patient throughout their career.”

Another said: “Nursing has become a thankless task. Patients’ expectations are high and cannot be met with the level of work required on the wards. Managers are implementing new ways of working with no training or support taking up time that could be spent delivering patient care. I worry for the future of nursing.”

A number of high profile reports and cases involving poor nursing care have been given widespread media coverage recently.

Examples, include critical reports from the Care Quality Commission and the Patients Association focusing on dignity and nutrition standards for older patients, as well as more extreme cases such as the claims of patient abuse at Winterbourne View and police investigations into patient deaths at Stepping Hill.

Asked whether they thought the media’s portrayal of nursing had changed over the past 12 months, 71% of respondents said it had got worse. Meanwhile 26% said it had remained the same and just 3% that it had got better.

One respondent said: “Nurses need to feel supported. Media attention mostly highlights bad practice. Nurses were once respected – what happened? Is the government partly to blame by continually freezing pay thereby suggesting nurses are not worthy of a pay rise?”

Another said: “Public and media perception of nurses is having a huge impact on nursing moral. As is staffing cuts and increased workloads. I don’t think it is seen as much of a profession to enter into anymore which will impact greatly on nursing in the future.”

A further respondent added: “I hate constantly reading in the media about bad nursing, I am constantly defending myself and colleagues. After all there are more good nurses out there than bad or indifferent ones, more nurses not less are needed.”

The poll findings released today are the fourth and last instalment of results to come from an online survey of around 400 nurses carried out by Nursing Times over the past week.

The poll has asked nurses about the “big issues” currently facing the profession. It has looked at other key areas including workforce, the health bill and the current review of the Nursing and Midwifery Council.


Readers' comments (8)

  • michael stone

    Seems very plausible - to someone who has no inside information about that.

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  • Nurses must become experts in clincial audits which will highlight low staffing impacting on care. An audit is factual and difficult to then make staffing cuts or reband if the agianst.

    Come on nurses fight its what the Drs do. Evidence you greatest asset your ability to deliver care given the right resources to do the job. Make patients see the difference between capacity to a job well and a inadequate resourced service.

    NHSI has the Nurse sensitive Outcome tool which looks at WTE/skill mix against key measures falls/pressure areas/HAI and patient dependance. And it is free so no permission needed for ward managers to just do it and present to their clinical leaders. Alternately PSDA of the biggest area of concern to support change in established wte.

    Doing nothing is not a option be advocates for the right care - that is what the public expects.

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  • Patient expectation has been elevated by political bragging about what should be provided (whist cutting resources). There seems to be a stong element of a sense of entitlement along with poor concept of contribution. Nurses take the brunt of all this.

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  • michael stone

    Anonymous | 16-Feb-2012 12:02 pm

    'Come on nurses fight its what the Drs do'

    If I had commented that nurses do not seem to 'stick up for themselves' enough, I would have got 'roundly slagged off' on this site. But I do suspect that is the case, and I also suspect - I'll get slagged off for this, anyway - that partly there is an 'attitude' that doctors make the decisions, and nurses follow orders. Before you all 'have a go' note that I'm saying I think that is an existing 'attitude' - I'm not saying whether doctors correctly make decisions and nurses correctly follow them, I'm saying that seems to be, at some level, 'somehow assumed to be the case'.

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  • tinkerbell

    Anonymous | 16-Feb-2012 12:02 pm

    Well said.

    michael stone | 16-Feb-2012 2:15 pm

    This may be as nursing is historically predominantly female and doctors are historically predominantly male. With exceptions to the rule men are generally better at speaking up. Hopefully females will catch up with their male colleagues.

    Awaiting the back lash:)

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  • Anonymous 16-feb-2012 12:05pm

    I agree the government does keep making high expectations which they promote and are unachievable by the exhausted staff that are left. Put DC in the middle of a medical ward on a monday morning with his bay of 10 dependant patients, give him a pinny, gloves, washbowls, towels, nightwear and sheets and let him get on with it. That is after he has done their obs, medication, and assisted doctors rounds, sorted discharges and spoke to relatives. Just the tip of the iceberg!

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  • Anonymous | 16-Feb-2012 8:28 pm

    not forgetting his hourly rounds as well!

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  • michael stone

    tinkerbell | 16-Feb-2012 4:21 pm

    Again, I do suspect that part of 'nurses not fighting their corner so forcefully' is indeed that most nurses were and are female, and possessing a Y chromosome tends to make someone 'more assertive'.

    And, again, if I had made that comment first, I would have been 'slagged off' on this website.

    But I also suspect that there is a complication which hinges on the role of nurses, in that often nurses are administering but not prescribing treatment - now that there are Nurse Prescribers, I find the complexity of 'who does what, and who is actually responsible for mistakes' somewhat problematic.

    Doctors, especially GPs, are now often female, but males are not re-balancing nursing in the same way, as far as I can tell.

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