Almost two thirds of nursing staff who have experienced a “red flag” event while working on an acute adult inpatient ward have failed to see nurse numbers immediately increased to deal with the situation, according to a major survey of NHS staffing levels.
National nurse safe staffing guidelines introduced last summer for England state that when a “red flag” event occurs – such as when less than two registered nurses are present on a ward, or there is a 30 minute delay for providing pain relief – the person in charge should consider allocating additional nurses immediately.
The snapshot survey of 5,100 staff carried out by Unison on 10 February, revealed that 62% of respondents who had experienced one of these events since the summer had not seen extra nurses brought onto the ward.
“It is clear that there has been no improvement in safe staffing levels”
In addition, 61% of all staff working on adult inpatient ward in acute hospitals in England said the safe staffing guidelines – which were introduced by the National Institute for Health and Care Excellence in July 2014 – had not led to improved staffing levels at their organisation overall.
“Seven months on from its introduction, this is deeply worrying,” states Unison’s report on the survey findings, called Red Alert – Unsafe Staffing Levels Rising.
“If staff raise ‘red-flag’ events on staffing levels and their concerns are not acted upon, they may be unlikely to escalate them in the future because they could have no trust or confidence in the process,” adds the report.
The union has called for NICE to immediately review compliance with the guidelines and to assess the effectiveness of “red flag” events.
It also wants to see NHS boards regularly receiving data on the number of “red-flag” events, where they occurred, and what action was taken to ensure patient safety.
Unison also reiterated its overall ambition to see the introduction of national mandatory minimum nurse-to-patient ratios, after finding 88% of respondents supported this proposal.
A spokeswoman for NICE said that ta the time of Nursing Times going to press it had not seen the survey in full so could not comment on its conclusions or recommendations.
“We believe our guidance represents the best approach to securing a safe staffing level”
However, she added: “Our guidance was welcomed by the NHS and by nursing leaders when it was published and we believe it represents the best approach to securing a safe staffing level.”
The Unison survey also revealed the majority of staff – 65% - had seen care left undone due to understaffing, suggesting nurses are more time strapped than last year, when 55% reported care had not been finished due to lack of staff.
On the day of the survey, 70% of staff said they were unable to take all or some of their breaks and 37% said they worked beyond their contracted hours, in most cases up to an hour more.
Some survey results showed slight improvements from 2014’s findings, but Unison said the fact remained there was still a continued problem with understaffing.
This year, 45% of respondents said staff numbers were not adequate to deliver safe, dignified, and compassionate care, compared to 60% in 2014.
Just under half of nurses this year said they were not able to spend enough time with each patient, compared with 65% in the last survey.
Similar to last year, 42% of respondents were caring for eight or more patients, the level at which research indicates harm is more likely to occur. This increased to 55% when staff were working on night shifts.
Meanwhile, the survey revealed 88% of nursing staff believe that if the government’s proposal to cut unsocial hours payments were to go ahead, this would have a detrimental effect on nurse to patient ratios.
“As already demonstrated, a nurse is more likely to care for eight or more patients on a night shift,” states the report. “Therefore, not only would cutting unsocial hours payments place serious limits on the ability of the NHS to deliver the seven-day services vision, it would have a detrimental effect on safe staffing levels and patient care especially on night shifts.”
Similar to 2014, the risk of serious care failings occurring at their organisation was reported by nearly a third of respondents, with around 12% saying they believed failings similar to those found at Mid Staffordshire Foundation Trust were already happening in places.
Just over 40% of nurses said they were not at all confident, not very confident or only somewhat confident to raise a concern at work.
“Unison expected the results of this year’s survey to be more positive and to have indicated significant improvements in safe staffing levels because of the government’s claims that it has increased nursing numbers, the issuing of NICE guidance for safe staffing levels in acute settings in England, and the Francis, Keogh and Berwick recommendations to improve staffing levels,” says the report.
The report adds: “However, when comparing previous year’s survey results with the 2015 results, it is clear that there has been no improvement in safe staffing levels.
“Still many nurses and health care assistants are having to care for eight or more patients – the ratio that research tells us it is when harm is occurring – on their shift. It’s unacceptable when elements of care are being left undone. This is despite staff working through all or some of their breaks and doing unpaid overtime on 10 February.”
The union warned politicians they would be “foolhardy” to underestimate the strength of feeling among nurses across all levels on the issue of safe staffing.
“This is an opportunity for politicians to put the NHS and patient care front and centre by committing themselves to the introduction of nationally set mandatory minimum nurse-to-patient ratios,” the report adds.