More than 75% of nurses fear for their patients’ safety due to inadequate staffing levels, poor ward layout and the bad attitudes of colleagues, a Nursing Times survey has found.
Just over 600 respondents from every level of the nursing profession replied to our Patient Safety Week survey asking about concerns, confidence in reporting incidents and harm to patients.
Less than a quarter were confident their patients were safe on the ward or other care setting all of the time. Inadequate staffing levels some of the time was the top cause for concern, followed by poor attitude of colleagues, poor skill mix and bad ward layout.
Worryingly, a quarter of respondents also said they never had enough staff to be confident patients would be safe.
Unison’s head of nursing Gail Adams told Nursing Times staff shortage was becoming systemic and urged nurses to report their concerns to the Nursing and Midwifery Council or their union.
“In the past you would get occasions where, for example, it’s a weekend and a couple of people were off but now it’s happening all of the time and people are worried.”
She said the fact that 41% of respondents were concerned for patient safety due to the attitude of their colleagues was “surprising”, but said it could be a result of the stress nurses are under.
“When you’re pulled every way trying to care for patients, your patience and tolerance can be affected,” she said.
A report by the Care Quality Commission published last week identified safety concerns with almost half of hospitals and care homes, with risk management one of the areas organisations were most likely to fall down on.
Asked what their biggest patient safety concern was, 24% of survey respondents highlighted the identification of deteriorating patients, followed by drug errors, slips, trips and falls and insufficient nutrition and hydration.
Concerns over identifying the deteriorating patient echo previous Nursing Times research, which found one if five nurses lacked confidence in colleagues on this issue (news, page 2, 25 January).
Only 4% worried about patients receiving the wrong treatment due to misidentification; however it was the second most common cause of patient harm seen by survey respondents.
Misidentification is one of 25 “never events” which, according to the Department of Health, should never happen if relevant procedures and guidance has been followed. Only 43% of respondents were aware of the list.
Nursing Times asked respondents about the prevalence of seven never events which nursing care could have the greatest impact on.
Failure to monitor and respond to oxygen saturation was seen as the most common, reported 131 times in our survey, followed by misidentification reported 77 times. Respondents reported 52 instances of patients getting trapped in bedrails, 50 occasions of misplaced enteral feeding tubes, 49 maladministration of insulin and eight instances of severe scalding.
On average, about half of respondents were confident they knew what procedures should be followed to prevent harm as a result of these seven never events.
In contrast, the survey revealed the majority of nurses were confident about reporting patient safety incidents. However, only half said they expected to be treated fairly if they reported an incident and a quarter were worried they would get into trouble or be bullied by management.
In total, 82% of nurses said they had reported an incident in the past and 86% said they would report a near miss, even if they were involved in it.
Nurse and National Patient Safety Agency director of patient safety Suzette Woodward told Nursing Times the results of the survey showed the importance being placed on patient safety by the nursing community.
“Identifying patient safety incidents and ensuring they are reported in an open and transparent manner is at the heart of reducing risk in healthcare,” she said.
Figures released by the NPSA last week showed an 8.5% increase in the number of incidents being reported between October 2010 and March 2011.
Full results of the survey can be accessed at nursingtimes.net