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Too few nurses on wards for older people care - RCN

  • 24 Comments

There are too few nurses on wards to provide basic, safe care to older people, nursing leaders have claimed.

The Royal College of Nursing (RCN) said the elderly are being let down by low staffing levels across the NHS.

It is calling on the Government to implement a patient guarantee, setting out the minimum number of nurses on older people’s wards.

While its own research shows one nurse currently cares for about nine elderly patients, the RCN said one nurse to seven patients should be the maximum ratio for providing basic, safe care.

Ideally, there should be at least one registered nurse for between five and seven patients, it added.

A survey of almost 1,700 nurses, including 240 working on wards for older people, found 78% said comforting and talking to patients was not done or done inadequately on their last shift due to low staff numbers.

Some 59% said promoting mobility and self care was left undone or unfinished, while 34% said they could not patients with food and drink.

A third (33%) said they were unable to fully help patients to the toilet or manage incontinence.

In a new report today, the RCN also highlighted an “inappropriate” mix of registered nurses to lesser-trained healthcare assistants (HCAs).

The RCN has said the NHS is too reliant on untrained HCAs who are asked to pick up nursing skills as they go along.

It has previously called for much tighter regulation and mandatory training.

However, the Government is not in favour of statutory regulation and has unveiled plans for a “code of conduct” and voluntary training for HCAs.

The RCN said today that hospitals are leaving too much in the hands of HCAs and recommends a ratio of 65% nurses to 35% HCAs.

Senior nurses should be able to decide their own levels locally depending on patient need, it added.

The RCN said the number of nurses on elderly wards compares poorly with other wards, such as adult general wards (6.7 patients per nurse) and children’s wards (4.2 patients per nurse).

RCN chief executive, Dr Peter Carter, said: “Patients on older people’s wards are being let down by systemic failings in our hospitals.

“Despite working tirelessly to provide patients with high quality care, nurses in these settings have repeatedly told us that they are unable to do this because of pressures caused by short staffing.

“It is unacceptable that there are not enough nurses on older people’s wards.

“This is an outdated historic disadvantage dating back to ‘geriatric’ wards of the past and must be urgently addressed.”

A spokeswoman for the Department of Health said: “Staffing levels should be set by the people who have local knowledge of the individual needs of patients, their levels of acuity and dependency, and the nature of the clinical care they require.

“There is a variety of guidance available to inform decisions about staffing levels, from expert bodies like the RCN.”

Care services minister Paul Burstow added: “We welcome the RCN’s work.

“The ratio of nurses to beds is already improving.

“We know from CQC inspections that good nurse leadership on the ward is essential to delivering high quality care.

“Through the Nursing and Care Quality Forum, we are working with the RCN and others to make sure that more nurse time is freed up for front line care.”

 

 

  • 24 Comments

Readers' comments (24)

  • Acute medical wards are on average 90% care of elderly. My ward is one qualified nurse to 10 patients, a drug round in a morning whilst recording patient TPR takes at least an hour and half, then there is usually a consultant round, sorting out discharges, plus any new admissions. Inbetween phone calls from social workers, speaking to OT and physio. Qualified nurses do not have the time to care to an acceptable level. I would love to be able to wash all my patients and even talk to them but we have to leave most of this task to our HCAs. Paperwork usually the last task to be done for the shift is the final straw it has gone bananas. Will anyone take notice of this report no because it would cost too much to finance.

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  • Anonymous | 20-Mar-2012 10:37 am

    Will anyone take notice of this report no because it would cost too much to finance.


    Nail and head spring to mind.

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  • Although we always read about unacceptable ratios I doubt anything will ever be enforceable. Our hospital is trying to save millions of pounds, yet has just installed 50 inch plasma screens on most wards plus expensive software to display patient status at a glance (the whiteboard we were using did not apparently do the same job?!). Unless the chief executive's mother is stuck on a ward where she has to sit in her own urine/ falls out of bed because noone was there to stop her etc etc nothing will ever change. It destroys me that nurses are hanging on by their fingertips, constantly under the threat of legality and hospital policy and audit. It is always the nurse who didn't do/ should have done. It's a horrible job to anyone who is consciencious. I stay late unpaid to make sure things are done (but I'm told this is bad time management). We are regularly short staffed, yet other wards struggle far more. What a sad state of affairs for a nation that is ageing and increasingly dependant. Patient stay would surely be shortened if nurses had more time to care for patients, with less unneccessary complications developing that could have been prevented. As a business I'm not suprised the NHS has gone into the red. No managers will ever see the real consequences as wards put on a display of best practice whenever a suit comes round. Getting old is a bad enough prospect as it is.

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  • It's not just a matter of having extra nurses on a ward.. its what they osbserve about their patients capabilities which is more important. If 10 nurses fail to know if a patient is not eating an adequate diet; is incontinent of faeces/urine; can't reach their water jug/glass/medicine/food; needs assistance with feeding/ walking/sitting/standing/ and all of their daily needs, then you might as well carry on as you do now.

    Patient care is ,essentially, what you do for a patient, not, what you write down on paper for exam purposes.
    I've known a lot of highly 'qualified' nurses, but they were the ones who were quite happy to ...'make a patient wait...' before reluctantly going to attend them. Others wanted to finish their coffee/tea/fag instead of answering a patients request for assistance. Even as an in-patient myself, my medication was often delayed/ not given unless I asked for some, and on one ocassion, it was refuse, because, the dr had writtenn an ''incorrect dosage'' on my medicine card medication - Heparin by imi for atrial fibrillation, so the' sensible nurse' decided to question it before administering it to me. Rather than admit his error, all the dr did was to discontinue the medication, no explanation what so ever was given, I ask you?
    It was absolutely soul destroying working with and sometimes for certain staff. I am glad I took early retirement.

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  • Anonymous

    Anonymous | 20-Mar-2012 1:25 pm

    Often it will be down to not enough staff, but as you point out you also need staff who have the right attitude.

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  • Although we always read about unacceptable ratios I doubt anything will ever be enforceable. Our hospital is trying to save millions of pounds, yet has just installed 50 inch plasma screens on most wards plus expensive software to display patient status at a glance (the whiteboard we were using did not apparently do the same job?!). Unless the chief executive's mother is stuck on a ward where she has to sit in her own urine/ falls out of bed because noone was there to stop her etc etc nothing will ever change. It destroys me that nurses are hanging on by their fingertips, constantly under the threat of legality and hospital policy and audit. It is always the nurse who didn't do/ should have done. It's a horrible job to anyone who is consciencious. I stay late unpaid to make sure things are done (but I'm told this is bad time management). We are regularly short staffed, yet other wards struggle far more. What a sad state of affairs for a nation that is ageing and increasingly dependant. Patient stay would surely be shortened if nurses had more time to care for patients, with less unneccessary complications developing that could have been prevented. As a business I'm not suprised the NHS has gone into the red. No managers will ever see the real consequences as wards put on a display of best practice whenever a suit comes round. Getting old is a bad enough prospect as it is.

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  • "Our hospital is trying to save millions of pounds, yet has just installed 50 inch plasma screens on most wards plus expensive software to display patient status at a glance"

    Sadly, with the NHS reforms, hospitals will probably see more of this as they focus on more hotel-like services to attract private customers.

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  • It doesn't take Einstein to work out that 23 dependent patients out of a 30 bedded ward requiring all care + 2 nurses for any moving or handling and only 7 nurses on a shift will be not getting adequate care.

    23 patients requiring help with meals + 7 nurses = malnutrition; 23 patients immobile + 7 nurses = pressure ulcers; 22 patients dependent on 7 nurses + 1 patient acutely ill = .....

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  • It's not just the elderly who suffer with the lack of staff, it's every patient in every ward.

    Where on earth do they come up with their nurse-patient ratio figures, I look after 13 patients with the help of one HCA on an acute ward where most of the patients are over 80 anyway. We have 4 staff on for 26 patients.

    When we do have an 'extra' member of staff on duty who is supposed to co-ordinate the shift and generally help out one member of staff inevitably gets moved to another ward.

    All very well these people saying it's unacceptable, nurses have been saying that for years but no-one is interested in what we have to say.

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  • Anonymous | 20-Mar-2012 5:34 pm

    "All very well these people saying it's unacceptable, nurses have been saying that for years but no-one is interested in what we have to say."

    I think that nurses need to find a different way of saying it.

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