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'Safety in numbers' in caring for patients

A new report suggesting that nurses are having to "ration care" towards their patients due to time pressures has been welcomed by the head of nursing at the union Unison.

Hospital nurses having to 'ration care'. Credit: Reuters

Gail Adams said: "This report adds to the growing evidence that there is safety in numbers when it comes to caring for patients.

"Earlier this year Unison's own survey of nurses and healthcare assistants found that nearly 60% did not have enough time to deliver safe, dignified and compassionate patient care.

"The introduction of minimum staff to patient ratios would be a life-saving initiative - one that would dramatically change life on the wards for patients and staff, providing a safer, more caring environment for all."

Nurse care raises 'difficult questions' over staff cuts

There is a strong relationship between registered nurses staffing levels and the prevalence of care being left undone, authors from the Florence Nightingale School of Nursing and Midwifery and the University of Southampton said today after a new report suggested nurses wee having to "ration care".

The authors added:

Most nurses working on general medical and surgical wards in this representative sample reported that some care was left undone on their last shift.

Registered nurses (RNs) working in English NHS hospitals report that care is needed but is often not done because of insufficient time. [The] better the practice environment the smaller the volume of care that is left undone.

Our findings raise difficult questions for hospitals in a climate where many are looking to reduce - not increase - their expenditure on nurse staffing.

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More than 80% of nurses missing out on patient care

More than 80% of nurses are being forced to "ration care" because they don't have enough time to properly look after patients, a new study suggests.

The authors from the Florence Nightingale School of Nursing and Midwifery and the University of Southampton, found:

  • 86% of nurses were unable to perform at least one of 13 care elements because they were too busy
  • 66% of nurses unable to comfort or talk to patients
  • Just over half of nurses saying they were forced to skip "educating patients"
  • 47% said they didn't have time to develop or update nursing care plans
  • The average nurse cared for 7.8 patients on a day shift
  • The average nurse cared for 10.9 patients on a night shift
  • Nurses looking after 11 or more patients were twice as likely to say they rationed patient monitoring as those looking after six or fewer patients
  • 78% of nurses in the best staffed environments reported some care was missed on their last shift, compared with 90% of those with lower staffing levels

Rushed nurses have to 'ration care' due to lack of time

Hospital nurses are being forced to "ration care" because they don't have enough time to properly look after patients, a new study suggests.

Fundamental aspects of care are "frequently being left undone", researchers found.

Hospital nurses having to 'ration care'. Credit: ITN

Almost nine in ten nurses questioned said they were so busy on their last shift that they were unable to perform at least one "care activity" such as proper patient surveillance, administering medication properly, comforting patients or changing a patients' position in bed - to prevent bed sores.

The study, published in the online journal BMJ Quality & Safety, examined data from almost 3,000 nurses who work in 46 English hospitals.

Read: A&E rescue plans facing crisis

Minister: Hospitals responsible for nurse staffing level

A new chief inspector of hospitals would be empowered to take action if hospitals are found to be compromising patient care with insufficient staffing, the Government has said.

Health Minister Dr Dan Poulter said hospitals were responsible for their own levels of staff numbers.

It is for hospitals themselves to decide how many nurses they employ, and they are best placed to do this.

Nursing leaders have been clear that hospitals should publish staffing details and the evidence to show that staff numbers are right for the care needs of the patients that they look after.

Overall, the number of clinical staff in the NHS has risen and the number of admin staff has fallen by 18,000.

– Dr Dan Poulter

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SSA: "More than 8 patients per nurse is unsafe'

The survey by Nursing Standard and the Sunday Mirror also found that almost half of nurses had seen patients suffer as a result of services being cut.

For the sake of clarity, more than eight patients per registered nurse is the level considered to be unsafe and putting patients at risk. It is not a recommended minimum.

For nurses to provide compassionate care which treats patients with dignity and respect, higher levels will be needed and these should be determined by every health care provider.

– Safe and Sound, the Safe Staffing Alliance statement

But 57.5% of nurses said they were still proud to work for the NHS.

Nursing leaders are united on patient safety issue

Speaking on behalf of Safe and Sound, the Safe Staffing Alliance, Professor Elizabeth Robb, chief executive of the Florence Nightingale Foundation, said nursing leaders were united in standing up for patient safety.

For the first time ever, nursings leadership is united on this. We are coming together to stand up for patient safety and for the profession.

We are saying that, with a ratio of one registered nurse to more than eight patients, there is a significantly increased risk of harm. We hope that by coming up with a figure we will give directors of nursing the evidence they need to argue for the staffing levels necessary to provide good care.

If government are saying that staffing levels are a local decision, then it is more important than ever to set out clear guidance.

– Professor Elizabeth Robb, chief executive of the Florence Nightingale Foundation

Patients said staff and nurses were overworked

Hospital units with worse staffing levels could expect more excess deaths, nursing leaders said.

A national nursing survey found that wards are run with one registered nurse to eight patients or more approximately 40% of the time.

Patients said they thought all staff, and in particular nurses, were overworked. Credit: Rui Vieira/PA Archive/Press Association Images

Katherine Murphy, chief executive of The Patients Association, pointed out that in the latest Care Quality Commission inpatient survey (CQC 2012) staffing levels were a key issue raised by patients.

Patients said they thought all staff, and in particular nurses, were overworked.A frequent comment was that staff were caring but that they did not have enough time for you.

The fact is without adequate staffing levels, overstretched nurses are not able to give patients the care they need.

Nursing leaders question 'unsafe' staffing levels

Patient care is unsafe on wards where each registered nurse is regularly looking after more than eight patients, according to nursing leaders.

Safe and Sound, the Safe Staffing Alliance, made up of senior expert nurses, says the 1:8 figure is based on hard evidence and they have issued new recommendations that under no circumstances should staffing be allowed to fall below that level.

A study by researchers at Southampton University, Kings College London and the National Nursing Research Unit found that hospitals with eight patients per registered nurse (during the day time on general acute wards) would see around 20 extra deaths a year more than better staffed hospitals.

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