03 February 2016

#NurChat nurses say understaffing is a chronic problem

Over 90% of #NurChat nurses say they have experienced staffing shortages in their workplace in spite of evidence that nurses are crucial to patient outcomes.

It’s almost three years to the day since Robert Francis QC reported ‘inadequate staffing levels’ and ‘a dangerous situation’ at Mid Staffordshire NHS Foundation Trust. In his 290 recommendations, safe staffing guidelines, putting patients first and accountability were three of the key themes. Recent reports show agency and bank nurse staffing requests increased considerably following publication of the findings, indicating that many acute, community and mental health trusts recognised the need for more nursing staff.

However, mandatory minimum staffing levels were rejected by Health Secretary Jeremy Hunt and NICE’s safe staffing work relating to minimum nurse to patient ratios in emergency departments was recently abruptly suspended, according to the HSJ. 9 out of 10 hospitals in England are also failing to meet their own targets for nurse staffing, so it would seem that nurse staffing levels remain a chronic problem.

This was echoed by the overwhelming majority of nurses, nursing lecturers and nurse leaders who took part in a #NurChat twitter debate on the topic of safe staffing. Many were dismayed to hear that NICE’s safe staffing work had been halted as they felt this would have provided much-needed step forward towards consistent safe staffing levels for the benefit of patients.

There are reservations about the new nursing associate role, with wide-ranging comparisons between the now phased-out state enrolled nurses and diploma-level nurses being withdrawn. Many fear standards of care will be compromised as financially-stretched trusts and organisations replace RNs with nursing associates. Without proper regulation and registration, staff in this new role will not be held to the same level of accountability as registered nurses.

The impact upon the individual nurse working in an under-staffed environment can be significant. Fatigue, loss of sleep, worry and fear of losing their pin number were all common. One nurse also reported having cold sweats at night due to worry and phoning colleagues to check patient care and record-keeping had been completed correctly from their shift earlier in the day. One manager also reported staffing levels driven by budget rather than patient need, which is likely to perpetuate the back-seat position of the patient. 

It’s clear that trusts and organisations need to do more to support their nursing staff, including ensuring their nursing teams contain a suitable number of qualified staff with the skill mix to care for the patients’ needs. Time for CPD and for mentors to provide positive placement experiences for students seem to be limited in some areas, which will undoubtedly impact the nurse workforce of the future.

#NurChat will return on 16th February at 8pm when the focus will be on student placements.