Medical Mistake Claims - Simpson Millar LLP

Care "rationed" by NHS nurses, says report

Author: Neil Fearn  Bullet  Dated: 08/08/2013

Nine out of ten nursing staff are too busy to cope with all their duties of care, according to a new report.

The study, which questioned 76 hospitals and 3,000 nurses, says "time poor" hospital nurses have to ration care as they have too little time adequately to look after patients.

Too busy

Some 90% of nurses who participated said their final shifts were so busy that they could not perform at least 1 care activity.

Such essential measures include good patient surveillance, care documentation, proper medication, comforting patients, preparing patients for discharge and adjusting patients' bed posture to prevent bedsores.

Comforting and talking with patients was the most commonly overlooked activity, with 66% of nurses insisting they had no time to do so on their final shift. Around 50% said they were forced to neglect "patient education" while 47% had no time to update care plans.

The researchers, from the Florence Nightingale School of Nursing and Midwifery and the University of Southampton, determined that, on average, almost 8 patients were looked after by nurses on day shifts and up to 11 overnight. The fewer patients a nurse had to care for, the less the likelihood of oversights.

The report said the majority of nurses on surgical and regular wards asserted that some care was overlooked on their final shifts.

"Care is needed"

"Registered nurses (RNs) working in English NHS hospitals report that care is needed but is often not done because of insufficient time," the report stated, noting how RN staffing levels are related to failings in care. "The better the practice environment the smaller the volume of care that is left undone."

The report concluded that hard questions had been raised for hospitals in an economy in which many NHS trusts want to lower their staffing costs.

Following the recent Keogh report into excessive mortalities at 14 NHS hospitals in England, the Royal College of Nursing (RCN) and Unison, the public servants' union, repeated requests for specified ward staffing levels.

Life saving

Unison's Gail Adams said the report is more proof that patient care is about "safety in numbers", adding that the union's own study found only around 40% had the time for "safe, dignified and compassionate" care for patients.

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

"Depressing but unsurprising"

The general secretary of the RCN, Dr Peter Carter, said the findings were depressing but unsurprising, given the burdens on nurses and their time limitations.

"Something has to give," Dr Carter said. "Without enough staff on the ground, it's vital care such as having the time to talk with and reassure patients that suffers."

False economy

Dr Carter added that removing nursing jobs in pursuit of cost-cutting was a false economy. "It leads to poor care which in turn creates more strain on the system, particularly in accident and emergency departments. We need to prevent poor care by making sure wards are well staffed, not just use poor care as an early warning sign. We urge all employers to make use of this research."

Robert Francis QC, who chaired a public inquiry into the notorious oversights at Mid Stafford, said health officials should consider the "benefits and value for money of possible staff-patient ratios".

However, the Government has resisted this, insisting that hospitals have to retain the "freedom and flexibility" to determine their own staffing levels.

A spokesperson for the DoH said that hospitals have to determine their own staffing levels on a ward-by-ward basis. "But we have been absolutely clear that these decisions must be based on providing the best patient care."

The spokesperson added that hospitals must publish evidence to prove that staffing levels are adequate for their patients' specific care requirements.

"The new chief inspector of hospitals will be able to take action if hospitals are found to be compromising patient care by not having the right number of staff on wards."

The spokesperson also said that ministers were working with the National Institute for Health and Care Excellence (NICE), the Care Quality Commission (CQC) and NHS England to create better ways of helping hospitals determine their own staff levels.

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