NHS nurses reaching danger point

A new survey of almost 3,000 nurses from across the UK reveals a health service under severe strain, with 65% of staff saying that they did not have enough time with patients and 55% reporting that as a result care was left undone.  This is despite the fact that 50% worked through their breaks or beyond their shift.

The survey – undertaken on Tuesday 4 March – shows a typical ‘day in the life’ of the NHS. The majority (60%) felt that the number of staff working on the day resulted in a lower standard of care and more shocking still were statistics showing that 45% of nurses were caring for 8 or more patients 

Despite the many recent investigations into the NHS, the survey report* – Running on Empty – exposes clear failings to improve staffing levels. The impact on patients was plain to see. A worrying 48% of respondents described their organisation as either being at risk of a similar situation to Mid Staffs, or stated that it was already happening inparts, or across their hospital. 

UNISON’s report highlights research that demonstrates the clear link between appropriate patient staff ratios and patient mortality. Independent evidence shows that nursing cutbacks are directly linked to higher patient death rates in hospitals. In addition, when a nurse or healthcare assistant is responsible for eight or more patients, harm is occurring.

Gail Adams, UNISON Head of Nursing, said:

“One of the most damaging findings of this survey is how little has changed since last year.  Despite all the Government rhetoric, despite the Francis, Keogh and Cavendish reports, the spectre of another Mid Staffs still looms large over the NHS. Progress on safe staffing levels has been glacial and that means poorer care and patients still at risk. 

“It’s clear that despite nurses working through breaks and beyond their hours, they simply do not have enough time to give patients the care and attention they need.  That is distressing for patients and for the staff trying to care for them.  The Coalition Government needs to face up to the damage it is inflicting on patients and staff, by not introducing legally enforceable nurse to patient ratios, and take urgent action.”

The over-use of bank and agency staff is also exposed in the survey with 45% of staff reporting that they worked alongside one or more agency/bank workers. UNISON has always supported their use to cover holidays or unexpected gaps, but the regular use of these staff is not cost effective or in the best interests of patients.

The union points to anecdotal evidence that some hospitals draft in bank or agency staff for the duration when they are expecting a CQC inspection. 

Gail Adams, went on to say:

“Relying on bank or agency nurses because of understaffing is a false economy.  It is frustrating for existing staff because they are often unfamiliar with the ward and it is unfair on patients who experience a lack of continuity of care.  The answer is to ensure that there are sufficient established nursing posts to provide safe dignified and compassionate care.”

 Key Findings

  • Three quarters of all midwives and 71% of all nurses (general and mental health) said they did not have adequate time with each patient.
  • 59% of all nurses on a night shift said there were elements of care they were unable to give.
  • 92% supported minimum staffing levels, with 65% supporting a legally enforceable minimum.
  • 45% of staff were looking after 8 or more patients during their shift, this increased to 53% on night duty.
  • Despite National Quality Board guidance, only 24% of workplaces displayed indented number of staff on duty.
  • Just over half (51%) were not confident about raising concerns locally, which, in a post Francis era, is worrying.

Some typical comments taken from the survey findings:

“I have been pressured to take admissions when due to lack of staff it has not been safe to do it.”

“On occasions, staffing levels are bordering on dangerous.  We are in a Mid Staffs situation and I don’t believe we are the only ones.”

“Both my staff and I frequently have to work alone which is very unsafe.”

“I did not feel able to provide the type of care I would have liked to the patients.  It felt more like a conveyor belt.  No compassion, little dignity, I left at the end of my shift feeling distraught and that perhaps I have made a huge mistake training as a registered nurse.”

“My department is running at VERY UNSAFE levels due to inadequate staffing.”

 “I am the only qualified nurse on a 13 hour shift, so I don’t get a break during these shifts.  You get tired. It’s unsafe. 

“Some shifts are now 100% bank staff.”

“We have patients that need to be monitored closely following procedures or during therapy, with many needing to be checked on an hourly basis.  That cannot be done when there is a ratio of one nurse to 11 patients.

“I felt I was being bullied to take extra patients from A&E.”

Staffing levels in the NHS will be debated at the UNISON annual healthcare conference in Brighton between 13-15 April 2014. 


Notes to Editors

UNISON is sharing details of any hospitals named as having failings on a par with Mid Staffordshire Foundation Trust with the Care Quality Commission prior to publication of the survey. 

The areas of care in which respondents worked on 4 March covered the whole spectrum of healthcare.  This included A&E, paediatrics, elderly care, community mental health, critical care, general practice, learning disabilities, medical, mental health (inpatients as well as secure unit) obstetrics and gynaecology, surgical, rehabilitation and theatre.

The report, “Running on Empty – NHS staff stretched to the limit” is available here