Nurses look after 15 patients at a time
NHS nurses are having to look after up to 15 patients at a time, a major study has found.The study of 46 NHS hospitals, also found that at one in six trusts, unqualified healthcare assistants now outnumber nurses on the wards.
The findings show a sharp rise in their workload to levels which patients’ groups said compromised safety and left little time for compassion.
It follows growing public concern that hospital patients, especially the elderly, are being denied basic dignity and left thirsty and hungry.
A public inquiry into the Stafford Hospital scandal – where hundreds died amid “appalling” failings in care – is preparing to recommend changes to improve the quality of nursing.
Both the Stafford inquiry and a review of nursing ordered by the Prime Minister are considering whether healthcare assistants should be subject to regulation, and whether rules should be set to guarantee nursing levels.
These could set out either a maximum number of patients per nurse, or a ceiling for the proportion of assistants to qualified nurses on any shift.
The NHS has never set rules on nurse number, but in parts of the US and Australia, mandatory levels have been imposed – typically at around six patients per nurse.
Among the findings of the research were:
* On average, nurses were allocated 11 patients at night and eight by day;
* At some trusts, nurses were asked to care for 15 patients at night;
* Across the country, the proportion of qualified nurses to unqualified staff has fallen below safe thresholds outlined by England’s most senior nurse last year;
* Five years ago, on average there were two nurses for each assistant; now the ratio is closer to 1:1;
* Of 3,000 nurses who took part in the research, two-thirds said they ran out of time to offer “comfort” to patients and relatives;
* More than one-third said they ran out of time to safely supervise their patients.
The statistics disclose a sharp increase in nurses’ workloads. Five years ago, they were allocated an average of seven patients on day shifts and nine at night, previous research shows.
Patients’ groups said the study demonstrated that nurses had become dangerously over-stretched, with little heed paid to the lessons of the Stafford Hospital scandal, where standards of care fell dangerously low as nurses were replaced by cheaper staff.
Katherine Murphy, chief executive of the Patients Association said: “The situation has become absolutely disgraceful. One nurse cannot care safely for 15 patients, and identify when their condition is deteriorating, let alone offer comfort or compassion.”
She said it was “appalling” that so many hospitals had increased their reliance on unqualified staff, given the warnings made in the 2009 investigation into Stafford.
Although the health service has been given increases in its budget, just above inflation, it has been told to make £20 billion of efficiency savings by 2015 so services can meet the needs of an ageing population.
The Coalition had pledged to protect frontline jobs from any cuts. Last month, after official figures showed the number of nurses has fallen by 4,500 in two years, Andrew Lansley, the Health Secretary, conceded that the number of posts has fallen. He said decisions were taken by trust boards, not the Government.
Janet Davies, director of nursing from the Royal College of Nursing (RCN), said: “When there aren’t enough nurses, it has a huge impact on the quality of care for patients; they are left unsupervised for too long, and it is harder to provide compassionate care.”
The RCN wants regulation of healthcare assistants – unqualified workers who are only supposed to carry out non-medical tasks such as washing and feeding. It wants a limit set so that they cannot make up more than 35 per cent of nursing staff on any ward.
In evidence to the Stafford public inquiry, which is due to report in the autumn, England’s Chief Nursing Officer, who has just retired, said most wards should not go lower than a 60:40 ratio of registered nurses to unregistered staff.
Dame Christine Beasley said the decision by Mid Staffordshire Foundation trust to reverse that ratio – with six healthcare assistants for every four nurses on some wards, before the scandal was revealed in 2009 – was “unacceptable”.
The research discloses that the average hospital trust now has a balance of 56 per cent qualified nurses to 44 per cent healthcare assistants. In some hospital trusts the proportion of qualified nurses was as low as 43 per cent.
The research, led by the National Nursing Research Unit at Kings College London, found that older patients received the least care and attention. More than three-quarters [76 %] of nurses polled by researchers said there were not enough staff to get the work done.
Tags: Care Professionals, Health Professionals, nhs cash shortages, nhs cutbacks, Nurses, Patients' Association, RCN