The impact of nursing shortages

Wake Smith Solicitors 13 November 2017

A recent report by the Royal College of Nursing (RCN) has shown some alarming shortages of staff across the UK which could be placing patients at risk.

Scott Haslam, a solicitor in clinical negligence at Wake Smith Solicitors, looks at the implications thrown up by the 2017 'Safe and Effective Staffing: Nursing Against the Odds' report.

“The RCN report makes for interesting, but uncomfortable reading and does pose the question about how safe we or our loved ones might be if admitted to hospital under the current staffing levels.

“It is the most natural thing in the world to assume that a patient admitted to one of our great hospitals is going to be looked after in the best way possible, but that can only happen if the hospital in question has exactly the right balance of medical and healthcare staff to ensure the safety and correct care of those patients.

“According to the RCN report, more than half of our hospitals are substantially lacking in qualified nurses and there is evidence to show more nurses are leaving the Nursing and Midwifery Council Register than are joining it, making this a long-term issue.

“One of the key summaries in the report is as follows:

'In 2009, the proportion of registered nurses within the nursing team in adult general wards was 62% – it is now at 58%. Having more support staff does not safely or adequately compensate for having too few nurses in terms of quality, outcomes or mortality rates.'

“What this clearly demonstrates is that the mix of nursing staff versus support staff, who are often unqualified and lack the relevant skills to to assess patients or to escalate treatment for those patients, is reducing and that has far-reaching effects.

“When a patient is admitted to hospital, the assessment that takes place to determine whether that patient is at risk, either through infirmity, confusion, long-term illnesses or other factors, is in danger of being overlooked or delayed if there are not enough qualified medical nursing staff in attendance. Additionally, the patient may not be monitored correctly during their hospital stay to see if he or she is in need of extra help as there are insufficient nurses to undertake this important role.

“Where we often see accidents in hospitals, it is because a full assessment of the patient's needs, beyond the immediate trauma or medical issue that brought them to hospital, hasn't been undertaken thoroughly or in a timely fashion.

“This is a fundamental part of the triage of care and should identify if the person is confused and therefore may not be able to let staff know when they need to go to the bathroom for example. Under those circumstances, the patient should be monitored more closely – in the most severe cases, this care may need to be on a one-to-one basis.

“Some patients may not have the mobility to take themselves to the toilet, or to move around in bed and alleviate pressure points which can lead to bed sores. Such patients should know that they can use a bedside buzzer to seek assistance, but with a lack of nursing staff, there are incidences where confused or elderly patients have attempted to leave their bed unsupervised and have fallen as a result

“The RCN report also outlines that 36 per cent of nurses surveyed had been forced to leave 'necessary care undone' due to a lack of resources.

“This is a very worrying statistic and although we must acknowledge that the nurses are not deliberately neglecting duties, pressure caused by reduced staff is causing these issues.

“There is also the extended problem of overcrowded and understaffed accident and emergency wards where patients may be left for a long period of time before any assessment is given. Figures recently obtained by the BBC confirmed that the NHS in England has so far failed to meet every monthly target this year – one of which is the target for A&E wait times of four hours. In 2012-13 it hit its key hospital targets 86 per cent of the time. This means that where a patient has been brought directly from a care home for example, they may not have any family with them and may be left unattended for several hours.

“Common problems and injuries which may arise from poor staffing in hospitals include falls, causing fractures and soft-tissue damage, bed-sores and ulcers from failings in ward care and progression of underlying health problems due to inadequate monitoring or assessment.

“What patients and families need to know is that the hospital has a duty of care and if these obligations are neglected, they can face legal action.

“As the RCN report is a relatively recent report on the state of nursing staffing levels across the NHS, we anticipate that this is an issue which will become more prevalent.”

The RCN report makes four key recommendations to healthcare providers to address the issue of under-staffing of medical nurses in hospitals and the effects of this reduction on patient care:

1. legislation for the accountable provision of safe staffing levels

2. increased funding, with political accountability for safe staffing

3. credible and robust workforce strategies

4. scrutiny, transparency, openness and accountability

Scott added: “The report details clear points which would go a long way to improving the standards of care that we all should expect from a hospital.

“These points are all valid and we are in support of them, particularly the need for legislation which will enable accountability for the provision of safe staffing levels, but credible and robust working strategies must also go some way to protecting the safety of those who are in hospital care.”

If you have been affected by medical negligence call Wake Smith on 0114 266 6660 or email at [email protected]

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