Posts Tagged ‘Nursing’

NICE guidance on hospital nursing levels

By Mike Broad - 15th July 2014 9:54 am

New NICE guidance sets out ‘red flag events’ which warn when nurses in charge of shifts must act immediately to ensure they have enough staff to meet the needs of patients on that ward.

‘Red flag events’ include patients not being provided with basic care such as pain relief or help to visit the bathroom. An appropriate response could be to provide more skilled nurses or increase numbers of staff.

The guidance says having more than eight patients to one nurse on a ward in the day should act as a trigger for checking if care was being compromised.

But NICE stops short of stipulating absolute minimums on staffing numbers.

This latest guidance is designed to help ensure safe and efficient nurse staffing levels on hospital wards that provide overnight care for adult patients in England and is in response to concerns about standards of patient care in the aftermath of the Mid Staffs scandal.

The Francis Inquiry and the Berwick report outlined ways in which the NHS can improve care. Both reports raised the issue of staffing levels, with the Francis report explicitly stating that inadequate staffing levels at Mid Staffordshire led to the poor quality of care. The reports identified that NICE should be the lead organisation in the development of guidance for the NHS on staffing levels.

NICE said that as patients’ needs differ from day to day, there is no single staff number that can be safely and adequately applied across the wide range of wards in the NHS.

The government said the move was a “major step forward”.

The guidelines cover problems with basic care such as delays getting pain relief, not being helped on a visit to the bathroom or not receiving their medication.

Both patients and nurses on wards can raise red flags, which must then be investigated and explanations provided for what has gone wrong.

Professor Gillian Leng, deputy CEO at NICE, said: “Safe staffing is more complex than setting a single ratio. The emphasis should not just be on the available number of staff, it should be on delivering safe patient care and making sure that hospital management and nursing staff are absolutely clear on best practice to do this.”

Currently it is up to hospitals to set their own nurse staffing levels, but NICE was asked to look at the issue by ministers after it was flagged up by the public inquiry into the Stafford Hospital scandal.

Miles Scott, CEO of St George’s Healthcare NHS Trust and chair of the Guideline Development Group, said: “Acute wards see a variety of patients, from appendicitis to broken bones, from young to very old, and each individual has very different needs. This guidance has been trialled in over 100 hospital wards in 14 different hospitals and clearly sets out the factors that must be taken in to account to work out what is the adequate skill level and number of nursing staff required on that particular ward.

“Safe staffing needs to be about ensuring you have the right staff, in the right place, at the right time, to give patients the care they need and deserve.

NICE estimated implementing the guidance could cost £200m - about 5% of the cost of employing nurses on hospital wards - although it said that in the long run it would save money through improvements in care.

Prof Sir Mike Richards, Chief Inspector of Hospitals at the Care Quality Commission, said: “We support the principle that staffing on hospital wards should be based on the needs of patients, and welcome NICE’s guidance.

“Staffing isn’t just about numbers. Under our new approach to hospital inspections, we assess whether staffing levels and the skills and training of staff are appropriate in each of the services we inspect.

“We know that staffing levels impact both on safety and on patients’ experience of care. If we judge that staffing levels are impacting adversely on the quality of care, we expect to see improvements.”

Read the guidance.

Nurses shouldn’t care for eight or more patients

By Mike Broad - 13th May 2014 9:21 am

Registered nurses should not be caring for more than 8 patients during the day time on a regular basis, a draft NICE guideline warns.

Eighteen months after the Francis report revealed care failings at the Mid Staffordshire NHS trust, there are still concerns about how best to ensure we have enough nurses to provide safe care for patients.

So NICE has issued a draft guideline to help the NHS determine safe staffing for nursing on adult inpatient wards.

The guideline said that if nurses care for more than eight patients there is an increased risk of harm.

It stresses the importance of checking if patient needs are adequately being met in these situations. The lead nurse should consider any ‘red flag events’ as indicators of the ward becoming in danger of being under-staffed and therefore tailor the number of available nursing staff as needed.

Following on from the Francis and Berwick reports, the Department of Health and NHS England asked NICE to develop evidence-based guidelines to advise the NHS about safe staffing.

Its recommendations respond to the immediate expectations set out by the National Quality Board and focus on wards that provide overnight care for adult patients in acute hospitals.

On individual wards, the draft guideline highlights the importance of the nursing team’s awareness of patient needs and ‘red flag events’ which are signals that require an immediate response, such as an urgent need for additional nurses.

‘Red flag events’ include patients not being provided with basic care requirements such as help with visits to the bathroom, being asked about their pain levels or delays in providing medicines.

Professor Gillian Leng, deputy chief executive and director of health and social Care at NICE, said: “There is no floor or ceiling number on the required number of nursing staff that can be applied across the whole of the NHS. What the safe staffing advisory committee concluded was that assessing patient needs was paramount when making decisions about the number of nursing staff and planning should allow for flexibility on a day-to-day or shift-by-shift basis.”

The draft guideline also calls for hospital boards and senior management to take greater responsibility and includes step-by-step guidance on how to determine the number of nursing staff that should be funded. Ensuring there are enough appropriately trained staff should be a consideration as the evidence shows providing a higher proportion of registered nurses in the skill mix contributes to better outcomes for patients.

To support use of the guideline in hospitals NICE will be assessing a range of practical toolkits designed to assist in estimating staffing requirements. Staffing toolkits which comply with guideline recommendations and meet specified criteria will be given the NICE endorsement.

Leng added: “This guideline is an important step forward in addressing the issues of having adequate numbers of nursing staff within the NHS. It is vital that we have the views of relevant stakeholders and we now encourage registered stakeholders to submit their comments via the NICE website.”

The public consultation for the draft guideline closes on Tuesday 10 June 2014.

The final guideline is expected to be published in July 2014.

Read the guidance.

4000 fewer senior nursing posts than 2010

By Mike Broad - 12th March 2014 10:54 am

‘Reckless policy’ has left the NHS with almost 4,000 fewer senior nursing posts than 2010, draining valuable leadership, experience and specialist knowledge from the health service.

These are the findings of a Royal College of Nursing (RCN) report. It warns that the health service has been treating staff with years of experience as ‘disposable’ and a quick way to save money, which means specialist clinical knowledge and leadership is being lost just as it is needed more than ever.

Another tactic is ‘down banding’, or forcing senior staff into lower pay grades, the report says. This short-term measure permanently devalues the role and sends a message that experience and leadership is not valued in the NHS.

The report reveals that there are 3,994 fewer full time equivalent (FTE) nursing staff working in senior positions - bands seven and eight - than in April 2010. Staff working at these bands include ward sisters, community matrons, clinical nurse specialists and advanced nurse practitioners.

Dr Peter Carter, general secretary of the RCN, said: “As the Francis report rightly pointed out, patient care is affected when there are not enough senior nurses to effectively manage wards. When these positions are targeted for cuts, ward managers have less time to develop and support staff.”

Senior nursing staff also act as a vital link between management and clinical staff, the report says, and Carter points out that there is often a lack of communication between management and frontline staff in struggling hospitals.

“Senior nurses are ideally placed to act as a bridge between frontline staff and management, enabling resources to be used where they are most needed.

“In the community, senior and specialist nurses often work with a great deal of autonomy and are often solely responsible for patients. It is these patients who are affected when these posts are removed.

“Just as worrying is the loss of specialist clinical skills and experience which is inevitable when so many band 7 and 8 nursing posts are cut and left vacant. As more patients require complex care from specialist nurses, letting so many years of skills and experience vanish from the NHS is an utterly reckless policy.”

Carter added: “We need to be doing everything we can to retain the skills we have in the NHS rather than using them as a quick and easy way to make savings. These cuts are a short-term attempt by trusts to find efficiency savings, yet they will lead to a very serious and very long-term crisis in our health service.”

Paperwork is preventing more nursing care

By Mike Broad - 22nd April 2013 2:58 pm

Excessive paperwork is preventing nurses from caring for their patients, a Royal College of Nursing survey reveals.

The increasing burden of administrative work on nurses means they spend an estimated 2.5 million hours a week on non-essential paperwork and clerical tasks - more than double the 2008 figure. This equates to an average of 17.3% of all the hours worked by NHS nurses in the UK.

The vast majority (86%) of the 6,387 nurses who responded across the UK to the survey said the amount of non-essential paperwork such as filing, photocopying and ordering supplies had increased in the last two years, with over half saying it had increased dramatically.

In addition, more than three quarters (81%) of nurses working in every setting surveyed said that having to complete non-essential paperwork prevented them from providing direct patient care.

Peter Meredith-Smith, of the Royal College of Nursing in Wales, said: “We are in a situation now where the paperwork is extremely burdensome and can be difficult to navigate. It has become a complex and time consuming nature of the process. We need to work toward eliminating redundant and non-value-added paperwork.”

More than a quarter (27%) of nurses said their workplace doesn’t have a ward clerk or administrative assistant who helps with clerical duties, and of those most (81%) thought having a ward clerk or administrative assistant would mean they would be able to spend more time providing direct patient care.

Worryingly, the survey also found that if technology is not used properly it can actually increase the workload of nursing staff. Over two-thirds (69%) said the use of Information Technology has increased the amount of time they spend on paperwork and administration.

Commenting on the findings, Mike Farrar, NHS Confederation chief executive, said: “We fully recognise the story that the RCN’s survey tells. It is entirely consistent with the picture that has emerged during the first phase of our work on tackling the burden of bureaucracy in the NHS.

“More than four out of 10 NHS clinicians, managers and board members have told us they spend between one and three hours of their working day personally collecting and recording information. Three-quarters told us certain information collected for regulators or for national requirements is irrelevant.

“It is clear we need to do more to free staff from the shackles of unnecessary form filling and create more time to spend on patient care. We need a smarter system of information use, not a bigger one. And we need to embrace technology that helps rather than hinders staff, moving away from the paper-based archaic NHS.”

“NHS community services struggling to cope”

The Guardian - 14th May 2012 9:28 am

District nurses and health visitors are facing job cuts, rising workloads and less time to care for patients, despite pledges by ministers that NHS community services would be boosted to relieve the pressure on overstretched hospitals.

A dossier of evidence assembled by the Royal College of Nursing (RCN), which represents the UK’s 400,000 nurses, reveals that NHS services outside of hospitals are struggling to cope with growing demand brought on by the ageing population, hospital bed shortages and staff cutbacks.

The union also claims that a total of 61,113 posts in the NHS across the UK have been lost or placed at risk since April 2010, as the service undergoes a financial squeeze, including a £20bn efficiency savings drive in England by 2015.

Read more in The Guardian.

Nursing standards: PM aims to tackle ‘care problem’

BBC Health - 6th January 2012 2:57 pm

Nurses have been told to do regular ward rounds, and patients encouraged to carry out inspections to improve hospital standards.

They are part of a package of measures announced by the prime minister for the English NHS to tackle what he sees as a “real problem” with patient care.

David Cameron told the BBC problems in some hospitals had been overlooked out of respect for the nursing profession.

This new move has come after a series of critical reports in the past year.

Read more at BBC Health.

Too many working beyond limits of competence

By Dr Stephanie Bown, director of policy and communications at the Medical Protection Society - 7th October 2011 10:50 am

The big story last week was the call for ministers to introduce standards for the growing number of unregulated healthcare assistants working in the NHS.

Firstly the Royal College of Nursing’s Peter Carter highlighted the increasing replacement of nursing roles with HAs. And then the Nursing and Midwifery Council’s Prof Dickon Weir-Hughes said the lack of compulsory regulation and training of HAs means that many are working beyond their competence levels, increasing the potential for things to go wrong. Hundreds of complaints are made against HAs each year, but with officials powerless to act, we continue in a circle where lessons aren’t learnt and changes aren’t made.

Our experience at MPS shows that working beyond the limits of competence is an issue for many other health professionals, including nurses and doctors.

Financial constraints can lead to more responsibilities being given to less expensive staff. While this may save money in the short term, it doesn’t add up to safe care and increases the risk of costly mistakes.

With savings of around 4% to be made annually over each of the next four years, the NHS faces a massive challenge in maintaining standards of healthcare. If high level tasks are pushed down the chain to staff with insufficient training, this will lead to unsafe practice and harm to patients. These short term savings could potentially lead to high cost claims and complaints in the future.

Today, our health service is staffed with people who have wide variations of knowledge, skills and experience. More and more, we see nurse practitioners and advanced nurse practitioners providing frontline care in general practice and out of hours, but there is no regulation or minimum standard for job titles. This causes confusion and a real potential for a mismatch between responsibilities and competence.

I am also concerned that doctors who have trained outside the UK can be recruited to work in the NHS without any language testing or familiarity of NHS structure. The GMC’s decision to introduce mandatory basic induction is a welcome step to address this issue, but I still think more needs to be done.

Employers have an important role to play in ensuring that they recruit the right people, with the right skills and experience, to the right role. It is unacceptable to recruit without assessing CVs, references, skills and reviewing performance. It is critical that they also invest in specific high level training to make sure all healthcare workers have the right breadth and depth of skills to ensure safe and sound assessment of patients.

The safety of patients should always be our primary concern and it is important that tighter budgets and increased responsibilities do not push an already stretched healthcare system over the edge.

Many NHS nurses in England fear losing their jobs

Guardian - 3rd October 2011 10:00 am

Almost 75,000 nurses expect to lose their jobs, have their hours cut or see their roles downgraded in the next year, according to a survey that highlights the growing impact of the NHS’s financial squeeze.

Five per cent of the NHS in England’s 410,000 nurses - some 20,500 in all - believe their posts will disappear in the next 12 months. Another 24,600 anticipate a cut in hours, while another 28,700 expect to have their jobs reassessed as involving fewer responsibilities.

The findings, extrapolated from a Royal College of Nursing (RCN) poll of 8,000 of its members, have prompted renewed claims that the coalition is not honouring repeated promises to protect the NHS frontline from cuts.

Read more in The Guardian.

Apparently doctors might have a useful purpose…

By Bob Bury - 27th September 2011 12:21 pm

I don’t know if you’ve noticed, but the last few weeks have seen a number of reports in the medical and lay media that seem to be leading to a rather startling conclusion. Namely, that dumbing down in healthcare provision is widespread and may be a bad thing. It may even end up with the frankly bizarre suggestion that doctors have a useful purpose to serve.

But let’s not get ahead of ourselves. We’ll start with The Times’ report on the issue of the poor quality of nursing in our hospitals (I’ll link to some of those reports, but only those of you contributing to Mr Murdoch’s pension fund will be able to access them). It began with the now customary and justified complaint that nurses spend too much time in the classroom and not enough on the wards learning how to look after patients, with even Peter Carter, President of the RCN joining in the condemnation.

This then morphed into an argument that there weren’t enough qualified nurses on the wards because cash-strapped trusts have been replacing them with an army of health care assistants (HCAs) who now undertake most of the jobs traditionally performed by nurses, a move which today’s Times headline trumpeted as ‘a disaster in waiting’.

We’ll pause there for a moment to allow you to savour the image of nurses complaining about the usurping of their role by less highly-trained workers. There - you enjoyed that, didn’t you?

Incidentally, the first of those articles prompted a letter from someone asking why, if this decline in nursing standards had been going on for so long, the doctors hadn’t spoken out against it. I couldn’t be arsed to reply that we had, and that I, for one, had had a letter in The Times stating that we were raising a generation of nurses more at home with a clipboard than a bedpan. And of course the result of letters and articles in that vein, coming from doctors, is the accusation of arrogance and elitism - usually from nurses. As is so often the case, we’re damned if we do, and damned if we don’t.

Which would bring me on to skills mix, and the rise of the ‘practitioner’, but we’re all sick of reading diatribes about noctors, and the arguments for and against have been rehearsed at tedious length here and elsewhere. For what it’s worth, and at the risk of repeating myself, I believe that role extension, properly instituted and monitored, can rationalise the use of highly-trained staff and improve the service. I have even been actively involved in the training of radiographer practitioners who fulfill a very useful role in many of our imaging departments. There’s no doubt, though, that this whole process is now running out of control, driven by managers hell-bent on cutting costs, with no regard for quality of service or patient safety.

And then we have the recent report on the capital’s health services, telling us that more consultants are needed to cover junior staff, and that this could save 500 lives a year. In other words, from top to bottom, we are seeing a downshift in the grading structure of NHS staff, with an over-reliance on less highly-trained, and cheaper, staff. And this can only get worse as Lansley and Cameron drive through their ill-considered ‘reforms’, fragmenting the service further and exposing it to the wholly commercial motives of ‘any qualified provider’.

But as I say, if you follow the HCA/nurse argument up the food chain, it does at least look as if there may eventually be a grudging admission that doctors have some small contribution to make to the health of the nation. Which would be nice.

Winston’s fears over poor English of foreign nurses

Telegraph - 9th September 2011 7:51 pm

Lord Winston, the medical professor and television presenter, warned yesterday of the potential risk to patients from nurses with poor English.

Speaking in the House of Lords, he pointed to particular problems with nurses coming from some former Eastern Bloc countries such as Romania and Bulgaria.

“Communication between the patient and the professional is of vital importance,’’ he told peers. “We run the risk of losing it with this issue of nurses who can’t speak the English language and have been trained in a different way.”

Lord Winston was taking part in a debate on the different training standards for foreign health workers.

Read more in the Telegraph.