Ratios Not Rationing
Executive summary
UNISON has been campaigning since 2012 for safe staffing levels in the NHS including in hospitals, on mental health wards and community clinics. As part of this campaign, the union has run an annual survey highlighting how understaffing affects nurses and patients.
Objective
The survey monitors staffing levels to assess the quality and safety of care patients receive. It calculates the average number of patients a registered nurse cares for on a ‘typical’ shift. Missed care, job satisfaction levels and burnout are measured too.
The report also investigates how risk levels on wards have been affected by this government’s policy of not enshrining minimum staffing levels in law.
Survey method
For this year’s report Ratios Not Rationing – the sixth carried out by UNISON – a total of 2,704 nursing staff completed an online questionnaire about their Tuesday 7 February 2017 shift.
Survey results
Three in five (63%) respondents said staff numbers were inadequate to deliver safe, dignified, and compassionate care. Two in five (40%) rated the quality of patient care as poor or fair, and more than a quarter (27%) said patient safety was failing or poor.
Nurses cared for an average of 13 patients but the nurse/patient ratio differed significantly between departments, with six the average for acute wards and 62 for community nurses.
Three in five (60%) respondents said slips, trips or falls happened on their shift; nearly half (49%) said pressure ulcers occurred; and more than two in five (44%) said errors were made in administering medication. These are all indicators of unsafe staffing levels according to health watchdog the National Institute for Health and Care Excellence (NICE).
Staff working extra hours and missing breaks are also warning signs that patients could be at risk along with frequent use of agency workers. Ratios Not Rationing found that more than two in five (41%) respondents worked overtime with more than a quarter (26%) doing more than one extra hour. Half missed all or some of their allocated break(s), and nearly two-thirds (64%) said agency staff were often used.
Missed care is another safe staffing concern. More than two-thirds (69%) of respondents said developing or updating care plans was more likely to be rushed, unfinished, not done to an acceptable standard – or even missed entirely. The responses were similar for educating patients and family (66%), and comforting or talking to patients (63%).
Work dissatisfaction was an issue for nearly half (49%) of respondents. More than half (54%) would leave their current job but carry on nursing if they could, and one in ten (10%) did not want to carry on nursing at all. Increased workloads (73%), stress at work (72%), and unsafe staffing levels (68%) were the most relevant factors in their decision to leave. High levels of exhaustion and feeling disengaged were also factors in leaving.
Nearly three in five (58%) had raised concerns about unsafe staffing levels during their shift. But a significant number (65%) said their worries had not been listened to, acted upon swiftly, or addressed.
UNSAFE STAFFING ON ACUTE WARDS
Ratios Not Rationing implies that staffing levels are worst on acute wards. Nearly three-quarters (72%) of staff treating acutely ill patients said numbers were inadequate to deliver safe, dignified, compassionate care.
Nearly two in five (41%) respondents were caring for eight or more patients during their shift, despite a NICE recommendation of eight as a maximum.
More than a third (34%) rated patient safety as failing or poor, and nearly half (46%) said the quality of patient care was either poor or fair.
Three-quarters (75%) said their ward or hospital unit often used agency staff, half (50%) were unable to take their entire break– or any breaks at all–and just under half (45%) worked overtime.
Many (73%) staff working on acute wards said comforting or talking to patients was unfinished, rushed, not done to a high standard or missed entirely.
Slips, trips and falls happened during shifts according to nearly four in five (78%) staff; more than two-thirds said this was the case with pressure ulcers; and more than half (54%) with medication administration errors.
More than half (51%) of respondents were not happy with their current job. Nursing staff on acute wards had the highest average levels of exhaustion and disengagement. More than two-thirds (67%) raised concerns about unsafe staffing levels, but seven in ten (70%) said their concerns were not listened to, acted upon, or addressed.
Recommendations
Ratios Not Rationing highlights how the government’s approach to safe staffing is not working because there are not enough nurses to deliver safe, compassionate care. The situation will get worse given nurses are considering leaving their job – or the profession altogether –because of burnout and work dissatisfaction.
The decision to abolish NHS bursaries this year has meant less people are applying for nursing courses. This means hospitals will have to hire more agency workers to fill staffing shortfalls.
UNISON is calling on ministers to commission research into safe staffing ratios and use the findings to set mandatory NHS limits. This would improve the quality of care and patient safety, increase recruitment and retention of nurses, and ensure greater workforce stability.
It could also encourage more people to train as nurses, boosting the workforce and ensuring patients receive the safe, dignified care they deserve.