Emergency nursing in ‘grip of an unprecedented exodus of staff’

A report by MPs published today highlights how the NHS in England could face a ‘substantially more difficult’ winter this year.

The Commons Health Committee document says poor performance has ‘become the norm’ for some NHS trusts, with increasing demand for services, insufficient staff numbers and bed-blocking.

A seminar comprising NHS trust leaders, held as part of the committee’s research, heard that the limited supply relative to demand for nurses meant they could be more selective where they worked – and they were not opting for emergency departments (EDs) because of the associated stress.

Unprecedented attrition

Responding to the report, RCN emergency care association chair Janet Youd said: ‘In emergency nursing across the country, we have seen attrition from the specialty that we have never seen before. 

‘Emergency medicine used to be a place where people wanted to work. It was exciting, cutting-edge and different every day. Now it’s seen as hard work. It’s frustrating when you feel you cannot deliver the care you feel is needed.’

Ms Youd called for more investment in education and training. She added that the RCN planned to publish frameworks showing the career trajectory for emergency nursing and the competencies required.

Her comments were echoed in evidence given to the committee by the RCN, which highlighted how EDs in England were buckling under the pressure of demand and a drastic shortage of nurses.

Building pressures

Responding to today’s report, RCN professional lead for acute, emergency and critical care Anna Crossley said: ‘EDs are not only coping with a lack of staff and resources, but also feeling the impact of pressures and delays elsewhere in the health and social care system. 

‘There is still a worrying lack of workforce strategy nationally to improve staffing levels and reduce these pressures.’

She added: ‘It is time the government had a serious look at how long health and social care services can continue to function when they are consistently under-funded and under-staffed.’

MPs also recommended the shortfall in social care provision is addressed to reduce avoidable admission and delayed hospital discharges. They pointed out that ED pressures were now felt all year round, peaking during winter.

Small improvement

Ms Youd said in her experience most ED attendees were not inappropriate users but older and frail people. She said a simple action to ease problems this winter would be to invest in extra blankets and pillows.

‘We know we are going to have patients on trolley beds. Let’s make sure they can be as comfortable as possible, let’s have blankets and pillows and allow nurses to take breaks.’

Figures show that for major EDs in 2015-16, only 88% of patients were admitted, transferred or discharged within four hours. The government standard is 95%.

Further information

• House of Commons Health Committee: Winter pressure in accident and emergency departments
• Emergency in emergency care?