High nurse vacancies, burnout and low morale found in overrun ED
Improvements ordered after catalogue of problems identified by inspectors
Inspectors of a busy emergency department (ED) have reported significant concerns about staff burnout, violence and aggression from patients, and dirty beds amid a sky-high nurse vacancy rate.
Inspectors from the Regulation and Quality Improvement Authority in Northern Ireland also flagged concerns about overcrowding and patient safety at the Royal Victoria Hospital in Belfast after an unannounced inspection between November 2022 and February 2023.
Staff vacancies were prevalent across all areas of the ED, with band 5 nurses seeing the highest vacancy rate at 44.7%, according to the inspection report published on 26 July.
Staff expressed concerns about the high number of newly qualified staff
The report comes just weeks after nurse Kieran McCormick sounded the alarm over the ‘dire’ situation at the hospital, run Belfast Health and Social Care Trust, after his 92-year-old grandmother was left waiting 14 hours for care.
The inspectors said: ‘Burnout of staff was reported to be a significant issue. Staff expressed concerns about the high number of newly qualified staff and the significant responsibility given to them as a consequence of crowding.
‘Themes emerging from staff engagement included low morale, consistent pressure due to crowding, staff shortages, impact on staff health and well-being, impacts on quality of care, and moral injury.’
They said some staff had experienced increased incidents of violence and aggression and ‘feeling unsafe at times’.
Quality improvement plan includes cleaning audits and reviewing roles and responsibilities of nurses
Inspectors also noted patients were being treated without the dignity of privacy, an increase in reporting of safety issues including patient sores, falls, medicine errors and beds blocking corridors, alongside infection control breaches.
The Regulation and Quality Improvement Authority issued a quality improvement plan to the trust including full cleaning schedules, monthly cleaning audits, and reviewing roles and responsibilities of nursing staff in light of overcrowding.
The authority’s chief executive, Briege Donaghy, said: ‘Clinical staff and their professional bodies have told us of their severe concerns, frustrations and distress at the persistence of the situation.
‘Without service reform the ED will continue to be pressed to operate beyond its capacity and outside its core purpose, with resulting increased risks to patient safety and to its staff.’
Trust cites challenging circumstances and says it has taken steps to address concerns raised by the authority
In a statement the trust told Nursing Standard that inspectors had visited ‘during a period of extreme winter pressures, unprecedented ED overcrowding and unacceptable waiting times’.
The trust said it had taken steps to address concerns raised by the authority, including establishing new triage pathways, the creation of a dedicated medical assessment unit and improved ambulance handover times.
It said: ‘Delivering these recommendations can only be achieved with our talented and dedicated workforce who ensure our patients and service users continue to receive the highest possible standard of care in spite of these challenging circumstances.’
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