Pressure on nurses at 'inadequate' North Middlesex ED exposed by CQC inspectors

A trust has been criticised for having inadequate nurse staffing and failing to ensure mandatory training had been completed.

The Care Quality Commission (CQC)  inspectors – supported by two senior nurses with experience in emergency and general medicine – this week published the results of their April and May visits to North Middlesex University Hospital (6 July 2016).

The London-based hospital’s urgent and emergency services have been rated ‘inadequate’ while medical care ‘requires improvement’.

Inspectors discovered the emergency department was often short of middle-grade doctors, leaving nurses to carry out rapid assessment and treatment of patients arriving by ambulance

Two-hour waits for triage

Meanwhile the first point of contact for walk-in patients was untrained receptionists leading to a two-hour wait for triage by a nurse – way over the national standard of 15 minutes.

Inspectors note an ‘insufficient number of nurses per shift’ to fulfil the 1:4 nurse-to-patient ratio which nurses themselves say averaged 1:10 because of high numbers of patients waiting in corridors to be treated.

One of the recommendations the CQC makes is to complete annual appraisals for all eligible nursing staff.

This comes after trust data showed only between 37% and 50% of those scheduled for the first three months of this year had been completed despite a target rate of 90%.

Mandatory training was being completed only by between 66% and 74% of nursing staff.

Ward death unnoticed for over four hours

Despite an hourly rounding target of 90% being achieved throughout January, it was reported that one patient had died in their bed and was not discovered for four-and-a-half hours.

The emergency department nurse vacancy rate for January-March was 12-14% against a 5% target while sickness absence among nursing staff was between 8-9% compared with a below 4% average in England.

On the positive side, inspectors were pleased to see specialist mental health liaison nurses available 24/7 while all band 5 nurses had completed an A&E training course.

Eight band 7 nurses are attending leadership courses.

'Listen to staff and the unions'

RCN London regional director Bernell Bussue said nurses had raised concerns about practices for some time, which was ‘reflected in a high turnover of nursing staff’.

He added: ‘The management need to listen to their staff and the unions to ensure effective and safe staffing and first class patient care.

North Middlesex University Hospital medical director Cathy Cale said: ‘We are extremely sorry for the current problems in A&E and for the long waiting times for some patients.

‘We are committed to getting back to the standards that we and our patients expect and, working with our health partners, are taking all the necessary steps to address the concerns raised, particularly the shortage of doctors which lies at the heart of it.’

For more information:

North Middlesex University Hospital Trust CQC report