Corridor nursing: why nurses are despairing and angry about the ‘new norm’ in the NHS
Nursing Standard readers reveal concerns over undignified care and patient safety breaches
Nursing Standard readers reveal concerns over undignified care and patient safety breaches
- Almost two thirds of respondents to our survey said corridor care was ‘a daily occurrence’ in their workplace
- December saw an unprecedented number of emergency department attendances in England
- Staff report missed meal rounds and toileting for patients stuck in corridors, and a lack of privacy
Nurses have described how ‘corridor nursing’ has increasingly become the norm, as NHS hospitals struggle to cope with rising numbers of patients.
Of the almost 850 nurses across the UK who responded to a Nursing Standard survey, nearly two thirds (65%) said providing care for patients on trolleys in hospital corridors was a ‘daily occurrence’.
Our findings prompted one leading emergency nurse to warn that the practice could become the next major care scandal (see ‘The sickest of patients...’ box below).
One respondent said their ten-bed ward often had 28 patients in its care, while another said patients were cared for in corridors ‘every single day, most of the day’.
‘It was said it would be a rarity, but it is every day,’ another nurse told our survey.
attendances were recorded at emergency departments in England in December 2019
(Source: NHS England)
Staff scared for the safety of patients
Staff say caring for people in corridors, a practice also known as ‘boarding’, is unsafe and robs patients of their dignity and privacy.
‘It scares me being a nurse, I’m scared for the safety of patients,’ one respondent said. ‘It should be a never event.’
Another added: ‘It isn’t proper nursing care, it’s merely a conveyor belt of patients receiving substandard treatment and it’s become totally acceptable.’
The current situation was described by one respondent as something staff would expect to see in a developing country.
‘We need a solution to the social care crisis’
RCN director of nursing, policy and practice, Susan Masters called the survey findings ‘shocking’.
‘No nurse goes into the profession to provide care in any inappropriate place, and no patient wants that for themselves when they go into hospital, yet these findings show that the practice is becoming more and more commonplace as emergency departments (EDs) become increasingly overcrowded,’ she says.
‘EDs must be safely staffed, and the same for all wards, which would mean more beds can be opened. Greater support in the community can prevent patients from going into hospital in the first place. We need a solution to the social care crisis, a knock-on of which means vulnerable older patients simply can’t be discharged from hospital.’
Unprecedented number of ED attendances
Our findings follow NHS statistics confirming that the health service in England experienced its busiest month on record in December, with an unprecedented number of ED attendances and ambulance call-outs.
NHS England monthly performance statistics show there were 2,181,024 ED attendances in December 2019, up 6.5% on December 2018. This resulted in 4,307 extra attendances per day – the highest number on record.
In November, every major ED in England failed to hit its four-hour waiting time target for the first time, with all 118 units falling below the 95% threshold, according to NHS England.
‘The sickest of patients are being left in corridors, frequently unsupervised’
Consultant nurse in emergency medicine Cliff Evans, of Medway NHS Foundation Trust, says the survey results show the problem of corridor nursing is ‘serious and widespread’.
He fears it could become the next big care scandal, comparable to that at Mid Staffordshire NHS Foundation Trust, where major failures of care led to patient deaths.
‘The association between placing undiagnosed and acutely unwell vulnerable patients in corridors and suboptimal patient outcomes is well established,’ he says.
‘There are ways to manage the problem safely, but for many organisations this is the first year this issue has arisen, and the result is alarming as the sickest of patients are being left in corridors, frequently unsupervised with little or no care.
‘Be clear, these patients are the most frail and vulnerable patients, frequently in their 80s, otherwise they would be placed in waiting rooms, but they require "major"-type care.
‘The lack of national guidance or standards leads to organisations applying local measures that frequently result in an unsafe and undignified environment.’
Trust ceased corridor nursing due to impact in patients
Mr Evans was seconded to Medway by NHS England in 2015 to address its high mortality rates.
He says corridor nursing was stopped at his trust in October 2016, when an internal review identified the significant impact of leaving patients in corridors.
This view was confirmed by a Care Quality Commission (CQC) report, which highlighted the practice of corridor nursing and the associated impact on patient mortality rates.
Earlier patient assessment introduced
After an extensive review of the literature and existing practice at Medway, Mr Evans, supported by the senior ED team, developed a bespoke initial assessment tool based on early warning scores.
This system ensures patients are seen earlier by a clinician and referred promptly to specialties or admitted. There is clear evidence that this can lead to a marked reduction in episodes of harm, including death.
In March 2017, the trust came out of special measures, with CQC inspectors noting ‘improvements made to the triaging and management of patients in the emergency department... patients were no longer treated in a corridor. The handovers and safety briefings in the ED were effective and ensured staff managed risks to people’.
Corridor nursing also occurs outside of emergency departments
Almost three quarters of our survey respondents (74%) said they had cared for patients in corridors over the past 12 months.
‘I have triaged, performed investigations and [provided] nursing care to ten patients at a time in a corridor,’ one ED nurse said.
Respondents said corridor nursing was an issue affecting not just EDs but also other wards, including acute medical, care of older people, neurology and paediatrics.
‘Some who can walk will leave their trolley and go to the toilet and, on coming back, find their trolley taken away or someone on it’
Nurses spoke of their despair at caring for patients crammed either between bays or lining busy, noisy corridors.
The number of extra attendances per day in emergency departments in England in December 2019
(Source: NHS England)
Corridors are often cold, staffing ratios may not take into account the extra patients, and they can be missed from meal rounds, respondents pointed out.
Treating patients in corridors raises privacy and medication problems
Nurses also said essentials of care such as toileting, pressure area skin checks and handovers can be missed in the chaos of patients being kept in areas they shouldn’t be.
One respondent said: ‘These patients need the toilet and it’s difficult because you cannot give a bed pan or urine bottles for men with everyone watching.
‘Some therefore wet the bed and become angry or ashamed. Some who can walk will leave their trolleys and go to the toilet and, on coming back, find their trolleys are taken away or someone is on it because it’s difficult to know who is where because the electronic system has just recorded them as corridor patients. It takes longer to give medication [because] the nurse has to ask [to] verify [a patient’s identity].
‘We have even had to create extra "cubicles" for resus patients with portable monitors and screens.’
Even patients with sepsis or cancer sometimes placed in corridors
Even extremely unwell patients may be placed in corridors, despite the lack of equipment and oxygen facilities available, respondents said.
Patients left in corridors included those who had sepsis or hip fractures, or who had experienced a heart attack.
‘Having to ask patients their full name and date of birth to give meds in front of other patients and relatives can feel intimidating, and I’m sure must breach data protection’
One nurse told the survey that her husband was placed in a corridor when dying from cancer.
The ‘exhausting and sometimes terrifying’ experiences that patients have had in hospital are making people who need acute care reluctant to go in, one respondent said.
Patients are often put in corridors by ambulance staff when EDs are full and, even with this, more ambulances are often backed up outside waiting to bring patients in.
‘Our department has for a long time used corridor nursing due to capacity,’ one respondent said.
‘Having to ask patients their full name and date of birth to give meds in front of eight to 12 other patients and their relatives can feel intimidating, and I’m sure must count towards a breach of data protection. It feels awful having patients, sometimes very old, lay in front of someone who is very intoxicated and not be able to afford them their privacy.’
The nurse shortage figure for England
(Source: NHS Digital)
Trolley waits are not only uncomfortable but often long
Waits are often long for patients on trolleys, the survey suggests. Some 44% of respondents have seen patients wait for between four and 12 hours in the past year, and 12% have seen patients stuck in a corridor for more than 24 hours.
One respondent told of a 97-year-old patient on a trolley for more than 24 hours, while another said patients have remained on a trolley in a corridor for six nights waiting for a ward bed to become available.
Our survey follows a warning at the start of winter from the Royal College of Emergency Medicine (RCEM) that the NHS in England needed at least 4,000 extra beds to prevent patients being treated in corridors.
It said more than 15,000 beds had been lost since the first quarter of 2010-11.
‘Cuts to the bed base must be reversed, otherwise we will end up seeing more patients stranded for hours on trolleys in crowded corridors,’ said RCEM president Katherine Henderson.
Government says emergency departments must be expanded
Responding to our survey findings, an NHS spokesperson said that while the health service has more beds open this winter than last, EDs have had to treat more than a million extra patients over the past year.
‘So as well as 50,000 more nurses and extra hospital beds, over the next few years it’s also going to be necessary to rebuild and expand most EDs across England,’ the spokesperson said.
How ‘corridor nursing’ went viral – and nurses’ views on the term
A photo showing a nurse wearing an armband bearing the phrase ‘corridor nurse’ prompted a huge response on social media when it was posted online in December.
While it is not known if the picture is genuine, the outpouring of comments from healthcare staff showed how widespread the problem of caring for patients on trolleys has become.
Some staffing rotas denote ‘corridor nurses’
In our Nursing Standard survey, many respondents said their trust did allocate staff to corridors and that some used the term ‘corridor nurse’.
Many nurses were appalled by the idea that caring for patients in corridors had become normalised to the point that it was part of the staffing rota.
Respondents described corridor nursing as demeaning, soul-destroying and unacceptable. ‘The "corridor" nurse is often more vulnerable than other nurses in the unit as they have no "safe space" for their patient,’ one respondent said.
‘No plumbed oxygen, no safe working space in the event of cardiac arrest, seizure [or] allergic reaction. Also, our corridor patients are split across the unit, male one side, female the other, in line with same sex policies as we are not A&E. This means that while I am tending to corridor patients on the male side, I can't see any potential issues that may be occurring on the female side.’
Staff also said they are more likely to receive verbal abuse from frustrated patients. ‘When you see your name next to "corridor nurse", it gives a sense of "oh great, I’m going to be screamed at all day".
‘I think it needs to be changed before it becomes the standard accepted term.’
More focus on targets than safety
For some respondents, however, corridor nursing is a practical response to a significant problem.
‘It is essential to have nurses on corridors to maintain observations and meds,’ one nurse said.
Another respondent reported: ‘Often the corridor patients have no one allocated to them at all and it's only passing staff that attend to them. Again, this is due to nurse managers who are more focused on targets than patient safety.’
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