Analysis

Telling it how it is: senior nurses voice concerns in RCNi survey

Nearly half of senior nursing workforce concerned for safe staffing on the front line

But, says RCN professional lead Christine McKenzie, 'we are on the cusp, given the new investment coming, of something new and brighter’


Picture: Alamy

Senior nurses have revealed growing concerns over safe staffing, quality of care and a perceived divide between front-line practitioners and decision makers.

In a Nursing Standard and Sunday Mirror survey of 3,100 UK nurses, 48% describe their role as clinical nurse specialist, nurse practitioner, matron, ward sister, nurse manager or director of nursing.

In response to the main findings, the RCN says experienced nurses should use their skills, power and influence to help support more junior staff and take on the ongoing challenges in the health service.

'Conveyor belt of recruitment'

1,356

of the 2,846 nurses who answered the question describe their role as senior

(Source: Nursing Standard/Sunday Mirror survey 2018)

One charge nurse from an acute trust in England explains: ‘I work with amazing, passionate, committed people, but I also feel let down every day and frustrated by the limitations that do not allow us to give the fantastic, innovative care we aspire to and are capable of.’

The nurse, who has worked in the NHS for 20 years, adds that lack of adequate services is affecting the safety and welfare of patients and staff alike.

She says: ‘I feel like I am constantly on a conveyor belt of recruitment with staff leaving the acute sector for what is seen as easier jobs in the community and public health.

'I feel let down every day and frustrated by the limitations that do not allow us to give the fantastic, innovative care we aspire to'

‘There are never enough nurses, and there is never enough time to do all the things expected of me as a nurse and ward manager.’

Plugging gaps on other wards

A district general hospital deputy sister says her band 5 nurses are regularly taken away from the critical care unit she manages, to cover shortages on other wards in the trust.

Key facts about survey

  • 3,100 nurses from all four UK countries responded to the online survey between 21 June and 4 July 2018
  • More than half of respondents (52%) work for acute providers in England
  • Around 14% are from community services
  • Another 8% come from mental health care providers
  • Approximately 6% work in general practice
  • 5% are from care homes
  • 15% come from the private sector, learning disability services and health boards and trusts in Northern Ireland, Scotland and Wales

‘When we are quiet, we have to go and support wards because they are so badly staffed.’

She tells Nursing Management it is often planned on a Friday afternoon that her staff can be taken away for use on Saturday and Sunday to cover weekend shifts on wards.

Nurses often say they feel out of their depth being put on unfamiliar wards and some have left for jobs elsewhere because of the practice.

‘There is no consideration of what might happen on our unit during that time and then we have two areas that are unsafe.’

She adds that there is a lack of much needed communication from staff at matron level and above.

‘We need better communication from our matrons as we hardly see them; a lot of nurses feel we are not well supported by the hospital hierarchy.’

RCN professional lead for the executive nurse network Christine McKenzie acknowledges that the situation across the UK is serious.

At the same time, she says it is ‘healthy’ that senior nurses feel able to raise such issues and points out there are examples of good practice around the country, despite the challenges.

Ms McKenzie says: ‘We are in an awful situation with acute nursing shortages and more nurses leaving the register than joining.

‘As an organisation, we are saddened by the experience of registered nurses and are working behind the scenes, and in front, to ensure we are building a profession fit for the future.’

What the survey also reveals

  • Three quarters of respondents (76%) say their workplace has inadequate staff to provide safe care
  • Half (49%) report being under pressure in their workplace to save money every day
  • Almost as many (47%) say they have seen patients suffer needlessly due to cuts to services
  • Most (64%) say they ‘infrequently’ have time to deliver safe care
  • More than 60% describe morale as ‘at rock bottom’ (19%) or ‘poor’ (42%)
  • 43% say they have considered quitting the NHS

76%

of nurses say they have too few staff to provide safe care

In response to the survey, a Department of Health and Social Care (DH) spokesperson says there are ‘near-record numbers of nurses’ working on wards since 2010.

He says the DH has increased the number of nurse training places by 25%, introduced flexible working arrangements and given NHS staff a ‘well deserved’ pay rise to address recruitment and retention issues.

But it is widely acknowledged that the NHS is floundering under the weight of a staffing crisis, as indicated by 40,000 vacancies in England alone, according to the RCN.

RCN chief executive Janet Davies warns that the extra NHS funding coming in England must now be invested in nursing staff, ‘both with new recruits and by valuing experienced staff to stop the haemorrhaging we’ve seen'.

Ms McKenzie adds that it is crucial that senior nurses, including directors of nursing, go back to the floor, engage with staff and listen to concerns.

She suggests that senior nurses join front-line nurses on day as well as night shifts, and take steps to ensure nurses receive support for continuing professional development, create safe forums for nurses to raise concerns and improve communication throughout the healthcare hierarchy.

‘It is not about fixing things overnight, but how can we as managers communicate better what we are doing; there are plenty of opportunities to share a dialogue and support staff.

‘How can we invite people to share dialogue and a common vision? Who can people talk to? That is leading and management.

‘There is also an opportunity for senior nurses to stay engaged through role modelling, and we need to create opportunities for nurses to do what they enjoy and are passionate about.’

Ms McKenzie concludes: ‘It does not feel like it now, but we are on the cusp, given the new investment coming, of something new and brighter.’

Senior nurses’ comments from survey

North west England acute trust nurse manager: ‘I just retired at a large financial loss to myself because the stress and responsibility of being a ward sister in the current climate was making me ill.’

West Midlands acute trust ward sister: ‘Healthcare needs to grow as social changes mean [that] managing discharge planning is taking nurses away from hands-on patient care.’

London acute trust clinical nurse specialist: ‘There are too many managers and, despite being a senior nurse, I am never sure what these managers are doing.’

South west England care home charge nurse: ‘The NHS has deteriorated over the years and I have watched this happening with a sinking heart. Politicians keep having meetings about how to improve the NHS while never asking people at the coalface how things can be improved. Get a group of experienced NHS nurses together to form a group. They will know what is needed by actual experience.’

‘I am frightened for the future – it is all about ticking boxes and hitting targets'

Scotland ward sister: ‘I am frightened for the future – the profession has changed in 25 years – it is all about ticking boxes and hitting targets. There is no time for professional development as the staffing establishment is too tight.’

 

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