Nursing single-handed: understaffed and caring for patients alone

Staffing pressures mean nurses are often left alone with an unreasonable caseload. But a safety system already in place can help you challenge such expectations

A nurse wearing a mask, caring for multiple patients alone on a ward, with one patient in bed in front of her and one in bed behind her
Picture: iStock

How many patients or people have you – or a colleague – been left to care for alone?

It is the kind of morbid nursing trial in which no one wants to participate but everyone has some experience.

Single-handed and not safe for patients or staff

The latest publicised case involves a nurse who was single-handedly in charge of 17 patients with complex needs, a Care Quality Commission (CQC) report uncovered.

Yet the incident at Good Hope Hospital in Sutton Coldfield, Birmingham, whose trust has been served with a warning notice to make safety improvements, wasn’t even its starkest staffing gap. On a separate occasion, a lone nurse on another ward at the hospital was left to care for 26 patients.

Since the report was published, we have been inundated on Nursing Standard social media channels with tales of far worse nurse: patient ratio crises dating back decades, with one nurse recounting a time when they had sole responsibility for 60 patients on a shift.

Staffing shortfall is a safety incident worth reporting

This is not a new problem, but today’s nurse staffing vacancies have made it more acute. Nursing workforce experts and unions have also been warning about the consequences for a long time, and unsafe staffing is a central issue in the ongoing pay dispute in England.

What is the answer? We all know we need more nurses who are better paid, so the profession can recruit and retain staff in sufficient numbers, but safe staffing isn’t as simple as numbers; skill mix is crucial.

‘Incident reporting is the way to go on staffing issues, with systems such as Datix designed to report safety concerns, which should be reviewed by senior staff’

Making a dent in the problem can seem beyond the scope and time of an average nurse who is just trying to get through a shift without incident. But incident reporting is the way to go on staffing issues, with systems such as Datix designed to report safety concerns, which should then be reviewed by senior staff.

No record without a report

There are legitimate concerns these reports will be ignored or discouraged, and also it takes confidence (and time) to submit an incident. But without them there is no evidence of workforce planning and management shortcomings other than nurses’ own burnout and post-shift anxieties.

Speaking up about working beyond your competency is similarly daunting, but can be empowering. This is about being the patient’s – and nurse’s – advocate.

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Further information

RCN (2023) Impact of Staffing Levels on Safe and Effective Patient Care

Flavia Munn is Nursing Standard editor