A&E nurses under pressure to meet four-hour target

Published: 29 April 2008

Nine out of ten [1] Accident & Emergency (A&E) nurses have felt unduly pressured to meet the four-hour waiting target, according to a new survey from the Royal College of Nursing (RCN).
 
The survey of over 500 frontline A&E nursing staff across the UK shows that pressure to meet the four-hour waiting time has had negative consequences on the quality of patient care. Three quarters (75 per cent) of nurses say patients are regularly admitted to inappropriate wards [2] just to meet the target.

RCN Scotland Director, Theresa Fyffe said that although more than half (52 per cent) of A&E nurses felt the introduction of the target generally had a positive impact on patient care, many believed that lowering the percentage of patients to be treated within the time limit would improve quality of care.

“Therefore the RCN is calling for a more realistic target of 95 per cent of patients seen within four hours rather than the current 98 per cent. This would give A&E staff the flexibility and time to deliver the personalised, quality care patients deserve.

“More than anything, A&E nurses want to meet the needs of patients, but feel constrained by the needs of the four-hour target. Nurses’ concerns need to be heard and addressed. The survey makes it clear the target is too restrictive and unrealistic to provide the kind of care nurses want to deliver,” Theresa said.

The survey was conducted by the RCN Emergency Care Association (ECA). Lisa Falconer, Staff Nurse in the Royal Infirmary of Edinburgh Emergency Department and member of the ECA, said:

“The survey results highlight the concerns of many healthcare professionals striving to achieve the four-hour target. Whilst the 98 per cent target allows a margin for clinical exception, there is no flexibility for occasions when service and resources are under excess pressure. Whilst many would agree the target has streamlined and improved efficiency of the patient journey, nurses feel they are compromised in their professional ability to deliver quality nursing care.”

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More information

For further information or interviews, contact Heather Wallace on 0131 662 6172 or 07962 801 005 (out of hours).

Notes to editors

Other survey findings include:

  • More than half of nurses (59 per cent) felt that the responsibility to meet the target lay primarily with nursing staff as opposed to other clinical colleagues.
  • The survey also found that 78 per cent of nurses felt that certain patients with multiple and complex needs had their care rushed and compromised to meet the target.
  • Survey results were released at the RCN’s 2008 Congress, being held in Bournemouth from 27 April to 1 May. 

Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world.  The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations

  1. 93 per cent of respondents said that they felt unduly pressured to deliver the 4-hour target.
  2. This means anywhere outside the Accident & Emergency Department. Once a patient is across the threshold of the A&E department, they have officially been discharged and they are off the A&E waiting list.