More than a quarter of nursing staff in hospitals across the UK say patients are being treated in the wrong setting, meaning their care is being compromised and even made unsafe, a Royal College of Nursing survey has found.
The poll, of more than 20,000 nursing and midwifery staff respondents, found 27% of respondents working in hospitals reported clinical care taking place in settings such as hospital corridors and waiting rooms rather than on wards.
When it comes to emergency care, that number soars to nearly two-thirds (63%), the RCN’s ‘Staffing levels 2022 – tell about your last shift at work’ survey found.
The RCN says staff shortages are a key factor, with shortages across health and social care settings causing delays to patients being discharged into the community. This is leaving hospitals full and emergency care staff having to provide care in inappropriate settings.
One specific issue identified by respondents was extra beds being added to wards, making carrying out care more difficult and leading to a lack of privacy for patients and their families.
Alongside this more than two in five (46%) respondents working in a hospital said necessary care had been left undone due to a lack of time – a consequence of the large workforce shortages amongst nursing staff.
The impact on the nursing staff themselves included: they were "not able to care for patients as we would like", heightened stress levels, and staff left feeling "incredibly frustrated and embarrassed".
The pressure on nursing staff across the whole of health and care remains unsustainable with waiting lists at record levels, and UK governments not doing enough to recruit and retain nursing staff. This is adding even more pressure on an already exhausted staff.
The RCN is calling on governments across the UK to bolster the domestic workforce. It says pay is a key factor affecting recruitment and retention – in the midst of a cost-of-living crisis this year’s NHS pay award must be significantly above the rate of inflation.
Outside of A&E/urgent care, the number of respondents who said patients were being treated in the wrong care setting were:
- 23% in an inpatient mental health ward
- 17% of respondents working in an older people ward
- 12% of respondents working in a care home
- 14% working in the community, rising to 18% in community mental health teams
- 14% in GP Practices
RCN General Secretary and Chief Executive, Pat Cullen, said:
"It’s scandalous that nursing staff have to treat patients in the corridors, waiting rooms and even in the back of ambulances outside of hospital entrances. This has to avoid becoming a ‘new normal’ – it is putting patients at risk.
"We’re in the situation largely because of the failure of governments across the UK to address the nursing workforce crisis, which has seen more than 25,000 nurses leave the profession in the last year alone.
"It is very simple choice – invest properly in nursing – plan staffing based on the population’s needs, hold yourselves accountable and put the funding in place or even more patients will be waiting on hospital trollies and the queue of ambulances outside of A&Es will grow even longer."
One respondent, an NHS A&E/urgent and emergency care nurse working in Northern Ireland said:
"Patients waiting more than the safe recommended time for triage, patients being triaged and nursed in corridors. Patients waiting in excess of 12 hours for admission with no extra staff to nurse them as ward patients."
An adult acute ward nurse in the NHS in Scotland said patients and their relatives had complained about an extra bed being squeezed into a four-bedded bay, meaning they had "no buzzer, no curtains, not two-metre distanced."
She added: "I feel incredibly frustrated and embarrassed. It is totally inappropriate for ward rounds, nursing procedures, Covid precautions and an extra stress on staff."
A registered nurse on an acute ward in England, said:
"I feel I’m pulled from pillar to post, trying to juggle everything. Some shifts are relentless with no time for breaks. We are not able to care for patients as we would like yet the expectation is still there."
A sister on an England acute ward, said:
"Low staffing levels constitutes physical, mental and emotional exhaustion or burn out. It affects not only the safe and efficient provision of service from health care staff but also the standards and quality of care received by patients."
President of The Royal College of Emergency Medicine, Dr Katherine Henderson said:
"The current NHS crisis is dire, particularly in Emergency Care. The results of this survey will be familiar to our members who treat patients or see patients being treated in inappropriate care settings daily.
"Paramedics, doctors, nurses and all staff working in the Urgent and Emergency Care pathway are incredibly distressed at the current state of care. There is deep discomfort, concern, and fear about how things develop from here, particularly as we head towards winter.
"Patients are not receiving adequate care, some face serious harm as a result of dangerously long waiting times. What is most distressing is the lack of political will to take the urgent and meaningful action needed to tackle the crisis.
"Political and health leaders must get a grip; patients deserve better, and health workers need to see some leadership. Our leaders must face-up to the reality on the ground; patients are at serious risk, the health service is ceasing to function as it should, and staff cannot face this much longer."
Ends
Notes to Editors
The RCN’s ‘Staffing levels 2022 – tell about your last shift at work’ survey took place in March 2022. The survey received 20,325 responses from all nursing and midwifery staff working in different settings across the UK. Respondents were asked to report on the staffing levels on their last shift and the impact this had on patient care, including whether clinical care took place in an inappropriate environment.
The survey found that:
- 23% (4,666 out of 20,325) of respondents said that clinical care took place in an inappropriate environment.
- 27% (3,822 out of 14,408) of respondents working in a hospital reported clinical care taking place in an inappropriate environment, such as waiting rooms and corridors.
- 63% of respondents (1,237 out of 1,954) working in A&E/urgent and emergency care
- 22% of respondents (1,040 out of 4,747) working in an Adult acute ward
- 22% in Outpatients services (213 out of 990)
- 22% in Inpatient wards (445 out of 2,004)
- 21% in an Inpatient children and young people’s ward (213 out of 997)
- 23% in an Inpatient mental health ward (214 out of 925)
- 17% of respondents working in an older people ward (188 out of 1099)
- 16% in Intensive care unit/high dependency (189 out of 1213)
- 12% of respondents working in a care home (83 out of 682) told us care took place in inappropriate spaces
- 18% of respondents (113 out of 612) working in community mental health and 12% (259 out of 2083) in community nursing
