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Nursing staff stretched to breaking point over workloads, report reveals

Press Release 28/11/2019

RCN employment survey reveals nursing staff stretched to breaking point

Nursing staff across the UK are under such pressure that six out of 10 say they cannot provide the level of care they want to patients.   Barely a quarter think their pay is appropriate for the level of responsibility and stress they face at work, while three in 10 have suffered physical abuse from patients or relatives in the past 12 months. 
These are some of the 2019 findings of the major survey of nursing staff carried out since 1986 by the Royal College of Nursing (RCN) [see notes 1 and 2]. 
The results come two weeks before the conclusion of the General Election campaign, in which the NHS and health and social care have played a major part, and on the day that official figures will reveal the extent of nursing shortages in the NHS in England over the last four years [see note 3].
The survey paints a bleak picture of the overwhelming pressure most nursing staff work under in the UK, whether they are employed in NHS hospitals, community nursing, care homes or GP practices.  It also highlights a pervasive ‘blame culture’ in healthcare, with nurses expressing how vulnerable staff shortages make them feel.  As a result, 37 per cent of those surveyed say they are actively looking for a new job. 
Key findings from the 2019 survey are:
  • 61 per cent of nursing staff say they are too busy to provide the level of care to patients that they would like, a significant increase from 43 per cent 10 years ago.  54 per cent say too much of their time is spent on non-nursing tasks such as paperwork
  • Six in 10 of those questioned say their pay band is inappropriate for the work they do, as it no longer reflects the level of education and training required to do their job, nor the stress, pressure and demands that 21st century nursing involves
  • The percentage of nurses who are happy with their working hours has dropped from 73 per cent in 2009 to 51 per cent this year
  • 29 per cent of nurses surveyed had suffered physical abuse from patients or relatives in the past year, while 65 per cent had experienced verbal abuse
  • Healthcare assistants reported increasingly being asked to take on the duties of registered nurses
  • Nursing staff working in independent sector care homes consistently provided more negative responses to questions, indicating that this sector is under particular staffing pressure

The survey asked questions about nurses’ experience across five different subject areas: working patterns and workload; pay and additional work; the nature of work, and respondents’ views about nursing; physical and verbal abuse and bullying; and education and training.

This response from a Band 5 staff nurse working in urgent and acute care in the North West of England was typical of those received:

“I struggle every day because I cannot give levels of care that I would like to give, so I work harder and harder and at the end of the day I feel exhausted. 

"All I do is go to work and sleep, and the occasional cooking and tidying my house.  We are expected to do so much training but I never get time to do it and I end up doing this in my spare time. I love being a nurse and [it] is all I want to do for the rest of my life, but I am looking at relocating to another country where I can have a better life work balance and where I can look forward to going to work”.

These comments from healthcare assistants reflect the trend among some employers use HCAs to take on registered nurse duties:

“We are increasingly expected to do jobs a qualified nurse is expected to do. We do not get paid the same and it increases our workload.”

Band 3 health care support worker, NHS hospital ward, North West of England

“The role of health care assistants is developing into traditional registered nurse roles. RNs are taking on more clinical tasks, senior nursing roles have developed but the banding system doesn’t reflect this.”

Band 3 health care support worker, NHS acute and urgent care setting, Wales

Commenting on the 2019 survey results, RCN Chief Executive and General Secretary Dame Donna Kinnair said:

“Our 2019 Employment Survey should be required reading for all politicians who want to form the next government.  The findings lay bare the serious consequences for both patients and nurses of the huge number of vacant nursing posts across the UK, with 43,000 vacancies in the NHS in England alone.  

“Yet failure to increase nurse numbers isn’t inevitable, but a political choice.   We need proper financial help for nursing students in every nation of the UK in order to ensure the supply of nurses in the future, and clear legal duties for Governments and NHS leaders across the UK to ensure there are enough nurses to provide safe care to patients [see note 4].  

“Health and social care services can't hope to recruit and retain staff if they don’t focus on the employment experience of their staff, but our new survey findings show that for many nurses, the picture is poor.

“Patients depend on nurses to keep them safe in hospitals, in care homes and in their own homes.  At its best, nursing gives people a sense of identity, pride, achievement and a huge sense of fulfilment. But our findings show that the pressures on staff are becoming so overwhelming that we risk losing more nurses from the already depleted workforce”.


Notes to editors

1. The RCN Employment Survey has been conducted since 1986.  Some questions have been retained throughout this period, allowing accurate comparisons of responses to be made over time.   Questions for the 2019 survey were sent to a selected sample of the RCN’s membership across the UK, with 8,311 responses received.

2. The 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. 

3. NHS Digital will publish NHS Vacancy Statistics for England, covering the period February 2015 - September 2019 (Provisional Experimental Statistics), at 0930 today [28th November]. The most recent data comprise both numbers of vacancies notified to NHS Improvement by Trusts, which revealed 43,617 nursing posts vacant in Q1 of 2019/20; and numbers of job advertisements posted, which are collected by NHS Digital.

4. Bursaries for nursing students in England were abolished by the Westminster Government in 2016.  However, since 2016, all students on nursing degree courses have been required to apply for loans. During this period applications to study nursing have fallen by 29 per cent.  The RCN is calling for at least £1 billion per year to be reinvested in nurse higher education in England, in order to encourage higher numbers to study nursing. Funds for cost of living should be sufficient and responsive to actual need, aligned with credible tuition support.  This must be the centrepiece of a package of investment that begins with encouraging more people to study, enables universities to offer as many nursing places as possible, and helps new graduates in the workplace.  Significant investment continual professional development of the existing workforce is also essential.

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