Most ward nurses are forced to ration care and leave aspects of it undone, due to low staffing levels across NHS hospitals.
A survey of 3,000 nurses working across 46 NHS hospitals in 2010, published online in BMJ Quality & Safety, found that 86% reported ‘missed care’ incidents.
The authors recommended that nurse-rated assessment of missed care be used as an “early warning” to identify risks to patient safety.
However, with Foundation Trusts looking to cut nursing levels by 4% across 2014–16, rationing of acute care is certain to worsen.
In 2011, Lord Hunt, the Chief Executive of Birmingham Heart of England NHS Trust, stated that cuts of 15% in nurse staffing levels would not affect the quality of patient care.
However, the survey identified a relationship between nurse headcount, risk of missed care, and danger to patient safety.
It considered 13 care activities. Of 2,917 respondents, 86% said they had been forced to leave undone at least one of these in their last shift.
On average, nurses were leaving four activities undone; those most likely to be rationed were talking to patients, updating care plans, and documentation.
The average number of patients per nurse was 7.8 by day and 10.9 by night. Nurses looking after more than 11 patients were twice as likely to ration patient monitoring as those looking after six or fewer.
The survey found a consistent relationship between levels of ‘missing care’ and patient safety: wards rated as ‘failing’ on patient safety by the nurses had an average of eight care activities left undone.
The authors said: “Our findings raise difficult questions for hospitals in a climate where many are looking to reduce – not increase – their expenditure on nurse staffing.”