A new report found that three out of four nurses say they have no time to talk to older hospital patients and many are so rushed they can’t help them to eat. A lack of qualified nurses is jeopardizing safe care for the elderly on wards which are still dominated by age discrimination, according to the Royal College of Nursing.
The RCN’s report says the over-65s are more likely than other hospital patients to be in the hands of healthcare assistants. Typically, one registered nurse is expected to look after nine elderly patients who may be frail, acutely ill and have complex medical needs. The RCN is calling for a new deal on nurse numbers to ensure the elderly are properly looked after, with at least one nurse for seven patients and two-thirds of staff being registered nurses.
At present, there is a 50:50 split of registered nurses and healthcare assistants (HCAs) on wards for the elderly which, coupled with staff shortages, is said to be putting patients at risk. The report says, “On older people’s wards that have fewer registered nurses than others, more episodes of missed or compromised care are reported. Often there is simply not enough time and skill to satisfactorily deliver activities such as comforting and talking with patients.”
The report, based on a survey of 1,700 nurses including 240 working on NHS wards for older people, found more than three-quarters said lack of time meant they could not comfort or talk to patients, or could only do so ‘inadequately’. More than half said promoting mobility and self care was left undone or unfinished, while a third said they could not patients with food and drink. A third said they were unable to fully help patients to the lavatory or manage incontinence.
The RCN’s research reveals average staffing levels of one registered nurse for nine older people which compares with 6.7 patients per nurse on adult general wards, and 4.2 on children’s wards. The RCN says basic, safe care needs one registered nurse per seven elderly patients and, ideally, one between five and seven. It recommends a ratio of 65 per cent nurses to 35 per cent HCAs.
Nurses often had too little time to supervise HCAs properly, said the RCN, which has previously criticized the NHS for being too reliant on less-qualified staff. RCN chief executive, Dr Peter Carter, said, “Patients on older people's wards are being let down by systemic failings in our hospitals. Despite working tirelessly to provide patients with high quality care, nurses in these settings have repeatedly told us that they are unable to do this because of pressures caused by short staffing. It is unacceptable that there are not enough nurses on older people's wards. This is an outdated historic disadvantage dating back to 'geriatric' wards of the past and must be urgently addressed.”
Dean Royles, director of NHS Employers, said, “Mandatory staffing levels cannot guarantee safe care.” And Jo Webber, deputy director of policy at the NHS Confederation, which represents NHS organizations, said, “We know that in too many cases, older people on NHS wards have been let down by poor care. The answer, however, lies in tackling a complex range of issues in areas like culture, values and styles of leadership.”
Care services minister Paul Burstow said, “The ratio of nurses to beds is already improving. We know from Care Quality Commission inspections that good nurse leadership on the ward is essential to delivering high-quality care. Through the Nursing and Care Quality Forum, we are working with the RCN and others to make sure that more nurse time is freed up for frontline care.”
In January, a survey of more than 2,500 NHS staff for Nursing Standard magazine found examples where HCAs were working beyond their competence. Nurses cited cases where HCAs administered drugs without proper training, were left in sole charge of patients with complex needs and some were left running units and clinics.
Michelle Mitchell, director general of Age UK said, “Low staffing levels on hospital wards dangerously compromises older patient’s care and dignity. Good quality care must combine high quality clinical care with compassionate care. Nurses need time to be able to look after, listen and respond to their older patients, many of whom will have complex medical and emotional needs. When healthcare professionals are understaffed and consequently focused on task based, rather than person based care, the dignity and care of older patients can be severely jeopardized.”
RCN Scotland director Theresa Fyffe said, “As health boards come under increasing financial pressure to deliver the same services to more and more people, they are saving money when nurses leave by not replacing them or by replacing them with nurses and healthcare support workers at lower paid bands. Older people often have more complex health conditions so they must be given the best care by an appropriate mix of qualified nurses and healthcare support workers. This is particularly the case if stays in hospital are to be minimized so older people can return home or to a care home as soon as reasonably possible.”
She added, “The resulting pressure on staff of health board cuts means that care needs, such as comforting and talking with patients and helping with food and drink, can be overlooked. It is time that senior charge nurses, who manage hospital wards, are given the genuine authority to be able to decide their own staffing levels locally on a day-to-day basis, to reflect fluctuating patient need. The needs of older people in hospital must not be overlooked as the move to better integrate health and social care services in our communities gathers pace.”
“While I welcome the Scottish government's commitment to improving the care of older people, today's RCN report lays bare the need to seriously tackle the issue of staffing levels in our older people's wards and I therefore urge the government to give serious consideration to the patient guarantee of a minimum of one professionally qualified nurse per seven patients.”
Labours' health spokeswoman Jackie Baillie said, “This report highlights the very real consequences the SNP's cuts to the health service are having on Scotland's older people.” Liberal Democrat MSP Alison McInnes said, “This research shows that the loss of nurses is putting a huge strain on the NHS. This loss of skill and expertise threatens the quality of care that patients, especially older and vulnerable patients, can expect to receive.”
Age Scotland's policy officer Callum Chomczuk said, “Low staffing levels on hospital wards can seriously compromise older patients' care and dignity. What we need is a shift in the balance of care in which resources are focused in the community and on keeping older people healthy, safe and out of hospitals.”
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