An experienced nurse claims she "dreads" coming into work some days due to significant staff shortages in her department. Sandra Robinson-Clark, a nurse who has spent 30 years in the health service, said speaking on behalf of Royal College of Nursing (RCN) in Wales these workforce issues have now become a daily occurrence.
Her comments come on the back of a new survey by the RCN which discovered that only one in five nurses who responded felt they had had enough time to provide the level of care patients deserved. Meanwhile four in five respondents (78%) felt that patient care was being compromised due to not having enough registered nurses on the shift.
Sandra, who works as a nurse in north Wales, explained: "Some days you dread coming to work because you're thinking 'Oh my God, how many wards are short-staffed today?'" By default, she added these staffing issues are compromising patient care. "It's common sense. If you haven't got enough staff to deliver the care, then obviously that care will be compromised.
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"You come to work to do a good job, you don't come to do a bad job. And it's just difficult because if you're short-staffed, you haven't got the time to care for everybody and do all the tasks and the care that is required. I've talked to patients myself, and patients have told me that they can see that the nurses are short-staffed and although patients obviously have a right to complain when you've had shortfalls in your care, it's not deliberate.
"Patients have the right to speak up and we encourage that we all need feedback, but patients have told me themselves they can see how fast we're running around and getting stressed trying to do everything for everybody."
She added that an over-stretching of the workforce can result in falls increasing - particularly in the older population - due to lack of supervision. Other issues that can arise include hospital-acquired pressure ulcers due to nurses not having the time to turn bed-bound patients.
Sandra said workload pressure on the nurses can also see mistakes occur with medication. She explained: "These are all the kinds of things that, when you're pressurised or interrupted doing your tasks, mistakes can happen."
While agency nurses can help to plug gaps in the workforce, Sandra said there is no continuity of workforce. Three-quarters of those who responded to the RCN's study reported a shortfall of at least one registered nurse on their shift (68%, compared to 57% in 2020). The majority were working with 50-74% of the planned number of registered nurses for that shift.
"We've just had two years through the pandemic, which has been extremely challenging and stressful on all of us. And now we're just feeling it's like winter pressures all through the year," said Sandra, adding that the pressures are taking a toll on their resilience and morale.
"It's very nice being called angels and clapped through the pandemic, but that doesn't help with the lack of nursing staff, or the pressures that we're under, or the poor pay, and it doesn't make us feel valued as a profession."
Despite this, Sandra said nurses continue to work beyond their contracted hours and often go home late in an attempt to get all the tasks completed. Additionally, she said nurses will work through their breaks in an attempt to ensure patients in their care are looked after.
All of these factors are leading to burnout and PTSD in nurses, thus being a "huge factor" in sickness and staff retention, Sandra explained, which she said is a shame as she views nursing as a "wonderful and rewarding career".
Helen Whyley, director at RCN Wales, said: "It is saddening yet not surprising that over half of our nurses in Wales are feeling demoralised. They are telling us that only 32% of shifts had the full number of planned registered nurses (RNs) on shift. We have safe nursing legislation here in Wales which has undoubtedly contributed to positive outcomes for patients. We want to see the legislation extended to other clinical areas including mental health and the community.
"We know that having the right number of appropriately qualified, competent, and experienced nurses protects both the public and the nursing profession. The Welsh Government needs to take action to address the responses from this survey. We need more nurses in Wales. We need fair pay, flexible working conditions and continuing professional development. These issues will not go away, and the government need to invest in nursing to ensure the safety of our patients in Wales."
Last year the Welsh Government announced record levels of more than £260m for training healthcare professionals in Wales. It said the investment for 2022/23, which is a 15% increase from 2021/22, will see the highest ever number of training opportunities in Wales. It will be the eighth consecutive year funding to support health professional education and training in Wales will increase.
The government's 'Six Goals for Urgent and Emergency Care' programme aims to support the NHS to make improvements to the way it provides services – including increasing staffing "in crucial areas" to help people access services as close to home as possible. An additional £25m annual funding for this programme, including £20m this year to increase capacity in urgent primary care and same-day emergency care.
In response, a Welsh Government spokesperson said: "Staff illness and Covid-related absences have had a significant impact on staffing levels in recent months, but we are committed to ensuring health boards across Wales have sufficient numbers of staff to deliver safe care for people in their communities. We hugely value all our NHS workers and continue to work with unions and employers to ensure staff are well supported, both in work and if they need to be absent from work due to sickness."
In addition, the Welsh Government said it is working with health boards and local authorities to increase social care workforce capacity and provide timely transfer for people from hospital to their homes with appropriate support in place.
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