Current nursing staff levels are the worst they have been since coronavirus cases started to significantly rise again in the autumn, according to nurses who responded to a survey by Nursing Times. The findings paint a worrying picture of a workforce at crisis point.
The survey shows that the pressures faced by those working through the latest Covid-19 surge have been exacerbated by high levels of staff sickness and the need to self-isolate, with nurses warning the pandemic is “crippling” the workforce.
“It’s exhausting; we are running a continuous sprint, but the Covid-19 pandemic is an endless marathon”
Nurse respondent
Almost all nurses were working shifts that have been short-staffed due to colleagues being unwell or isolating, the survey suggests, with nearly two-thirds warning that levels were now at the worst that they had been since October.
Concerningly, 86% said they had worked shifts in recent months on which they felt patient safety had been at risk due to staff shortages – 23% felt this way during every shift and 26% on most shifts.
Similarly, 85% felt staff safety was being put at risk, with 20% feeling like this on every shift and 27% on most shifts.
The snapshot survey, carried out during the last two weeks of January and involving 1,200 nursing staff across the UK, highlights the extent to which nurses are feeling the impact of staff absences, with many warning that the situation was only getting worse.
Latest data from NHS England shows the number of staff off sick is on the rise. Almost 100,000 people were off work as of 6 January; of those, nearly half were related to coronavirus.
In our survey, 65% of respondents thought staffing levels were the worst they had been since October and a further 30% reported the situation was the same now as during the last few months. Just 5% said staffing levels were getting better.
Of those surveyed, 35% had taken time off work due to having Covid-19 or needing to self-isolate since October.
Meanwhile, almost a quarter had been off due to stress, fatigue or because of another mental health concern.
The negative impact of the pandemic on nurse mental wellbeing has been of great concern for many in the profession, and sparked Nursing Times to launch the Covid-19: Are You OK? campaign last April to raise awareness and lobby for support for the workforce.
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A hospital nurse who took part in the survey stressed that Covid-19 was “crippling the NHS workforce”, while another warned that “staff are already burnt out and the situation is getting worse”.
Reflecting on the seriousness of the current situation, one community nurse said: “I have been a nurse for almost 40 years – I’ve seen colleagues with low morale but this time they are broken.”
Another hospital nurse stated: “We are on our knees on every shift. Our trauma is continuing, we have no time to recover, we work extra shifts to support each other [and] there is no option to listen to our feelings, sickness, tiredness, stress or trauma we had on [our] last shift.”
Those who completed the survey recognised that more support was now available for staff wellbeing, but said a key issue was that they did not have time to access it.
“The problem is staff need time away to access the support and, due to lack of staff, sickness and competent staff, this is virtually impossible,” said one hospital nurse.
The negative impact of redeployment was also indicated by the survey. Many respondents said they were experiencing anxiety caused by working in areas they were not used to and without adequate staffing levels.
One was currently off sick with stress and anxiety, because of “being moved without notice to areas I’m unfamiliar with” and having to work on “dangerously understaffed Covid wards”. “I feel frightened and overwhelmed all the time,” they said.
“The staff I speak to every day tell me they have no fuel left in the tank and their resilience is being seriously tested”
Donna Kinnair
Meanwhile, another hospital-based nurse highlighted the anxiety felt by paediatric staff who now had to work in adult settings, noting that, although they wanted to help their colleagues, this caused much stress and was sometimes also at the detriment of staffing levels in their own area.
Likewise, several nurses also flagged issues around working with staff who were unfamiliar with the setting to which they were being sent to plug gaps.
“Staff redeployed from other areas to help us are of limited help, as they lack the specialist skills necessary,” said one nurse.
Respondents also warned that staff who had joined their team over the past year had “not received adequate training due to the demands of Covid”.
Concerned about staff and patient safety, one hospital nurse said the skill mix where they worked was “inadequate” and, like many other respondents, they were relying on staff to do extra shifts to cover sickness absences.
“Staff get moved from my unit almost every shift,” added another hospital nurse. “We are told it is the same everywhere… but I feel little is being done to help.”
Meanwhile, a critical care nurse highlighted that 50% of colleagues on their active roster had less than 12 months’ experience of working in an intensive care unit but were expected to manage “multiple, extremely complex” patients safely. The nurse added that staff were exhausted.
“You have to be on the ball at the top of your game constantly. It’s exhausting; we are running a continuous sprint, but the Covid-19 pandemic is an endless marathon,” they said.
Fears have also been mounting that many nurses will leave the profession after the Covid-19 crisis, especially those able to consider early retirement.
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A combination of workforce pressures and the negative impact on mental and physical wellbeing would be to blame, according to survey respondents.
One hospital nurse said they had already resigned “due to staffing levels and stress”.
In addition, there were concerns about the negative impact the staffing challenges were having on newly qualified nurses.
One hospital nurse, who qualified last October, said they felt “nothing but regret for entering this profession”, as they were unable to provide the level of care they wanted to and colleagues were too busy to support them.
Another newly qualified nurse said both the demands of the job and a “lack of support due to staff shortages” had already had a “negative impact” on their career and meant they were “thinking of leaving”.
For nurses currently off work, such as those who are shielding or unwell, it can also be a difficult time – some feel guilty for not being able to support colleagues.
“It is crucial that hard-working staff who have delivered care to thousands during this pandemic are also well supported and cared for”
Ruth May
Our survey revealed that some staff in nursing or care homes had even come back to work “too soon”, because they knew they were needed.
However, some respondents said they felt support seemed to be “geared towards” those shielding or off sick, while others said they felt they could not take time off for mental health problems, because it would leave the team short and “more at risk”.
Commenting on the survey findings, Dame Donna Kinnair, chief executive and general secretary of the Royal College of Nursing, said they “echo many of the concerns members are raising with us and where we are already demanding improvements”.
“The current pressure on health and care services is taking a toll on the wellbeing of nursing staff,” she told Nursing Times.
“The staff I speak to every day tell me they have no fuel left in the tank and their resilience is being seriously tested.”
Dame Donna stressed it was “vital” that staff were able to access funded support “where and when it is needed”.
She highlighted the shortage of 50,000 nurses across the UK that existed before the pandemic, saying it was “impacting patient care and staff wellbeing now more than ever”.
Meanwhile, Unison head of health Sara Gorton said: “Winters are always difficult, but the extra pressures of Covid mean unprecedented levels of anxiety and exhaustion for nurses and their colleagues.”
She added: “Nurses won’t abandon their patients. But the longer this unbearable situation continues, the risk increases that many will simply walk away when it’s all over.”
Responding to the survey, Ruth May, chief nursing officer for England, flagged the mental health and wellbeing advice lines set up to support the profession.
In a statement for Nursing Times she said: “It is crucial that hard-working staff who have delivered care to thousands during this pandemic are also well supported and cared for.”
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