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Nurse leaders issue warning over staff numbers

Hospital nurses

Campaigners say more nurses means better care


Senior nurses have issued an “unprecedented warning” about hospital ward staffing levels in England.

The Safe Staffing Alliance says hospital wards regularly have each registered nurse looking after eight patients – which they say is unsafe.

The group, which includes the Royal College of Nursing, Unison and the Patients Association, says safe nursing levels have been ignored for too long.

The government said hospitals were responsible for their own staffing.

The Safe Staffing Alliance, which also includes a number of directors of nursing at English hospitals, was formed last summer.

It says the one nurse to eight patients ratio should not be regarded as a minimum acceptable level of staffing.

And it says research has shown the risk of harm and death increases if a nurse is asked to look after more than eight patients.

It is calling for any instances where nurses have to look after more than that number of patients to be publicly recorded and investigated.

‘Compassionate care’

The alliance quotes a survey of nurses at 31 English hospitals, in which just under 3,000 people took part.

Overstretched nurses are not able to give patients the care they need”

Katherine MurphyPatients Association

They said that wards were run with the one to eight ratio about 40% of the time.

In a statement, the group said: “For the sake of clarity, more than eight patients per registered nurse is the level considered to be unsafe and putting patients at risk. It is not a recommended minimum.

“For nurses to provide compassionate care which treats patients with dignity and respect, higher levels will be needed and these should be determined by every health care provider.”

Katherine Murphy, chief executive of the Patients Association, said the Care Quality Commission had cited staffing levels as a key issue for patients.

“Patients said they thought all staff, and in particular nurses, were overworked,” she said.

“A frequent comment was that staff were caring but that they ‘did not have enough time for you’.

“The fact is without adequate staffing levels, overstretched nurses are not able to give patients the care they need.”

Elizabeth Rob, the chief executive of the Florence Nightingale Foundation – which is part of the Alliance – said adequate staffing was vital.

“We already have fundamental standards in a range of areas: in maternity, in intensive care, in children’s services – so this is not new,” she said.

“We just don’t have it for the majority of general hospital wards, and that’s really important – because it’s where our most frail, most vulnerable elderly patients are, and it is our view that this has to be brought in.”

Health minister Dan Poulter said: “It is for hospitals themselves to decide how many nurses they employ, and they are best placed to do this.

“Nursing leaders have been clear that hospitals should publish staffing details and the evidence to show that staff numbers are right for the care needs of the patients that they look after.”

And he said the soon-to-be appointed chief inspector of hospitals would be tasked with taking action if hospitals were found to be compromising patient care by not having the right number of staff on wards.

But Dean Royles, chief executive of NHS Employers, said setting a minimum national nurse-to-patient ratio was not the best way to work out staffing levels.

“The report does say, for example, that ratios of one to four or one to six are often provided, and that the majority of organisations do do that,” he said.

“To me it would be a tragedy if we started all working towards a national nursing ratio at the expense of those other professionals that are providing fantastic care to patients too.”


Stafford Hospital nurse ‘refused to help lift patient’

Tracy White and Sharon Turner (left to right)
Tracy White (left) and Sharon Turner (right) are accused of altering hospital records

A senior nurse at Stafford Hospital refused to help lift a seriously ill elderly patient from a wheelchair on to a bed, a tribunal has heard.

The hearing was told sister Tracy White also called the woman, known as Patient B, “a naughty little monkey” for not taking her medication.

The patient died a day after being admitted to A&E in May 2007.

Ms White and another nurse, Sharon Turner deny a series of misconduct charges.

Former A&E staff nurse Helene Donnelly told the Nursing and Midwifery Council tribunal at the Old Bailey that Tracy White had refused to lift the patient from a wheelchair.

She also claimed Ms White then told a junior doctor to discharge Patient B because she was going to “breach waiting time targets.”

Patient B was taken to a nursing home but was readmitted the next day, when she died of a pulmonary oedema.

‘Victims of management’Helene Donnelly said Tracy White was not to blame for the patient’s death but she said the woman had been given “a very uncared-for and undignified last 24 hours.”

“I feel this is because of the pressure placed on nurses and junior doctors by the nurse in charge at the time, who was sister White,” she told the tribunal.

Also giving evidence, Katherine Kelly, a staff nurse and later sister in A&E, said the two nurses were “victims of hospital management,” which at the time had a “bullying culture”.

Helene Donnelly
Helene Donnelly told the hearing Tracy White had put pressure on doctors to discharge patients

“Nurses were punished by the trust if they spent more time with the patients, if that resulted in them breaching the four-hour target,” Ms Kelly said.

Ms Kelly told the tribunal that in October 2007 Ms Turner had advised nurse Donnelly to lie about a breach time.

The two senior sisters are accused of falsifying hospital data and instructing others to do the same.

They also face charges of making inappropriate comments about patients and staff, and transferring patients before they had been properly assessed.

Ms Kelly said Ms Turner had a dry sense of humour and comments could be “not politically correct,” but with no intended malice.

The pair both deny the allegations, which if upheld could lead to them being struck off.

The fitness-to-practise hearing is expected to last up to two weeks.


Enhanced incentives to attract more to join healthcare sector

A nurse helps a patient to a bed

SINGAPORE: Mid-career professionals will enjoy enhanced incentives when they switch careers to become a nurse or allied health professional from April next year.

These include fully-sponsored course fees and higher monthly training allowances of between 50 and 70 per cent.

Minister of State for Health Amy Khor announced the changes on Saturday.

As the government invests in more healthcare facilities to cater to an ageing population, the demand for nurses and allied health professionals will also increase.

One way to grow the pool is to attract more mid-career professionals, who will need to undergo a professional conversion programme by the Workforce Development Agency.

Former electrical engineer, Yeo Suan Hoe, said: “WDA has provided this opportunity for me to study diagnostic radiography and this has helped me to prepare myself to work as a radiographer in SGH.”

Such programmes typically cost between S$62,000 and S$68,000 for each trainee.

About 20 to 30 per cent of fees are currently funded by employers, while the rest are subsidised by WDA.

But from April next year, WDA will bear all training fees.

Monthly training allowances will also go up.

For example, registered nurses or allied health trainees can expect to receive allowances of between S$1,500 and S$1,700, compared the current S$1,000 payout.

Minister of State for Health Amy Khor said: “We find that one of the stress points for mid-career professionals switching into healthcare really is the loss of income during their conversion training period… and the cost of the training itself. This is why we are enhancing our training allowance for the sponsored candidates during the conversion training period by 50 to 70 per cent.”

To help mid-career professionals make an informed decision on the career switch, from next year, they will also be given an opportunity to undergo an attachment at a healthcare institution prior to joining the conversion programme.


Nursing the call to heal

from left) Betterline Nyorid, Muhd Farhan M. Yusof and Kalaiselvi Kumaresan

Being a nurse involves dedication and compassion. Three nurses tell Kasmiah Mustapha more about the challenges

THEY have chosen a profession that many of us take for granted. Theirs is a career that, according to them, receive little, if any, recognition and appreciation.

But their desire to help others has helped them overcome the challenges they face as nurses. Three nurses from Pantai Hospital Kuala Lumpur, tell us they have no regrets.

In his three years on the job, Muhd Farhan M. Yusof, 25, has had to deal with more challenges since he is working in a women-dominated profession. While those in the healthcare industry are used to male nurses, the public is still a bit sceptical about their capabilities.

“They think male nurses are effeminate, because it is a woman’s job. Some patients are uncomfortable with me, so I can’t do my job properly. Even my friends teased me when I told them I wanted to become a nurse.

“I told them that nursing was like any other job that both  genders can do. Of course, there are more women doing it but that does not mean the job is not for men,” says Muhd Farhan, a staff nurse in the operating theatre.
He admits that even he was hesitant when his father’s friend suggested that he become a nurse after he quit his job. When he found out that nurses earned good salaries and had the opportunity to work abroad,he decided to give it a try. He joined Pantai Nursing College and graduated in 2009.

“I love being a nurse in the operating room because I learn a lot and it’s challenging. There are days when I have to pull a double shift and help the surgeons with complicated surgeries.
“Not many people can do my job, especially with the blood and stress but that is what makes it interesting and exciting. Now I can tell my friends about all the wonderful things I am involved in.They are impressed and have even changed their minds about male nurses.”


Though new at the job, he feels that nurses are under-appreciated and there is a lack of acknowledgement from the public. He hopes there will be efforts made to raise awareness of nurses’ roles and responsibilities.
“I feel that people outside the healthcare industry do not understand what we are doing. They think that nurses only follow doctors’ orders. And they still find it difficult to accept that a man can be a good nurse. It’s difficult to convince them otherwise.”

Muhd Farhan plans to go and work in Saudi Arabia once he has enough experience. At the moment, he is still under contract with the hospital.
“I want to work abroad for the experience and the money, of course. I believe working abroad will help me to further my career.”
Kalaiselvi Kumaresan, 41, says a nurse’s role has changed over the years. Nurses no longer just stand beside the doctor and wait for instructions. Now they have opportunities to choose their field of specialisation, including branching into management and teaching.

“They can specialise in orthopaedic, neurology or infectious diseases. They can also further their studies up to doctorate level. Doctors today often seek nurses’ opinions on cases, so our responsibilities have changed. Senior nurses even guide new doctors.”
Kalaiselvi says she wanted to be a nurse because she felt strongly about helping people. She qualified as a staff nurse in 1993 and had worked in various units including medical, surgical and the catheterisation laboratory. In 2001, she started the infection control programme and is now the nursing officer in charge of the unit.
“Handling infectious diseases is perhaps the biggest challenge in my career. When we had the SARS and H1N1 outbreak, we had to ensure steps were taken to handle them. We set up a team and found beds for the patients. I learnt to handle equipment and protect myself and others from being infected.
“With the possibility of a new outbreak, I have to upgrade my knowledge of infectious diseases. We have an infection control committee headed by a consultant. Link nurses throughout the hospital would monitor infections and report them immediately.”
Her responsibilities include auditing the workers and teaching nurses how to prevent infectious diseases such as the proper way of washing hands.


Nursing supervisor Betterline Nyorid, 31, did her post basic course in diabetic management in 2001. Now she counsels diabetic patients and educates them so that they have better control of the disease.
“It is an exciting field because diabetes cases are increasing every year. More people are diagnosed with diabetes and unfortunately some of them have no control over it. I want to help them understand their disease better,” she says.
“I’ve been a nurse for 14 years and have been involved in various units but I have always had a passion for teaching. As a nursing supervisor, I am in charge of the orthopaedic ward and I train new nurses.”
Betterline says nursing is a career that offers a lot of opportunities and as the healthcare industry expands, nurses’ role and responsibilities have also evolved. “Nurses see patients before doctors do. Nurses are around 24 hours a day. When doctors go home, we take care of the patients. It is a challenging career.”

Kalaiselvi says nurses need to be dedicated to the job. “People may not appreciate nurses but without us, hospitals will not function. Doctors cannot work alone without nurses. I feel satisfied when I help patients get better. It is teamwork and everyone has a role to play. Once you are a nurse, you will not regret it.”

Read more: NST

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