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30 July 2013, 06:46
Hospital nurses are being forced to "ration care'' because they don't have enough time to properly look after patients, according to researchers at the University of Southampton.
They found fundamental aspects of care are "frequently being left undone".
Almost nine in ten nurses questioned said they were so busy on their last shift that they were unable to perform at least one "care activity'' such as proper patient surveillance, documenting care, administering medication properly, comforting patients, preparing them for discharge or changing a patients' position in bed - to prevent bed sores.
The study, published in the online journal BMJ Quality & Safety, examined data from almost 3,000 nurses who work in 46 English hospitals.
They were asked whether they were unable to perform basic care elements because of time constraints.
The authors from the Florence Nightgale School of Nursing and Midwifery and the University of Southampton, found that 86% of nurses were unable to perform at least one of 13 care elements because they were too busy.
Comforting and talking with patients was the most common activity to be axed by busy nurses, with 66% saying that they didn't have time to do this on their last shift.
Just over half of nurses saying they were forced to skip "educating patients'' and 47% said they didn't have time to develop or update nursing care plans.
They found that the average nurse cared for 7.8 patients on a day shift and 10.9 at night. And the fewer patients a nurse looked after, the less likely care would be missed or rationed, the authors found.
Nurses looking after 11 or more patients were twice as likely to say they rationed patient monitoring as those looking after six or fewer patients.
They found that 78% of nurses in the best staffed environments reported some care was missed on their last shift, compared with 90% of those with lower staffing levels.
"Most nurses working on general medical and surgical wards in this representative sample reported that some care was left undone on their last shift,'' the authors said.
"Registered nurses (RNs) working in English NHS hospitals report that care is needed but is often not done because of insufficient time. There is a strong relationship between RN staffing levels and the prevalence of care being left undone - and, the better the practice environment the smaller the volume of care that is left undone.
"Our findings raise difficult questions for hospitals in a climate where many are looking to reduce - not increase - their expenditure on nurse staffing.''
Following the publication of the Keogh review into high mortality rates at 14 hospitals, the Royal College of Nursing (RCN) and union Unison reiterated calls for mandatory staffing levels on hospital wards.
Officials found that in some wards there were inadequate numbers of staff. The review panel said they witnessed staff so busy they were unable to deliver compassionate care to patients.
Robert Francis QC, chairman of the public inquiry into the serious care failings at Stafford Hospital, said that health officials should consider the ''benefits and value for money of possible staff-patient ratios''.
But ministers have resisted calls for minimum staff levels, saying that hospitals need the "freedom and flexibility'' to decide on how many staff to employ.