Workforce shortages in hospital and community services are so severe that patients are being left in pain and in some cases dying alone, the Royal College of Nursing (RCN) reveals, as new analysis shows just a third of shifts had enough registered nurses.
Shortages mean individual nurses are often caring for dozens of patients at a time. The RCN is now calling for safety-critical limits on the maximum number of patients a single nurse can be responsible for.
The College is releasing its latest ‘Last Shift’ survey results [NOTE 1], which asked more than 11,000 nursing staff about their experiences on their most recent shift.
On the first anniversary of the NHS Long Term Workforce Plan, nursing staff say they are demoralised from being unable to keep patients safe, with hundreds of services unable to fill the number of registered nurse posts planned for.
In hospitals and community settings, just a third (Hospital, 32%; Community, 36%) of nursing staff said that their shift had the planned number of registered nurses on it. One in three hospital shifts were missing at least a quarter of the registered nurses they needed, whilst in the community almost four in ten shifts were missing up to half of the planned number of registered nurses.
Across all settings, eight in ten (81%) say there aren't sufficient numbers of nurses to meet the needs of patients safely.
Registered nurses are degree-educated, highly skilled professionals who deliver the vast majority of clinical care, but in England there are no limits on the maximum number of patients a single nurse can care for. The RCN says safety-critical nurse-patient ratios ensure staff don’t care for an unsafe number of patients. Today, it is calling for legally enforceable ratios to be introduced.
Across shifts in hospitals and in the community, nursing staff say there are too few of them to keep up with demand. In A&E settings, significant numbers of nurses reported having more than 51 patients to care for. In outpatient settings, caseloads of more than 51 patients were consistently reported [NOTE 2].
A nurse working in the community in the South West of England, said: “We have days when we have 60 visits unallocated because we don't have enough staff. Every day we are asked to do more. We are always rushing.”
Another, also working in the community in the South of England, said: “We leave over 50 patients requiring nursing care unseen on a daily basis due to poor staffing levels. This leads to increases in hospital admissions and death. It is left to us to decide who gets seen and who gets missed, which is heartbreaking.”
The RCN says understaffing creates a ‘vicious cycle’ in which patients cannot access guaranteed timely care close to home, causing conditions to worsen and heaping more pressure on hospitals where shortages are just as severe.
In a hospital in the West Midlands, England, one nurse, said: “I have not been able to sit with patients who are dying meaning they have been left to die alone. I have not had the time to make sure patients are fed properly and have adequate drinks.”
A midwife, working in a hospital in Yorkshire, said: “Completely unsafe care due to unacceptable staffing levels. The standards of what is acceptable care for a service to provide have fallen so low, the benchmark is survival.”
A student nurse, working in an NHS hospital in the West Midlands, said: “Medications have been hours late, leaving patients in severe pain. Patients have not had their personal care done as often as necessary to keep them clean after episodes of incontinence.”
The testimony from nursing staff follows a Channel 4 Dispatches documentary which revealed the harrowing impact of pressures inside accident and emergency departments. The RCN says its survey results show that the scenes in Shrewsbury are commonplace across health and care services, including the community where there aren’t enough staff to keep patients safe.
Across NHS services in England, there are over 31k unfilled registered nurse posts.
Nurses are ‘fighting a losing battle’ and suffering moral injury delivering compromised care, sometimes in corridors and other inappropriate places, the College says.
RCN Acting General Secretary and Chief Executive Professor Nicola Ranger said:
“In every health and care setting, nursing staff are fighting a losing battle to keep patients safe. Without safety-critical limits on the maximum number of patients they can care for, nurses are being made responsible for dozens at a time, often with complex needs. It is dangerous to patients and demoralising for nursing staff.
“When patients cannot access safe care in the community, conditions worsen and they end up in hospital where workforce shortages are just as severe. This vicious cycle fails staff and patients - it cannot go on.
“We desperately need urgent investment in the nursing workforce but also to see safety-critical nurse-patient ratios enshrined in law. That is how we improve care and stop patients coming to harm.”
Ends
Notes to editors
NOTE 1 - In March 2024, the RCN invited nursing and midwifery staff from across the UK to tell us about their experiences of the last time they were at work. The survey received 11,057 responses and provides valuable insight into the realities of staffing levels across the UK, and the impact on nursing staff and the people they are caring for.
NOTE 2 - In A&E settings, significant numbers of nurses [18%] reported having more than 51 patients to care for. In outpatient settings, caseloads of more than 51 patients were consistently reported [15% of respondents].
