Experts have dismissed the idea “uncaring” nurses are to blame for poor NHS care and called for their numbers to be boosted, as winter strain on puts the NHS under some of the worst pressure it has ever faced.
The British Medical Journal analysis said there was no evidence indifferent nurses cause poor treatment – as high-profile reports have suggested – and that it is actually a lack of nurses on duty that is “strongly” linked to patients being dissatisfied with care.
“The narrative that quality deficits in hospitals are due to ‘uncaring’ nurses is not supported by the evidence,” write the BMJ researchers.
“On the contrary, our findings suggest that reducing missed nursing care by ensuring adequate numbers of [nurses] at the hospital bedside, and improved hospital clinical care environments, are promising strategies for enhancing patient satisfaction with care.”
The BMJ article comes after more than 60 senior A&E doctors warned Theresa May that patients are “dying prematurely” in hospital corridors amid “intolerable” safety risks.
Just 85.1% of A&E patients were seen within four hours in December, falling significantly short of the 95% target, meaning 300,000 patients waited too long for care. It is the joint worst level since the target was introduced in 2010.
In October, analysis by health researchers The King’s Fund warned that the number of nurses had fallen on a year-on-year basis for the first time since 2013.
There were 316,725 nurses in post in June 2017, 703 fewer than June 2016.
Jeremy Hunt announced there would be 5,000 extra nurse training places to make up for the shortfall in EU citizens applying. The number of EU citizens joining the register fell by 96% in the aftermath of the Brexit vote.
The BMJ article, published on Thursday evening, compared a survey of patients discharged from acute NHS trusts with a survey of nurses and found a correlation between patients’ dissatisfaction and nurses’ feeling there were not enough nurses on duty.
A total of 57% of patients who felt there were “always” or “nearly always” enough nurses on duty rated their care excellent, compared with 14% of those who said there were “never” or “rarely” enough.
The nurse survey also revealed a disparity in the number of patients nurses were looking after, which the BMJ calculated as ranging from 5.6 to 11.6.
The survey also showed 65% of nurses felt they did not have enough time to comfort patients, 52% said they couldn’t properly brief patients and their relatives about how to manage care after they were discharged and 7% said they were too overworked to properly manage patients’ pain.
The BMJ article dismissed “highly publicised reports, citing preventable deaths and deficiencies in hospital care in England, have uniformly concluded that inadequate hospital professional nurse staffing is a contributing factor”.
As an example, it cites the 2013 Francis Report on the Mid-Staffordshire scandal as an example of a claim that poor nursing was to blame for bad care.
The Francis Report said “caring compassionate nursing” was part of the solution to problems in the NHS, after hundreds of excess deaths at Mid-Staffordshire Hospital between 2005 and 2009.
“Increasing the registered nurse headcount may boost satisfaction with the quality of care,” the BMJ writes.