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Clinical Updates

Cutbacks in mental health care to blame for NHS staff wanting to quit

“Staff in mental health services are facing burnout as a result of years of underfunding.”



Cutbacks in mental health

Mental health workers are seeking better-paid and less-stressful employment elsewhere.

Cuts to services are driving mental health staff to consider quitting their jobs, according to a survey by UNISON.

Employees also say they want to leave because it has become increasingly difficult to deliver the quality of care people need and deserve – and the work is affecting their own mental health.


These findings are based on a new survey, Mental Health Matters, of more than 600 employees across the UK who mainly work in the NHS.

They reveal budget squeezes that are pushing workers so close to the brink that many are seeking better-paid and less-stressful employment elsewhere, says UNISON.

The number one issue affecting the quality of support was the lack of staff, according to respondents, including those in adult community teams, learning disability services and in mental health units for children and adolescents.

‘Unable to deliver high-quality care’.

The issue of job pressures faced by mental health staff and the numbers wanting to quit are being debated at UNISON’s annual health conference, which began in Bournemouth earlier this week.

Almost half of respondents to the survey said they were thinking about leaving. Cuts to services were given as the top reason, because they made it harder for workers to do their jobs.

The next most cited reason was that staff felt unable to deliver high-quality care, followed by work having an impact on mental health, a lack of support from managers and issues overpay.

The overwhelming issue affecting mental health provision was dwindling staff numbers. Other top concerns were a lack of local services, not enough mental health beds available for adults and long waiting lists.

Sara Gorton, UNISON’s Head of Health, said: “Staff in mental health services are facing burnout as a result of years of underfunding.

“It’s no wonder so many are thinking of finding better-paid and less-stressful jobs elsewhere

“If this situation continues, the NHS risks losing staff who are passionate about making a difference. What’s needed is proper investment so staff can deliver the quality of care to those in need.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.



Nurse with patient in bed

Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.


Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 




A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.


Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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