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Clinical Updates

Loss of learning disability nurses could see return to ‘Victorian’ institutions, warns RCN



learning disability

Learning disability care is facing crisis as the latest workforce data shows a 40 per cent drop in specialist nurse numbers.

The latest figures from NHS Digital show the number of learning disabilities nurses down from 5,368 to 3,247, a reduction of 2,121 posts since May 2010.

A lack of new students could exacerbate the existing staff shortage. A national survey carried out by the Council of Deans for Health on behalf of Health Education England found that 46 per cent of institutions have discussed discontinuing their Learning Disability Nursing programmes this September.


Since the removal of funding for nursing education, learning disabilities has been hard hit. It is feared that as student numbers dwindle universities are determining that courses are no longer financially viable for them to run.

In May, Health Minister Stephen Barclay promised to offer £10,000 golden hellos to postgraduate students in specific hard-to-recruit disciplines such as mental health, learning and disability and district nursing, but waited too long to provide investment, missing yet another chance to address the recruitment crisis this year.

Fall in mature students is ‘worrying’.

People with significant life experience are more likely to study learning disability and mental health nursing, the areas most seriously hit by the national nurse shortage.

Yet there has been a 16 per cent drop in the number of students aged over 25 in June 2018, compared to the same time last year, and a total decline of 40 per cent since June 2016.

The situation has become so critical that Health Education England has promised extra funding to train 200 nursing associates who spend at least 50 percent of their time working in learning disability, and are able to start training before the 31 December 2018.

However this does not address the core problem of insufficient numbers of registered learning disability nurses. Whilst the nursing associate role has the potential to support people with a learning disability, they should never be used to substitute for registered nurses.

According to Mencap, 38 per cent of people with a learning disability died from an avoidable cause, compared to 9 per cent in a comparison population of people without a learning disability. Specialist learning disabilities nurses play a vital role in improving outcomes.

Learning disabilities nurses work in a variety of settings, where they support patients with a learning disability and help them access healthcare.

Many of these specialist nurses work in the community, providing vital support to patients with a disability and their families. Without this help, many patients may not be able to remain at home with their loved ones.

Some acute trusts also employ learning disabilities teams to plan care and work with patients who need specialist help.

Harming some of the most vulnerable.

Dame Donna Kinnair, Director of Nursing, Policy and Practice at the Royal College of Nursing, said: “The nursing shortage in England is harming some of the most vulnerable members of society – those with learning disabilities already face a lower life expectancy and poorer health outcomes than the general population, and a lack of specialist knowledge will make matters worse.

“Without the specialist support provided by registered nurses, more patients may end up in institutions, away from their families and friends and shut off from society – this bleak Victorian image is not what care should look like in the 21st Century.

“Funding for 200 extra nursing associates is too little too late. Ministers have known about the steady drop in applications for the best part of a decade, and have allowed a crisis to develop in learning disability care.

“We want to see urgent investment to attract more applicants into learning disability nursing, and an effective workforce plan to ensure every member of our society receives safe and effective care.”

Jonathan Shaw, a member of the learning disability steering group for Mencap’s Treat me well campaign, said: “Learning Disability nurses are very important. If you are unwell and have something seriously wrong with you, the Learning Disability nurse can explain everything clearly. They can make things more comfortable for your family too. 

“Learning Disability nurses are an important way for hospitals to make sure people with a learning disability don’t die avoidably. It is worrying that these universities are stopping the course. I feel like more people should be getting this training, not less!”

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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