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Clinical Updates

NHS short of more than 100,000 staff

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New research estimates that the NHS is short of 42,855 Nurses, 11,187 Doctors and 12,219 Healthcare Support Workers.

Freedom of Information requests by the Labour Party has revealed that the NHS is short of nearly 100,000 Doctors, Nurses and Healthcare Support Workers. These figures show a significant rise over the last year and come only a month after NHS Employers said staff shortages in the NHS pose a fundamental risk to patient safety.

The figures show that 82 NHS trusts had 35,993 unfilled full-time equivalent posts, representing a 9% vacancy rate. With some of the worse trusts being;

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  • Guy’s and St Thomas’ NHS Trust in London had 1,610 vacancies – 10% of its overall workforce.
  • Central Manchester University hospitals had 1,304vacancies.
  • Heart of England in Birmingham had 1,236vacancies.
  • London’s Royal Free had 1,225vacancies.

The information demonstrated that mental health services are experiencing some of the worst understaffing, raising questions over ministerial pledges to boost the workforce by 21,000 by 2022.

Janet Davies, Chief Executive and General Secretary of the Royal College of Nursing, responding to Labour analysis on vacancy levels in the NHS, said:

“This analysis pulls back the curtain on the state of staffing in the NHS this winter. Despite Ministers’ rhetoric on the importance of safety, it will enter a perilous January without enough staff to give safe care.

“Nurses are spread too thinly and starting to blow the whistle on falling standards. Hospital wards and care homes alike increasingly rely on unregistered healthcare assistants, especially at night. The Government must no longer allow nursing on the cheap – patients, particularly vulnerable and older individuals, can pay the highest price.

“The NHS has never been busier and yet it is haemorrhaging experienced nurses quicker than it can find new ones. A lethal cocktail of pressure inside the NHS and falling pay has left people heading for the door. The NHS advertises for nurses but, too often, new uniforms stay in the box.

“It is time to draw a line under this false economy with a new law and investment in nurse education. We need legislation that makes Ministers and others accountable for proper workforce planning and safe and effective staffing levels.”

The report has sparked fresh concerns over patient safety as nursing and medical roles remain unfilled.

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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.

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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.

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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’. 

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Observations

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.

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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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