Mental Health Low Staffing Levels Are Impacting On Patient Care

Patient care is being compromised due to low staffing levels of mental health nurses according to a new survey from the Royal College of Nursing (RCN).

The survey, ‘Untapped potential: A survey of RCN nurses in mental health 2007’, found almost half (42%) of nurses reported that low staffing levels compromised patient care at least once a week and two-thirds did not consider that current numbers of staff were sufficient to meet patient needs.

The survey also shows a third of mental health nurses’ time is spent on administration and clerical duties, with 73% of those working in the community and 59% of those working in hospital settings reporting that too much of their time is spent on paper work. Over half (52%) report that they work excess hours at least several times a week.

The deficits crisis appears to be still hitting services hard with 70% of respondents reporting a recruitment freeze in their work area. Training for mental health nurses has also been hit with training days, essential for development and clinical excellence, falling by two days a year since 2005.

Speaking today, RCN General Secretary, Dr Peter Carter said; “This survey shows that mental health nurses are facing serious obstacles to delivering the kind of care that their clients deserve. Nurses shouldn’t be spending a third of their time on paper work, this time would be much better spent with their clients.

“We need to ensure nurses are fully supported by appropriate staffing levels and proper access to the training they need to update and maintain their skills. This survey is a warning that without proper staffing levels, morale drops, career development falters and patient care suffers”

Other key findings in the report;

— The skill mix ratio in mental health wards is more dilute than acute general hospital wards at a mean of 50% registered nurses: 50% health care assistants on day shifts (41%: 59% in elderly mental health wards)

— 43% of nurses say skills they have acquired are not used – most commonly these skills are; psychological therapy (64%), but also family – centred approaches (23%) and prescribing (10%).

— Insufficient time is the main reason given for skills lying dormant – this correlates to a relationship with reported insufficient staff within the nursing establishment

— Respondents have a mean age of 42 years and have worked in mental health for a mean of 17 years

— 29% report they feel unable to balance their work and home lives because of the hours they work.

— The three biggest frustrations reported are lack of resources and/or staff, too much time spent on administrative work, unsupportive management

— Despite the above, 70% state nursing is a rewarding career with 48% reporting they would recommend nursing as a career

— The particular area of most job satisfaction for nurses in mental health is direct work with service users and clients

Last year the RCN published guidance on skill mix and staffing levels. In light of this survey the RCN recommends mental health staffing is reviewed and have published the following principles as guidance.

1. Changes to the overall numbers, competence or specialist expertise of registered nurses must be based on nurse staffing reviews.

2. Executive nurse sponsors and nurse leaders should lead staffing reviews.

3. Ward and team leaders and their staff must be directly involved in all stages of the staffing review.

4. Nurse staffing must be reviewed regularly and systematically – at least biennially, and more often if patient needs or other factors change significantly. It is good practice to undertake these in partnership with nursing organisations such as the RCN.

5. Two or more recognised methods to measure and model nurse staffing levels should be used to increase the validity of the results, and linked to available data on patient, staff and organisational outcome measures wherever possible. A consistent approach to nurse staffing reviews needs to be used within organisations.

6. Protected staff time for undertaking nurse staffing reviews should be built in wherever possible.

7. Nurse staffing review findings must be communicated effectively to inform executive and board decisions about risk management and investment

8. Patient safety is paramount and there must be a recognised process in each organisation for nursing staff to record and report risks to patient care if they believe nurse staffing is inadequate.

9. The ward or team manager must have authority and control over the delivery of nursing care including the human and budgetary resources they require.

10. Registered nurses must be enabled to work effectively and maximise the impact of their skills and time on patient care. Nurse staffing reviews must consider the whole team and how all staff are deployed.

11. Ward and team establishments must have an allowance of at least 25% built in to the staffing budget for annual leave, sickness absence, other types of leave, and training and development.

12. The ward or team establishment should be the focus for nurse staffing reviews and staff time spent on services additional to the establishment such as ward based outpatient clinics and the work of specialist nurses employed out with that establishment excluded.

Royal College of Nursing (RCN) is the voice of nursing across the UK and is the largest professional union of nursing staff in the world. The RCN promotes the interest of nurses and patients on a wide range of issues and helps shape healthcare policy by working closely with the UK Government and other national and international institutions, trade unions, professional bodies and voluntary organisations.

This research was commissioned by the RCN Policy Unit and Mental Health Nursing Forum from an independent research organisation, Employment Research Limited. It is the first RCN survey that looks specifically at NHS mental health nurse staffing and the related issues of workload, work satisfaction and use of nursing skills.

Embargoed copies of the survey are available on request from the RCN media office.

The survey is based on RCN mental health nurses working in the NHS across the UK, However, responses from nurses in Scotland, Wales and Northern Ireland are insufficient to draw specific conclusions for these countries.

Copies of this report are being sent to Directors of Nursing working in Mental Health Trusts in England.