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Found 145 results
  1. Content Article
    This guidance document seeks to provide a framework to help your local simulation-based endeavours achieve the most benefit for the needs in your organisation and department. Further resources and examples of practice to support each domain of the framework are currently being collated for sharing nationally in the immediate future. Working in collaboration, The Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists have developed this website to provide the UK intensive care and anaesthetic community with information, guidance and resources required to support their understanding of and management of COVID-19. Intensive care practitioners and anaesthetists are integral to the safe and effective care of patients diagnosed with COVID-19, and play a role in informing and reassuring the public about this viral outbreak.
  2. Content Article
    ITU handover Bedside checklists Transducing arterial lines Arterial line sampling Bedside monitoring Observations Ventilation basics Activity sheet. About the author Sam is a registered nurse who works for a Trust on the South Coast of England
  3. News Article
    Nurses caring for patients in the community have been spat at and called ‘disease spreaders’ by members of the public, according to England’s chief nurse and the Royal College of Nursing (RCN). The nursing union urged members of the public to support the UK’s “socially critical” nursing workforce during the coronavirus outbreak. The RCN said it had received anecdotal reports of community nurses receiving abuse while working in uniform. Separately, England’s Chief Nurse Ruth May said she had heard reports of nurses being spat at. Susan Masters, the RCN’s director of policy, said abuse of nurses was “abhorrent behaviour”. She said a number of nurses had raised concerns about abuse on forums used by members to talk confidentially. Describing one incident she told The Independent: “These were community nurses who had to go into people’s homes and were in uniform. Members of the public who saw them called out to them and said they were ‘disease spreaders’.” She added: “We don’t know how big this problem is, it is anecdotal, but it is absolutely unacceptable. Read full story Source: The Independent, 21 March 2020
  4. Content Article
    Six months ago, I left my band 7 managerial role to work as a band 5 agency nurse on the wards. Despite the band drop, this move has financial advantages which will help me to achieve some personal goals. Signing up After successfully completing the recruitment process, I am asked to attend mandatory training. This includes basic life support, manual handling and infection control. The usual, run of the mill stuff. I can book shifts a week or a day in advance, but these shifts can change to any speciality or department in the hospital, depending on staffing levels. I book my first shift after six years of having not worked within a ward setting. An unsafe start I turn up to the shift and introduce myself to be met with a mutter. The team and I receive handover and I am allocated my bay of patients. I notice I have twelve patients, three more than the other nurses. I reiterate this is my first time here and that I haven’t worked in ward work for some years. I ask if it would it be possible for someone to show me around – resuscitations trolley, toilets, codes to the drug cupboards. General housekeeping. I receive a grunt and a point, followed by some numbers hurled at me, along with keys. Ok, perhaps they’re just not morning people. I will give them the benefit of the doubt. Off I go to introduce myself to my patients and to immediately make use of my prioritisation skills, escalating any concerns I have to the seemingly disengaged shift leader and (more helpful) doctors. I find that my patients are acutely unwell and in need of a lot of care. I have to remind myself of my 13 years’ experience and how good I am at communicating, reassuring myself I will be ok. Hours later and still no toilet break Seven hours later, hungry and in need of a wee, I ask my shift leader if she could cover me so I can take a break. I am met with, ”your patients are too unwell for you to leave them for 15 minutes, and I don’t have the staff to cover you”. Followed by the ultimate toxic saying within the NHS, ”that’s just how we do it here, always have”. I start to feel neglectful that I would even have thought to have a drink and pass urine. Ten hours pass and still I haven’t had any water or a wee. Three emergencies have taken place without me even having had a proper induction. I take solace in my bond with my patients and lovely doctors who understand how it feels to be isolated and new to an area. Speaking up Perhaps out of dehydration and kidney shut down, I find the voice to politely approach the other nurses and shift leader. I explain that my patients are now stable and highlight my own personal fluid needs. I mention that I still haven’t received an induction. No one has asked me my skills or background nor if I know how to use the different IT systems (drug charts are now on computers). Again, I am met with, “well you choose to be agency, we just all get on with it here”. These are words that frighten me. It isn’t safe to get on with it. I felt out of my depth, overwhelmed, deprived of basic human rights and unwell. Losing confidence Then, a patient’s relative approaches me to say, ”I didn’t want to trouble you as you were running around looking so busy, but dad has chest pain”. At that point my heart breaks. How have I given the impression that I am the unapproachable one on this ward? Have I neglected this poor man? The same man who had cried with laughter at a joke I had made about some TV show we both watched the night before while I was catheterising him. Protocol follows and I investigate his chest pain. No acute cause. Phew. I still leave his side feeling that I am terrible at this. The end of my shift approaches, still no break, still no water or food. Handover time… I introduce myself to the night team. Finally, someone kind welcomes me to the ward. They tell me they all feel like they are doing a bad job and not giving satisfactory care. I think they are trying to reassure me. I cycle home in tears; shattered and broken. The next day I have serious doubts about my own ability. I call my agency and have a long chat with my recruitment consultant (who has never set foot inside a hospital and works on commission). His response? ”Well, you don’t have to go back”. I start to have serious doubts about my choice to work in this way and feel even more perplexed that our wards and teams have become like this. What a difference a day makes My next shift is in an emergency department. Dreading it, I don’t sleep the night before and I turn up riddled with anxiety about what is to fall upon me. I meet the team and prep myself to ‘kill them with kindness’. Everyone is pleasant and welcoming. The senior nurse asks me about my skills and mandatory training and shows me around. She informs me of their expectations and what I could, in return, expect of her team. It seems so simple, a five-minute job, huddling with your team for the sake of patient safety. But what a huge impact it has on my shift. My patients are more acute, I am busier and still don’t urinate. But I am supported and able to escalate concerns without being gas-lighted. Final thoughts I have now booked all of my shifts on that busy emergency department, simply because of the manager. I respect her management style and her approach to the safety of her unit. She doesn’t use those unhelpful and unsafe words, ”we just get on with it” or ”that’s how we do it here”. Since becoming a bit more settled in this world of agency nursing, I have spoken with matrons and lead directorate nurses within this trust about my experience. Often met with, ”what can I do about that?”. But sometimes met with, ”I will look into how that particular ward manages staff safety”. The latter leads on to better patient safety. Key learning points Inductions to new staff in new areas, should be mandatory. It should be the nurse in charge's duty to support junior staff. Doing safety rounds and checking in on all staff would help to manage workload, support flow and build confidence and reassurance among staff on duty. Safety huddles at the beginning, middle and sometimes end of each shift are a simple way of combating so many of the patient safety issues raised in this account. Early warning scores should be displayed and visible for all professionals on duty. They should be checked regularly and actioned accordingly.
  5. News Article
    Third year undergraduate trainee nurses will be invited into clinical practice to support the coronavirus effort, while routine care quality inspections are “going to need to be suspended”, the Chief Executive of NHS England has said. Speaking at the Chief Nursing Officer’s summit event in Birmingham this morning, Sir Simon Stevens told delegates NHSE was working with the Nursing and Midwifery Council to “see how many of the 18,000 [relevant] undergraduates are available”. It is understood they would be paid, and follows government moves to pass emergency legislation to relax rules around working in healthcare. Asked about Care Quality Commission inspections during the outbreak, Sir Simon said: “There will be a small number of cases where it would be sensible to continue for safety related reasons… but the bulk of their routine inspection programmes is clearly going to need to be suspended and many of the staff who are working as inspectors need to come back and help with clinical practice.” Read full story (paywalled) Source: HSJ, 11 March 2020
  6. News Article
    The Royal College of Nursing (RCN) has issued a warning about insufficient staffing in the NHS in the wake of a mental health trust being downgraded. Earlier this week, Tees, Esk and Wear Valleys (TEVW) NHS Foundation Trust being rated as "requiring improvement" by the Care Quality Commission. It had previously been rated as "good" but inspectors said some services had deteriorated. Among the concerns raised were ones over staffing, workload and delays. Glenn Turp, Northern Regional Director of the RCN: "The CQC has rightly highlighted some very serious concerns and failings which call into question whether this trust can provide safe patient care. After the very tragic and sad deaths of two vulnerable patients last year and the findings of the CQC, the trust and NHS commissioners must take immediate action to ensure patient and staff safety." "They have a responsibility not to commission and open new beds with insufficient nursing staff to provide safe patient care. Having the right number of nursing staff with the right skills in the right place at the right time is critical to protecting patients. It also protects those staff who too often find themselves struggling to maintain services in the face of nursing vacancies." Read full story Source: The Northern Echo, 7 March 2020
  7. Content Article
    The evidence from this study demonstrates that the effectiveness of intentional rounding, as currently implemented and adapted in England, is very weak and falls short of the theoretically informed mechanisms. There was ambivalence and concern expressed that intentional rounding oversimplifies nursing, privileges a transactional and prescriptive approach over relational nursing care, and prioritises accountability and risk management above individual responsive care.
  8. News Article
    Hospitals in the UK will be among 60 across Europe that will be supported to redesign their systems and ways of working to tackle nurse burnout and stress, under a ground-breaking four-year study. The first-of-its-kind project will see chosen hospitals implement the principles of the Magnet Recognition Programme, an international accreditation scheme that recognises nursing excellence in healthcare organisations. Run by the accreditation wing of the American Nurses Association, the scheme is based on research showing that creating positive work environments for nurses leads to happier and healthier staff and the delivery of safer patient care, in turn improving recruitment and retention. Among the key pillars of Magnet are transformational leadership, shared governance and staff empowerment, exemplary professional practice within nursing, strong interdisciplinary relationships and a focus on innovation. The new study – called Magnet4Europe – is being directed by world-renowned nursing professor Linda Aiken, from the University of Pennsylvania in the US, and Walter Sermeus, professor of healthcare management at Katholieke Universiteit Leuven in Belgium. Read full story Source: Nursing Times, 24 February 2020
  9. News Article
    The number of nurses in schools has fallen in recent years, prompting fears that pupils’ lives are being put “at risk”. Teaching assistants are being asked to carry out medical interventions, such as injections, without adequate training or support, the GMB union, which represents school staff, has said. Data, obtained by the GMB union through a Freedom of Information request, shows the number of school nurses has fallen by 11 per cent in four years – from 472 in 2015 to 420 in 2018. Karen Leonard, National Schools Officer at the GMB union, said: “The uncomfortable truth is that in too many schools children are not getting the medical support they need.” Ms Leonard added: “School staff should not administer medicine unless they feel fully confident in their training and lines of accountability, but often they are placed in uncomfortable situations." “This is a highly stressful state of affairs for children, parents, and staff, who fear they will be blamed if something goes wrong. It is not alarmist to say that lives are at risk.” Read full story Source: The Independent, 23 February 2020
  10. News Article
    Nurses will be trained to perform surgery under new NHS measures to cut waiting times. Nursing staff will be urged to undertake a two year course to become “surgical care practitioners” as part of the drive to slash waiting times but critics have warned it will worsen the nursing shortage. Nurses who qualify will be tasked with removing hernias, benign cysts and some skin cancers, according to the Daily Mail. They will also assist during major surgeries such as heart bypasses and hip and knee replacements. The re-trained nurses will be tasked with closing up incisions after operations. The proposals are contained within the NHS’s People Plan, due to be unveiled next month. Lib Dem health spokesman Munira Wilson said: "This is a sticking plaster solution to very serious staffing crisis across our NHS workforce.'" However the proposals were backed by Professor Michael Griffin, president of the Royal College of Surgeons of Edinburgh. He said: "We are totally supportive of this. We have very little anxiety about this.” Read full story Source: 24 February 2020
  11. News Article
    Registered nurses at Queen of the Valley Medical Center (QVMC) in Napa, Calif, USA, will hold an informational picket followed by a vote to authorise a strike in an effort to raise patient care standards and win a fair contract, the California Nurses Association/National Nurses United, (CNA/NNU) has announced. Nurses at QVMC will picket to highlight cutbacks and eroding patient care. Among the nurses’ top concerns is safe patient care, including safe staffing and dedicated staff for safe patient handling. “After eight months of negotiations, it's time for Queen of the Valley nurses to bring our concerns to our community and let them know nurses are fighting to give them the best patient care,” said MaryLou Bahn, registered nurse in labour and delivery at QVMC and member of the bargaining team. “We’re fighting for adequate staffing levels because we refuse to put profits over the needs of our patients.” Read full story Source: National Nurses United, 20 February 2020
  12. News Article
    A new app has been piloted in North East London to help district nurses document chronic wound management more efficiently. The tech has been used in community services and stores a catalogue of photographs to accurately document chronic wounds. District nurses can use the app on a smartphone – making it lightweight, portable and easy to clean. Using two calibration stickers placed either side of the wound, the app can scan it and capture its size and depth to build a 3D image. Nurses can then fill out further characteristics on the software such as colour, pain level, location and smell to give a full picture of the wound’s development. Read full story Source: Nursing Times, 12 February 2020
  13. News Article
    A senior district nurse who was unfairly dismissed after blowing the whistle over valid safety concerns has told how the ordeal has left her life in "chaos" and she feels forced to quit the profession for good. Linda Fairhall, who had worked at North Tees and Hartlepool NHS Foundation Trust for 38 years, has spoken to Nursing Times about her experiences after she successfully challenged her employer's decision to sack her. Between December 2015 to October 2016, Ms Fairhall raised 13 concerns to the trust regarding staff and patient safety. At the time, she was managing a team of around 50 district nurses in her role of clinical care co-ordinator. Read full story (paywalled) Source: Nursing Times, 17 February 2020
  14. News Article
    A trust unfairly dismissed a senior nurse after she tried to invoke its formal whistleblowing policy, an employment tribunal has ruled. North Tees and Hartlepool Foundation Trust had suspended Linda Fairhall for 18 months without a “meaningful or adequate” explanation prior to her dismissal, the judgment said. Ms Fairhall, who led a team of 50 district nurses in Hartlepool, reported on the trust’s risk register that a “change in policy” by the local authority had directly led to increased workloads for her staff. The change meant staff had to monitor patients who had been prescribed medication “so as to ensure the correct medicines were being taken at the correct time”, the judgment said. She reported numerous concerns to senior management between December 2015 and October 2016, amounting to 13 protected disclosures according to the tribunal, ranging from work-related stress, sickness, absenteeism and a need to retrain healthcare assistants. A patient’s death triggered a meeting involving her and senior managers, which she said could have been prevented had her earlier concerns “been properly addressed”. Ms Fairhall told care group director Julie Parks she wanted to initiate the formal whistleblowing policy on 21 October 2016, before going on annual leave a few days later. When she returned, she was told she had been suspended for 10 days. The judgment, handed down at Teesside Justice Hearing Centre and published last week, added: “No reasonable employer, in all the circumstances of this case, would have conducted the investigation in this manner.” The judgment said the tribunal believed the principal reason for her dismissal was because she had made protected disclosures. It upheld her claim that her dismissal was automatically unfair. Read full story (paywalled) Source: HSJ, 17 February 2020
  15. Content Article
    So, what does it feel like working in chronically depleted staffing levels? "We are down three nurses today" – this is what I usually hear when I turn up for a shift. It has become the norm. We work below our template, usually daily, so much so that when we are fully staffed, we are expected to work on other wards that are ‘three nurses down’. Not an uncommon occurrence to hear at handover on a busy 50-bedded medical ward. No one seems to bat an eyelid; you may see people sink into their seat, roll their eyes or sigh, but this is work as usual. ‘Three nurses down’ has been the norm for months here, staff here have adapted to taking up the slack. Instead of taking a bay of six patients, the side rooms are added on making the ratio 1:9 or sometimes 1:10, especially at night. This splitting up the workload has become common practice on many wards. "That was a good shift" – no one died when they were not supposed to, I gave the medications, I documented care that we gave, I filled out all the paperwork that I am supposed to, I completed the safety checklists. Sounds a good shift? Thinking of Erik Hollnagel’s ‘work as done, work as imagined’ (Wears, Hollnagel & Braithwaite, 2015) – this shift on paper looks as if it was a ‘good shift’ but in fact: Medications were given late; some were not given at all as the pharmacy order went out late because we had a patient that fell. Care that was given was documented – most of the personal care is undertaken by the healthcare assistants (HCA) now and verbally handed over during the day – bowel movements, mobility, hygiene, mouth care, nutrition and hydration. As a nurse, I should be involved in these important aspects of my patients’ care, but I am on the phone sorting out Bed 3’s discharge home, calling the bank office to cover sickness, attending to a complaint by a relative. It’s being attended to by the HCA – so it's sorted? I have documented, probably over documented which has made me late home. I’m fearful of being reprimanded for the fall my patient had earlier on. This will be investigated and they will find out using my documentation what happened. The safety checklists have been completed for all my patients; comfort rounds, mouth care, falls proforma, bed rails assessment, nutritional score, cannular care plan, catheter care plan, delirium score, swallow test, capacity test, pre op assessments, pre op checklists, safe ward round checklist, NEWS charting, fluid balance charting and stool charting… the list is endless. Management have made things easier with the checklist ‘if it’s not written down it didn’t happen’ so now we can ‘tick’ against the check list rather than writing copious notes. However, I cut corners to enable me to complete all my tasks, some ticks are just ‘ticks’ when no work has been completed. No one would know this shift would they? What looks as if it has been a ‘good shift’ for the nurse, has often been the opposite for the patients and their family. There is a large body of research showing that low nurse staffing levels are associated with a range of adverse outcomes, notably mortality (Griffiths et al, 2018; Recio-Saucedo et al, 2018). What is the safest level of staff to care for patients? Safe staffing levels have been a long-standing mission of the Nursing and Midwifery Council (NMC)/Royal College of Nursing (RCN) in recent years. In the UK at present, nurse staffing levels are set locally by individual health providers. The Department of Health and professional organisations such as the RCN have recommended staffing levels for some care settings but there is currently no compliance regime or compulsion for providers to follow these when planning services (Royal College of Nursing 2019). I was surprised to find that there are no current guidelines on safe staffing within our healthcare system. It left me wondering… is patient safety a priority within our healthcare system? It seems not. While the debate and fight continues for safe staffing levels, healthcare staff continue to nurse patients without knowing what is and isn’t safe. Not only are the patients at risk and the quality of care given, but the registration of that nurse is also at risk. What impact does low staffing have on patients and families? ‘What matters to them’ does not get addressed. I shall never forget the time a relative asked me to get a fresh sheet for their elderly mother as there was a small spillage of soup on it. I said yes, but soon forgot. In the throes of medication and ward rounds, being called to the phone for various reasons, answering call buzzers, writing my documentation, making sure Doris doesn't climb out of bed again, escorting patients to and from the CT scanner, transferring patients to other wards – I forgot. My elderly patients’ daughter was annoyed, I remember she kept asking and I kept saying "in a minute", this made matters worse. She got annoyed, so that I ended up avoiding her altogether. How long does it take to give her the sheet? Five minutes tops, so why not get the sheet? MY priority was the tasks for the whole ward, tasks that are measured and audited on how well the ward performs by the Trust; filling out the observations correctly, adhering to the escalation policy, completing the 20 page safety booklet, completing the admission paperwork, ensuring everyone had their medication on time, making sure no one fell – changing a sheet with a small spot of soup on it was not on my priority list. It was a priority for my patients’ family. My patient was elderly, frail and probably wouldn’t get out of hospital alive this time. Her daughter was the only family she had left. It’s no wonder families feel that they are not listened to, are invisible, are getting in the way and not valued. These feelings do not encourage a healthy relationship between patients/families and healthcare workers. Studies have shown that involving patients and families in care is vital to ensure patient safety. Patients and their relatives have the greatest knowledge of patients and can often pick up subtle signs physiological deterioration before this is identified by staff or monitoring systems (O’dell et al, 2011). If our relationship is strained, how can we, as nurses, advocate for the safety of our patients? So, what impact does low staffing have on the staff member? "Fully staffed today!" The mood lifts at handover. People are sat up, smiling, quiet excitable chatter is heard. This uplifting sentence is quickly followed by either: "Let’s keep this quiet" or "someone will be moved" or "someone will have to move to XX ward as they are down three nurses". Morale is higher when wards are fully staffed. The mood is different. There are people to help with patient care, staff can take their breaks at reasonable times, staff may be able to get home on time and there is emotional support given by staff to other staff – a camaraderie. The feeling does not last long. Another department is ‘three nurses down’. Someone must move to cover the shortfall. No one wants to go When you get moved, you often get given the ‘heavy’ or ‘confused’ patients. Not only that, you are working with a different team with different dynamics – you are an outsider. This makes speaking up difficult, asking for help difficult, everything is difficult: the ward layout, where equipment is stored, where to find documentation, drugs are laid out differently in the cupboard, the clinical room layout is not the same. The risk of you getting something wrong has increased; this is a human factors nightmare, the perfect storm. I am in fear of losing my PIN (NMC registration) at times. At some point I am going to make a mistake. I can’t do the job I have been trained to do safely. The processes that have been designed to keep me and my patients safe are not robust. If anything, it is to protect the safety and reputation of the Trust, that’s what it feels like. Being fully staffed is a rarity. Being moved to a different department happens, on some wards more than others. Staff dread coming to work for threat of being moved into a different specialty. Just because you trained to work on a respiratory, doesn’t mean you can now work on a gynae ward. We are not robots you can move from one place to another. I can see that moving staff is the best option to ensure efficiency; but at what cost? Another problem in being chronically short staffed is that it becomes the norm. We have been ‘coping’ with three nurses down for so long, that ‘management’ look at our template. Is the template correct, we could save money here? If we had written guidance on safe staffing levels, we still have the problem of recruitment and retention of staff; there are not enough of us to go around. Thoughts please... Does this resonate with you? Has anyone felt that they feel ‘unsafe’ giving care? What power do we have as a group to address this issue of safe staffing levels? References 1. Wears RL, Hollnagel E, Braithwaite J, eds. The Resilience of Everyday Clinical Work. 2015. Farnham, UK: Ashgate. 2. Griffiths P et al. The association between nurse staffing and omissions in nursing care: a systematic review. Journal of Advanced Nursing 2018: 74 (7): 1474-1487. 3. Recio-Saucedo A et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing 2018; 27(11-12): 2248-2259. 4. O’dell M et al. Call 4 Concern: patient and relative activated critical care outreach. British Journal of Nursing 2001; 19 (22): 1390-1395.
  16. News Article
    Leaving the EU means the UK has greater control over the training of healthcare professionals. The Department of Health and Social Care (DHSC) has announced that nurses and other allied healthcare professionals will be able to retrain as doctors ‘more quickly’ now the UK has left the EU. Under training standards set by the EU, existing healthcare professionals wishing to move into another area would have to complete a set standard of training, regardless of any existing health background or qualifications. Under the potential new system, a nurse who has been in the job for 10 years could benefit from training standards based upon experience and qualifications, rather than strict time-frames. Health Secretary Matt Hancock said: “Our incredible NHS is full of highly-qualified and dedicated professionals – and I want to do everything I can to help them fulfil their ambitions and provide the best possible care for patients. Without being bound by EU regulations, we can focus on ensuring our workforce has the necessary training which is best suited to them and their experience, without ever compromising on our high standards of care or on patient safety. The plans we are setting out today mean that we can retrain healthcare workers and get them back to the frontline faster. This is good for patients, and good for our NHS." Nursing leaders warn that the move needs to come without compromising patient care. Andrea Sutcliffe CBE, Chief Executive and Registrar at the Nursing and Midwifery Council (NMC) said: “Having enough health and care professionals with the right knowledge, skills and values is vital to meet the individual needs of people across all four countries of the UK now and in the future." “The NMC supports the wish to explore how education and training for registered nurses and midwives may be achieved in more flexible ways while ensuring our high standards are maintained and not compromised. Every nursing and midwifery professional must be safe and competent to provide the best care and support possible." Read full story Source: Nursing Notes, 9 February 2020
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