Nurses Say Staff Shortages Pose Barrier to End of Life Care

Peter Russell

May 29, 2019

Short staffing has led to some nurses spending their break times sitting with dying patients, a survey suggested.

The poll carried out by the charity Marie Curie and the magazine Nursing Standard found that 65% of nurses surveyed said that staffing shortages were the main barrier to providing good care for dying patients.

In 2018, 38% reported the same reason.

Meanwhile, 57% of nurses reported time constraints as the biggest obstacle to providing care for people approaching the end of life, up from 25% the previous year.

The survey also found that 33% of nurses felt they were not sufficiently supported at work to manage grief and emotional stress.

A 'Devastating Impact'

The survey, which received 5346 responses from nurses across acute, community, and hospice care, revealed the "devastating impact too few nurses are having on end of life care across the UK", according to Marie Curie.

Some nurses, particularly those working on busy acute wards, reported having to look after as many as 12 or 13 seriously unwell patients, it said. Others spoke about how making time for end of life care meant using their breaks to sit with patients or families.

Julie Pearce, the charity's executive director of nursing and allied health professionals, said: "The results show that in the NHS and the caring sector, staff are doing their best to do the right thing for patients, but are feeling hard-pressed.

"There seems to be more fragmentation in services, which affects vital continuity of care for patients and their families during a very significant part of their journey through life and death.

"There is only one opportunity to get end of life care right for people – when it doesn't go well it can affect a family for many years."

The survey identified concerns over a lack of community services for people at the end of life, with 92% of respondents saying they had to cope with seeing dying patients stuck in hospital waiting for arrangements to allow them to leave. It found that 29% of nurses thought a lack of provision for community services, including home care, and places in hospices and care homes, was a "significant barrier" to providing care for these patients.

Some patients commented on a lack of support for staff caring for dying patients. One nurse, who witnessed 10 of her patients dying within a 6 week period, said she was asked whether she was in the wrong job when she requested support from management.

"To enable staff to care for patients and their families in a compassionate way, organisations really need to invest in the health and wellbeing of staff and the type of support they offer," said Julie Pearce.

NHS Long-term Plan

Commenting on the survey, Amanda Cheesley, professional lead for long-term conditions and end of life care at the Royal College of Nursing said: "Staff shortages are placing nurses under intolerable strain right across the NHS, and it is not surprising that nurses caring for people at the end of life feel unable to provide the level of care that these patients and their families expect and should have. 

"With a current shortfall of 40,000 registered nurse vacancies in England alone, it’s time for the government to change the law so that ministers and local NHS providers are explicitly accountable for making sure the NHS is safely staffed."

A spokesperson for the Department of Health and Social Care said: "Nurses play a vital role in delivering high quality end of life care and there are over 17,100 more nurses on our wards since 2010, with 52,000 more in training.

"As part of the NHS long-term plan we are committed to creating a modern working environment for staff, ensuring their mental and physical health is fully supported at work.

"The UK is ranked as one of the best countries in the world for palliative care and we are committed to improving patient choice and ending variation through the NHS long-term plan."

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