Editorial

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Have you ever felt your department was understaffed? Ever asked why you have to fill in an incident form every time something goes wrong? Well, in the United Kingdom one National Health Service Foundation Trust found itself the centre of media attention and the ‘whipping boy’ of all that is bad in care with both these issues top of the agenda. Mid Staffordshire National Health Service (NHS) Foundation Trust were slammed for allowing receptionists to triage patients in the absence of trained staff. One former employee suggested that there was no proper triage in their Emergency Department either in the day or at night leaving the care of vulnerable patients in hands of unqualified staff (Clews, 2009).

The sad thing here is that poor practice had been flagged up by caring professional practitioners years before it came to the media’s attention. Extensive and sometimes excessive incident ‘form filling’ for even the slightest problem seems to put many staff off reporting poor practice. Added to this is the perception that ‘nothing will change’ which leaves many with a bitter taste in their mouth. I wonder how many managers said on the day this news reached the headlines, ‘there but for the grace of God’. Staff shortages are nothing new and the Healthcare Commission in the UK estimated that 400 more people than expected may have died over a three year period at Mid Staffordshire NHS Foundation Trust due to these shortages (Nursing Times, 2009). The National Nursing Research Unit at Kings College London has produced a report titled ‘State of the Art Metrics for Nursing: a Rapid Appraisal (2008) in which performance indicators are explored as a measure for the quality of care. Within this report it is clear that staffing numbers and skill mix have a role to play in the quality of service provided. This won’t come as a massive shock to shop floor workers but seemingly, to some Trusts, the reality of investing in trained staff becomes a dilemma when compounded by budgets and book balancing. Indeed the report makes falls prevention, infection rates and pressure ulcer formation their key performance ’front runners’ and therefore key performance indicators. These indicators have been reported in this way because most patients die from these conditions; although they are treatable, suggesting staffing levels and skill-mix are ‘less likely’ to be a good performance indicator. This said if you haven’t got the staff to deal with the falls, infections and pressure ulcers in the first place the battle may already be lost. I believe quality care is delivered by well trained, knowledgeable and supported staff. Orthopaedic nursing can be challenging at the best of times whether in the acute or elective arena and like many other specialist areas the public expect knowledgeable and enthusiastic staff on the front line of their service. The complexity of orthopaedic nursing and the many specialist roles within it demands a commitment to updating at a rate never seen before. Handing away these roles to none trained employees may see a cost saving but also an erosion of the key points of contact with our patients. Receptionists are a great resource and are valued members of the health service team but it is unfair to manoeuvre them into a position where, however competent they are, patient compromise will be the only outcome. If Mid Staffordshire NHS Foundation Trust had addressed adequate staffing levels and had listened to the concerns of their staff this whole debacle may have been avoided - but I’m sure they are not alone.

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References 

1. Clews G. 2009. Nurses Warnings about Mid Saffs Ignored. Available from: <http://www.nursingtimes.net/whats-new-in-nursing/acute-care/nurses-warnings-about-mid-staffs-were-ignored/5000070.article> (accessed 05.05.09).
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2. Health Care Commission, 2009. Investigation into Mid Staffordshire NHS Foundation Trust. Available from: <http://www.cqc.org.uk/publications.cfm?widCall1=customDocManager.search_do_2&tcl_id=2&top_parent=4513&tax_child=4574&tax_grand_child=4575&tax_great_grand_child=4595&search_string> (accessed 05.05.09).
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3. Kings College London, 2008. Available from: <http://www.kcl.ac.uk/content/1/c6/04/32/19/Metricsfinalreport.pdf> (accessed on 05.05.09).
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4. Nursing Times, 2009. Debate on Mid Saffs Hospital Rejected. Available from: <http://www.nursingtimes.net/whats-new-in-nursing/acute-care/debate-on-mid-staffs-hospital-rejected/5000150.article> (accessed on 05.05.09).
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