Page last updated at 17:44 GMT, Tuesday, 20 April 2010 18:44 UK

Members at 'breaking point' - Royal College of Nursing

Hospital ward

The Royal College of Nursing says its members are at 'breaking point' due to working in a climate that is driven by targets and financial controls.

Part of the problem is that up to 16% of positions remain vacant as managers hold back recruiting staff in order to save money.

The result, for some nurses, is that their work load has doubled. One ward manager has been telling our Health Correspondent, Marie-Louise Connolly, that too many tiers of management are only enhancing the problem.

The Health Service is currently under tremendous pressure and by all accounts the situation is going to get worse.

Nurses in every health trust say they're finding it increasingly difficult to sustain the current service and fear for the future with additional cuts looming. A ward manager, who works in an acute hospital, but who wants to remain anonymous, says wards and staff are stretched.

"There are fewer of us than ever and we are taking bigger case loads, working longer hours, often without breaks and throughout trying to provide patients with a safe service.

"And as well as this we are trying to meet the other organisational targets that we are encouraged to achieve as well."

The BBC has learned that up to 16% of nursing posts lie vacant. That means when a nurse phones in sick or goes off on maternity leave, their job is not being filled.


The ward manager says it is common practice.

"If a nurse phones in sick, I have to show managers that I have used every other opportunity available to me to get staff.

"For example I would try other wards to persuade nurses to change their shifts or promise a nurse they will get the extra hours back later.

I am sorry that they feel they are at breaking point and I acknowledge they are working under pressure
Chief Nursing Officer, Martin Bradley

"And I have to have explored all those avenues before I look for authorisation to recruit someone else.

"Then, when I do, there is a process that I must go through and it's two tiers of management in order to get that authorisation.

"All of that takes a lot of time in a situation when we are already short."

The Director of the Royal College of Nursing (RCN), Janice Smyth, says the problem is widespread.

"Nurses at this point in time are stretched to the limit, they are at breaking point. The current economic climate means nursing posts when they become vacant are not being filled which means increased workload and decreasing numbers of staff to look after patients.

"Nurses are concerned about patient safety, they admit there is a line upon which they should not be crossing, they feel on occasion they are being asked to cross that line and we are telling employers that actually holding vacant posts is not the safest way of saving money."


The Chief Nursing Officer, Martin Bradley, acknowledges there is a freeze on nursing posts and that nurses are feeling the pressure.

"I'm sorry they feel they are at breaking point and I acknowledge they are working under pressure," he says.

"But we need to get ourselves to a point that we can redesign our services in such a way that we can keep to the budget allocated to us while at the same time maintain quality and safety.

"This will not happen overnight.

"Demand is up on services by 9% this year - and we don't have the resources to meet that demand."

Nurses, according to the RCN, are also under pressure not to complain about staff shortages.

Janice Smyth says they are aware of an increase in the number of incident report forms being completed by staff which can be registered when a nurse experiences a problem on the ward due to a lack of staff.

She says: "There is an increasing number of nurses coming to the college for support, they feel they are under pressure not to complain, not to raise the issue of staff shortages in incident report forms - one member told me they were told to tear the form up.


"They are not working in an atmosphere which is conducive to speaking out and a recent survey by the RCN indicated that 81% said they would be concerned about victimisation or a negative effect on their career if they reported concerns to their employers."

The RCN says its members are under pressure

When the BBC asked the individual health trusts to provide them with figures for the number of incident report forms completed by nurses, only two trusts were able to do so.

Incident report forms are completed by nurses when there are problems on their wards.

Issues can range from equipment breaking, to people falling but nurses have told the BBC that more often they are over staffing levels.

Of the two trusts that replied, in six months more than 9,000 forms were completed by nurses.

Within the next few weeks the health minister, Michael McGimpsey, will outline how he plans to live within the next year's budget.

Finance Minister Sammy Wilson has already said how £367m is going to be cut from the overall budget next year, with £113m being cut from health.

All of the health trusts will be expected to make efficiency savings in order to plough some of that money back into the service.

According to some of those working on the front line, including the anonymous ward manager, it will be up to staff and patients to bear the brunt of those cuts.

"It feels to nurses that we are providing a service based on what we have, rather than on what we need.

"And that is what politicians are trying to do - they are providing a service based on what is available to them and maybe not necessarily what the Northern Ireland health service actually needs."

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