• Wye Valley Trust board told staff are “burnt out” and care could be at risk
  • The trust’s acute admissions unit identified specific concern over vacancy levels and staffing
  • Nursing director says action underway to turn around the situation

An NHS trust has increased nurse staffing levels in its acute admissions unit and is changing its shift patterns to more flexible rotas to tackle widespread nursing vacancies.

Wye Valley Trust is facing a 25 per cent shortage of registered nurses on its medical division and executives have been warned patient care could be at risk when staff are “burnt out” and working beyond their hours and without breaks.

Lucy flanagan

Lucy Flanagan: ‘We have to continue to reduce our reliance on temporary workforce’

A report to the trust board this month said there were 47 full-time equivalent vacancies in inpatient areas with gaps being covered by agency staff.

It added: “The medical division has 25 per cent of registered nurse posts vacant. The effects of high registered nurse vacancies within the trust also has an impact on quality and safety of care to our patients, their carers and families.”

An executive risk management meeting report seen by HSJ said the 35 bed acute admissions unit had “insufficient staffing”. It warned: “There is a risk that patient safety and quality care provided by the nursing staff on Frome ward is compromised as a result of insufficient staffing ratios and skills. The impact of this risk could result in patient harm, reduced staff recruitment and retention.”

The report said there had been recent incident reports for “suboptimal care” related to fluid management and medication. It also warned “staff morale is affected due to the lack of skill mix and additional workload; resulting now in staff ‘burnt out’, which is affecting patient safety and care”.

The ward has 7.5 full-time equivalent vacant nursing posts but the report said this was not the root cause of the issues and instead pointed to the lack of band five staff with a band four staff member “being used as a replacement for a band five due to the current establishment budget”.

The report added: “The current substantive staff on Frome [ward] continue to work above and beyond their rota hours and often without breaks to meet the clinical need to reduce the risk to patient safety.”

The trust has replaced the band four role on the ward for an additional band five nurse with six registered nurses and five healthcare assistants planned for each shift. An additional band six nurse has also been appointed.

An update to the board earlier this month said the new nursing levels were being met, adding: “Incidents regarding quality of care have reduced and morale is improving.”

Across the trust, steps to increase flexible working include new shift patterns from January and offering a pool of staff guaranteed work for set hours.

The trust has also changed its agency provider and is filling 94 per cent of requested shifts, which is above the national average. It is part of the first tranche of trusts working with NHS Improvement on recruitment and retention changes.

Trust nursing director Lucy Flanagan said she was confident the situation on the AAU had improved but she accepted that the trust was facing wider recruitment difficulties.

She said the trust recognised acuity on the unit was rising in August with patients needing increasingly complex levels of care, so a decision was made to increase the number of registered nurses on each shift.

Since then, the ward’s fill rate had been in excess of 100 per cent. She said: “Our fill rate for that ward is on an improving trajectory and where we would expect it to be.”

Ms Flanagan said: “We are particularly challenged around our vacancy factor and retention rates. That is why our work with NHS Improvement around recruitment and retention is so important. If all our vacancies were occupied our staffing numbers would be really good; our overall establishment is good.

“We have to continue to reduce our reliance on temporary workforce and we need to focus on the journey we have started in relation to recruitment and retention. In the meantime, there is daily scrutiny of staffing undertaken by an experienced senior nurse to ensure patient safety is maintained.”