National Assembly for Wales / Cynulliad Cenedlaethol Cymru
Health and Social Care Committee/ Y Pwyllgor Iechyd a Gofal Cymdeithasol

Safe Nurse Staffing Levels (Wales) Bill / Bil Lefelau Diogel Staff Nyrsio (Cymru)

Evidence from Susan Fletcher – SNSL(Ind) 03 / Tystiolaeth ganSusan Fletcher – SNSL(Ind) 03

Hello.

I am concerned about the working conditions for nurses regarding staff levels. This appears to be prevalent all across Wales whichever type of nurse you speak to in a variety of care settings. I write to you today about acute mental health settings as this is what I am familiar with.

There appears a general consensus that safe staffing equals a set amount of nurses and healthcare support workers on duty on any particular shift. This is not so, having a 'certain number' of staff on duty does NOT make for safe staffing. For example, the number of staff on shift does not reflect skill mix or the amount of highly acute patients upon the ward and pertinent to mental health the unpredictably of patients. In mental health there are certain patients that require being within eyesight observations or within arms distance from a member of staff.

To prevent patients being over-sedated and maintain a good quality of life the minimum therapeutic doses of psychotropic medication is prescribed and administered. As excellent practice this is alongside other therapeutic interventions the 'negative side' to this an increase in aggression (particularly in dementia patients) and challenging behaviour. This manifests itself in a number of ways, for example,as verbal and physcial aggression towards staff, other patients and visitors to the ward. Other behaviours include, sexual disinhibition, undressing in public places, invading personal space of others, collecting and hoarding items that they see, destructive behaviour (ie. ripping hand rails off walls), throwing furniture and smaller items, toileting themselves in inappropriate places, climbing furniture, answering and breaking telephones, taking away paperwork away from staff that staff is writing on and refusing to hand back and destroying it. This list is not exhaustive.

Staff planners are utilised effectively but if a member of staff is in a meeting and four members of staff have to take a very aggressive patient to the toilet (it takes a minimum of 3 staff legally to restrain a patient who is aggressive) who has been incontinent of urine of faeces (and only 5 staff in total being on duty on shift) there is no-one to observe the other patients who are within eyesight observations or within arms distance of a member of staff. Nurses are then working illegally, after many pleas and negotiations for more staff, which mostly gets ignored and statements such as '' That's the nature of the ward" and "You are not utilising your staff effectivley" becomes the 'catchphrases' on the unit and thus nurse morale becomes broken. Some nurses have to go without a break on a 12 hour shift and quite often do not even get to use the toilet as the ward will be left even more unsafe.

There are a lot of fantastic nurses but they are not miracle workers, after patients are washed, dressed and had medication and breakfast in the morning they do not sit still in chairs all day, they are not inanimate objects. Nurses have to give care in very challenging circumstances anyway due to the nature of the illnesses the patients suffer. Many nurses, however hard they strive cannot deliver the high standards of nursing care they wish to deliver due to the ridiculously unsafe conditions they have to work in. It's fine if everything is going according to plan and nothing serious happens but if a major incident occured it will be the nurse in charge's responsibility and not those who created unsafe conditions for nurses to work in. In a lot of cases it is illegal for a nurse to simply turn up for duty due to the unsafe conditions they will be working in. Many nurses carry on regardless because the patients are important to them and making a difference to sick peoples' lives.

Please vote for the Safe Nurse Staffing Bill. At some point in your life you may have had or will have nurses looking after you or your family members. Let us nurse you safely and give of our best to you and your loved ones.

Kind Regards

Sue Fletcher