Two thirds of nurses struggle to provide good care to dying patients due to staff shortages

Almost two thirds (65%)¹ of nurses say staffing shortages are the main barrier to providing good care to dying patients, with one third (33%)² saying they are not sufficiently supported at work to manage grief and emotional stress, an exclusive survey has found.

The annual survey, carried out by Nursing Standard and the charity Marie Curie, was answered by almost 5350 (5346) nurses and other caring staff who revealed the devastating impact too few nurses are having on end of life care across the UK.

In 2018 only 38% told the same survey staffing was the biggest barrier in providing care for people approaching the end of life, while the proportion reporting time constraints also showed a big jump this year, with 57%³ saying it was a major barrier, compared to 25% the previous year.

Despite so many staff saying their roles involve caring for people in the final months, weeks or days of life (78%)⁴, more than half (52%)⁵ said they found accessing support systems to help them manage feelings of grief and emotional stress either difficult or they were unable to do so. A third (33%)⁶ say they are also not sufficiently supported at work to manage the grief and emotional stress.

Nurses reported they often felt the need for extra support, but a lack of time and short staffing made even the chance to debrief with colleagues difficult.

One respondent said: “When I was in the ward if the patient had passed away we wouldn't stop because we have other patients to look after. It's never easy for nurses.”

Another said: “Recently clinical supervision [has] stopped due to a shortage [of] staff.”

Many respondents reported that they drew support from colleagues and expressed the value of a strong team. Although one commented that senior staff seemed to have little idea of the impact caring for patients at end of life could have: “[I] had 10 patients die within six weeks, five aged 45 to 55. [I] spoke to manager about lack of support to staff [and] was told if I needed management support perhaps I was in the wrong job.”

Nine out of 10 (92%)⁷ respondents also had to cope with seeing dying patients stuck in hospital waiting for arrangements to allow them to leave. Almost a third (29%)⁸ said a lack of provision of community services, including care in a patient’s home, care homes and hospices, was a significant barrier to providing care to such patients.

Julie Pearce, Marie Curie Executive Director of Nursing, Allied Health Professionals and Quality says: “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 the 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 and when it doesn’t go well it can affect a family for many years.”

She adds that the lack of support for staff is very worrying and would further impact patients and their families: “The emotional burden of care should not be under-estimated and requires active support by employers in supporting the health and wellbeing of its staff. 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. This is a key area for us as at Marie Curie.”

Nursing Standard editor Flavia Munn said: “The experiences recounted by the thousands of nurses who responded to our survey make heart-breaking reading. They include stories of dying patients stuck in hospital desperate to be discharged to spend their final days in their place of choice and nurses sacrificing their own well-being to provide care and support at bedsides.

“None of this should be happening yet sadly it is an all too familiar situation for nurses. For too long there has been a woeful shortage of nurses and our survey highlights the personal toll of this staffing crisis. It is high time ministers took action to ensure there are enough nurses with sufficient time to care for dying patients in their final hours of need.”

The full results of the survey are available here: Rcni.com/marie-curie-2019