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Content ArticleFollowing on from the care failures highlighted in the 2021 report, 'No one's listening', the Sickle Cell Society have published a new report taking a deeper look at sickle cell nursing care. The findings show the need for vastly more resources, training and support in this critical area of care. The report highlights that not only is no-one listening, but that lives are still being put at risk.
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Content Article
Thirlwall Inquiry
Mark Hughes posted an article in Other reports and inquiries
The Thirlwall Inquiry has been set up to examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital. This website provides information about inquiry team, terms of reference and publications relating to this. -
News ArticleThe public inquiry into the Lucy Letby murders will seek changes to NHS services and culture next year despite the fact that formal hearings are likely to be delayed until the autumn. Inquiry chair Lady Justice Thirlwall will issue an update message later today. In it she will stress the inquiry will “look for necessary changes to be made to the system of neonatal care in this country in real time and at the earliest opportunity, avoiding delays in making meaningful change”. HSJ understands Lady Thirlwall will look to agree on some changes, based on the inquiry’s evidence gathering and discussions with the sector before it begins oral hearings – which are unlikely to start for at least a year due to ongoing legal action. Lady Thirlwall will say the legal constraints mean its early work will focus on the experience of families who were named in the cases already heard; and “on the effectiveness of NHS management, culture, governance structures and processes, as well as on the external scrutiny and professional regulation supposed to keep babies in hospital safe and well looked after”. She said, “I want this to be a searching and active inquiry in the sense that it will look for necessary changes to be made to the system of neonatal care in this country in real time and at the earliest opportunity, avoiding delays in making meaningful change”. Read full story (paywalled) Source: HSJ, 22 November 2023
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Content ArticleUS healthcare organisations continue to grapple with the impacts of the nursing shortage—scaling back of health services, increasing staff burnout and mental-health challenges, and rising labour costs. While several health systems have had some success in rebuilding their nursing workforces in recent months, estimates still suggest a potential shortage of 200,000 to 450,000 nurses in the United States, with acute-care settings likely to be most affected.1 Identifying opportunities to close this gap remains a priority in the healthcare industry. This article highlights research conducted by McKinsey in collaboration with the ANA Enterprise on how nurses are actually spending their time during their shifts and how they would ideally distribute their time if given the chance. The research findings underpin insights that can help organizations identify new approaches to address the nursing shortage and create more sustainable and meaningful careers for nurses.
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News Article
Nursing watchdog to miss target to cut soaring complaints backlog
Patient Safety Learning posted a news article in News
The nursing watchdog will miss its target to tackle a 5,500-case backlog of complaints as referrals hit a record high. The Nursing and Midwifery Council NMC has admitted it won’t hit its pledge to cut the number of unresolved complaints against nurses and midwives to 4,000 by March 2024. The news comes as it faces questions over the way it handles complaints after The Independent revealed a number of serious allegations, including poor investigations that have led to fears of rouge nursing going unchecked. The newspaper exposes have prompted two independent reviews. Details of the first two reviews have been revealed for the first time and will look at: The NMC’s response to whistleblower concerns, including whether they were treated fairly and whether it acted fairly and reasonably. Any evidence of cultural issues which may have impacted the NMC’s response to whistleblowing. Whether concerns raised are substantiated and indicate a decision-making process by the NMC which is insufficient in protecting the public. Evidence of shortcomings in guidance and training. The senior whistleblower whose evidence prompted the review said: “The NMC has refused to change its approach to the investigations into my whistleblowing concerns to allow me to share and explain my evidence without fear of reprisal. I don’t think it is possible to draw safe conclusions about either how I have been treated or the impact of our culture on case work from reviewing only 13 of our current 5,500 open cases, and 6 closed cases and a selection of my emails.” Read full story Source: The Independent, 16 November 2023 -
Content ArticleA substantial barrier to progress in patient safety is a dysfunctional culture rooted in widespread disrespect. Leape et al. identify a broad range of disrespectful conduct, suggesting six categories for classifying disrespectful behaviour in the health care setting: disruptive behaviour; humiliating, demeaning treatment of nurses, residents, and students; passive-aggressive behaviour; passive disrespect; dismissive treatment of patients; and systemic disrespect. At one end of the spectrum, a single disruptive physician can poison the atmosphere of an entire unit. More common are everyday humiliations of nurses and physicians in training, as well as passive resistance to collaboration and change. Even more common are lesser degrees of disrespectful conduct toward patients that are taken for granted and not recognised by health workers as disrespectful. Disrespect is a threat to patient safety because it inhibits collegiality and cooperation essential to teamwork, cuts off communication, undermines morale, and inhibits compliance with and implementation of new practices. Nurses and students are particularly at risk, but disrespectful treatment is also devastating for patients. Disrespect underlies the tensions and dissatisfactions that diminish joy and fulfilment in work for all health care workers and contributes to turnover of highly qualified staff. Disrespectful behaviour is rooted, in part, in characteristics of the individual, such as insecurity or aggressiveness, but it is also learned, tolerated, and reinforced in the hierarchical hospital culture. A major contributor to disrespectful behaviour is the stressful health care environment, particularly the presence of “production pressure,” such as the requirement to see a high volume of patients.
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Content ArticleNurse bullying has been an issue for decades and continued during the Covid-19 pandemic. Now, in the post-pandemic era, allegations of toxic behaviour are continuing to climb. Becker's spoke with Jennifer Woods, vice president and chief nursing officer at Baptist Health Hardin in Elizabethtown, Pennsylvania, and Jamie Payne, chief human resources officer at Saint Francis Health System in Tulsa, Oklahoma, to understand the increase in nurse bullying and how their health systems are working to address it.
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Content ArticleThis article in the British Journal of Anaesthesia argues that the criminalisation of medical accidents leaves clinicians scared to report systemic causes and contributors to bad outcomes, removing a foundational pillar of patient safety. Looking at the case of RaDonda Vaught, a nurse who was found guilty of criminally negligent homicide for a fatal medication accident, the authors highlight the need to move away from seeing adverse incidents in healthcare as being easily avoided through greater attention, trying harder or adherence to rules. They call on healthcare organisations to learn from the case and argue that healthcare systems need to be collaboratively redesigned with a systems perspective.
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Content Article
PRSB: Nursing Care Needs Standard
Patient Safety Learning posted an article in Patient safety standards
Nurses are at the heart of care across a wide range of services, with people and other professionals often reliant on their expertise. The Professional Record Standards Body (PRSB) worked with the NHS and social care to create a new nursing standard for use across different health and social care settings. -
News Article
US nurse charged with killing 2 patients admits to trying to kill 17 more
Patient Safety Learning posted a news article in News
A former Pennsylvania nurse admitted she tried to kill 19 people at multiple different care facilities, piling dozens of new charges on the woman who allegedly administered lethal doses of insulin to numerous patients, killing two. On Thursday, the state's attorney general's office announced the new charges against Heather Pressdee, who now faces two counts of first-degree murder, 17 counts of attempted murder and 19 counts of neglect of a care-dependent person. The 41-year-old nurse was first arrested in May for killing two nursing home patients and injuring a third. From 2020 up until her arrest, prosecutors say Pressdee gave 19 patients at five different care facilities excessive amounts of insulin, some of whom were diabetic and needed it and others who did not. The plaintiff would typically administer these insulin doses overnight while fewer staff members were working and as "emergencies wouldn't prompt immediate hospitalization," Pennsylvania Attorney General Michelle Henry said. "If Pressdee sensed the victim would 'pull through' there is a pattern of her taking additional measures to try to kill the victims before they could be sent to the hospital by either administering a second dose of insulin or the use of an air embolism to ensure death," the criminal complaint, which also said Pressdee admitted to harming patients with intent to kill, said. Read full story Source: Scripps News, 3 November 2023 -
Content ArticleThis study from Allan et al. investigates whether nurses working for a national medical telephone helpline show evidence of “decision fatigue,” as measured by a shift from effortful to easier and more conservative decisions as the time since their last rest break increases. The study found that for every consecutive call taken since last rest break, the odds of nurses making a conservative management decision (i.e., arranging for callers to see another health professional the same day) increased by 5.5% from immediately after 1 break to immediately before the next. Decision-making was not significantly related to general or cumulative workload (calls or time elapsed since start of shift). The authors concluded that every consecutive decision that nurses make since their last break produces a predictable shift toward more conservative, and less resource-efficient, decisions. Theoretical models of cognitive fatigue can elucidate how and why this shift occurs, helping to identify potentially modifiable determinants of patient care.
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Content Article
The risks in perioperative care are well known. However, for patients having surgery in some African countries, the dangers are far more apparent. Staff are few and far between and many have not been able to access rationale for their practice or receive adequate training over the years. Friends of African Nursing (FoAN) is a small UK-based charity that has been providing education in several African countries to address this issue. More than 3,000 nurses and other healthcare workers have been trained face to face—and many more on-line—in patient safety, staff safety and infection prevention. FoAN's Chair of Trustees Kate Woodhead describes the challenges facing nurses working in perioperative care in many African countries. -
Content ArticleThe Thirlwall Inquiry has been set up to examine events at the Countess of Chester Hospital and their implications following the trial, and subsequent convictions, of former neonatal nurse Lucy Letby of murder and attempted murder of babies at the hospital. This document sets out the terms of reference for this inquiry, following an engagement process led by the inquiry’s independent chair, Lady Justice Thirlwall, with the affected families and other stakeholders.
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Content ArticleArtificial intelligence, as a nonhuman entity, is increasingly used to inform, direct, or supplant nursing care and clinical decision-making. The boundaries between human- and nonhuman-driven nursing care are blurred with the advent of sensors, wearables, camera devices, and humanoid robots at such an accelerated pace that the critical evaluation of its influence on patient safety has not been fully assessed. Since the pivotal release of To Err is Human, patient safety is being challenged by the dynamic healthcare environment like never before, with nursing at a critical juncture to steer the course of artificial intelligence integration in clinical decision-making. This paper presents an overview of artificial intelligence and its application in healthcare and highlights the implications which affect nursing as a profession, including perspectives on nursing education and training recommendations. The legal and policy challenges which emerge when artificial intelligence influences the risk of clinical errors and safety issues are discussed.
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News ArticleThousands of complaints made against nurses and midwives were rejected by the watchdog without investigation last year as it battles a huge backlog amid concerns rogue staff are being left unchecked. The Nursing and Midwifery Council has rejected hundreds more cases a year since 2018, including 339 where nurses faced a criminal charge, 18 for alleged sexual offences and 599 over allegations of violence in 2022-23, according to data shared exclusively with The Independent. The new figures come after The Independent revealed shocking allegations that nurses and midwives accused of serious sexual, physical and racial abuse are being allowed to keep working because whistleblowers are being ignored and that the NMC was failing to tackle internal reports of alleged racism. And now, a new internal document, obtained by The Independent, reveals more staff have come forward to raise concerns since our expose. Former Victims’ Commissioner Dame Vera Baird KC said the backlog of complaints was “worryingly high” and called for urgent action to tackle it. Read full story Source: The Independent, 19 October 2023
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Event
Safer case loads and workforce standards (10 November 2023)
Sam posted an event in Community Calendar
untilThis free online event is an exciting opportunity to hear nursing workforce expert, Professor Alison Leary MBE, speak on the subjects of safe caseloads in community nursing. Professor Alison Leary PhD RN FRCN is Chair of Healthcare & Workforce Modelling at London South Bank University and Director of the QNI’s International Community Nursing Observatory. We will also hear from Cathy Woods and representatives of the software company Yarra, on the Use of E-CAT software for Monitoring Caseloads. The E-CAT product for district nursing is an electronic tool which supports caseload analysis and audit. Underpinned by a bespoke dependency tool and based on a methodology validated by the University of Ulster, the tool looks at caseload variables at all levels, from caseload holder to commissioner and facilitates caseload benchmarking and performance management. The tool has been implemented in all five health trusts in Northern Ireland providing a significant regional evidence base. We will be able to hear about the experience of using E-CAT in Northern Ireland from the NI Public Health Agency. Register -
Content ArticleIn this opinion piece for the BMJ, Rammya Mathew talks about the limits of a no blame culture in identifying where harm is being caused by a clinician. "The Letby case is an extreme example of the shortcomings of a “no blame” culture. When things go wrong we’re encouraged to always support staff and ensure that no one feels implicated. It’s as though only systems and processes can be criticised, and discussing the possibility of individual accountability is considered “off grounds.”
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News Article
Messages revealed healthcare workers were drugging patients
Patient Safety Learning posted a news article in News
Two healthcare workers who exchanged vile texts while needless drugging sick people to ‘keep them quiet’ have been found guilty of ill-treating patients. Senior nurse Catherine Hudson, 54, was found to have regularly tranquillised patients unnecessarily for her own amusement and to have an ‘easy’ shift. While Charlotte Wilmot, 48, an assistant practitioner, wrote vile texts encouraging her to carry out the dangerous acts, with complete disregard for the consequences. Preston Crown Court heard the pair worked on the stroke unit at Blackpool Victoria Hospital and had carried out needless sedations between 2017 and 2018. Restrictions on prescription drugs were so lax in the stroke unit that staff would help themselves and self-medicate or steal drugs to supply to others, the court heard. Drugs such as Zopiclone, a powerful medicine used to treat insomnia, were often stolen and used to drug multiple patients. Police launched an investigation in November 2018 after a student nurse raised concerns about the treatment of patients in the stroke unit. A number of staff members were arrested during the course of the investigation and their mobile devices were seized. Read full story Source: The Independent, 6 October 2023 -
Content ArticleThis article in the Nursing Times looks at how a sincere and prompt apology, using appropriate language and tone, can help those involved come to terms with something that has gone wrong. Nurses may be concerned that saying sorry will make litigation more likely, but the evidence is that patients are less likely to resort to the courts if they feel they have been listened to and have been offered a "proper" apology.
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Content ArticleThis Newsnight report looks at the case of Rebecca Wight, an advanced nurse practitioner who raised concerns about a colleague at at Manchester’s Christie cancer hospital and felt her treatment by Trust management as a whistleblower was poor. She is now taking The Christie to an employment tribunal for constructive dismissal. The video also features an interview with Helené Donnelly, a nurse who tried to raise the alarm more than 100 times at Mid Staffs and went on to be a key witness in the subsequent Francis inquiry. She calls for failing NHS managers to be struck off, highlighting that a decade on from one of the worst failings in NHS history, those raising concerns were still not being listened to.
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Content ArticleThe nurse-to-patient ratio represents the number of patients a registered nurse cares for during a shift. Most hospitals have guidelines to ensure safe staffing ratios, but staffing shortages have led to heavier nursing workloads. This article outlines which US states have laws and regulations in place for safe staffing ratios.
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Content ArticleThe Patient Safety Network (PSNet) produces primers which provide guidance on key topics in patient safety through context, epidemiology and relevant PSNet content. This primer focuses on nurse-related medication administration errors and highlights that despite error reduction efforts through implementing new technologies and streamlining processes, medication administration errors remain prevalent. It covers the background to the issue, low-tech and high-tech prevention strategies and the current context.
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Content ArticleMost US healthcare organisations use staffing guidelines to decide a nurse's patient load on a given shift, but current staffing shortages are pushing nurse-to-patient ratios to the limit. In this article for Nurse Journal, registered nurse Alexa Davidson asks whether laws and regulations could prevent nursing workloads from getting out of control. She argues that mandated staffing ratios are a proven way to ensure patient safety. She describes the situation in Massachusetts and California, the two US states where laws have been passed mandating nurse-to-patient ratios, and outlines the implications of introducing ratios for nurses and patients.
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News Article
Steve Barclay names Lucy Letby inquiry lead amid patient safety address
Patient Safety Learning posted a news article in News
Health secretary, Steve Barclay, has named Lady Justice Thirlwall as the chair of the independent inquiry into the crimes committed by former Countess of Chester Hospital nurse, Lucy Letby. The inquiry was given statutory powers last week and will be led by one of the country’s most senior judges, who currently sits on the Court of Appeal. The announcement came during Barclay’s speech in the House of Commons, where he also announced that the chair of the Essex mental health inquiry will be Baroness Lampard, who investigated the crimes of Jimmy Saville in a similar inquiry led by the Department of Health and Social Care (DHSC). The rest of the health secretary’s address centred around patient safety and what the government has done, is doing and will do. Barclay drew attention to the appointment of Dr Aidan Fowler as NHS England’s first ever national director of patient safety in 2018, and thus the following patient safety strategy in 2019. Read full story Source: National Health Executive, 4 September 2023 -
Content ArticleThis is an oral statement given to the House of Commons by the Secretary of State for Health and Social Care, Steve Barclay MP, to update on the Lucy Letby statutory inquiry.
