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Nurses ill-equipped to deal with widespread malnutrition

Survey provokes call for serious action to raise awareness of the UK's three million malnourished, as it reveals 86% of primary care nurses lack basic training in nutrition support.

The Nursing in Practice-Fresenius Kabi Online Survey - of more than 600 primary care nurses - showed that almost 86% have not undertaken basic training in nutrition support, and only 24% feel comfortable seeing patients with nutritional needs. Health visitors admitted to having the lowest training rates - only 9% said they had undertaken nutrition training.

This is despite the government's plans to include nutrition as part of the nurse training programme with the aim of tackling malnutrition among elderly patients. In October last year health minister Ivan Lewis warned that nurses who fail to help people eat and neglect older people should face disciplinary action.1 Mr Lewis said: "We somehow have to change the culture that says nutrition is not important. It is as important as access to the right medication."

District nurses had the highest training rates, at 30%. However, one district nurse said: "I feel we need more nutritional training and for every patient to be assessed and reassessed regularly."

"It would be very useful to have ongoing nutrition training embedded into nurse training," said another district nurse based in London. "I feel it is overlooked in many instances."

Malnutrition in hospital and the community affects more than three million patients and costs the NHS £7.3bn a year.2 However, it is estimated that 70% of malnutrition in the UK goes unrecognised and untreated.3 Respondents were asked whether they routinely screen for malnutrition. Sixty-five percent of respondents said they don't routinely screen for malnutrition, and when asked if someone else was doing it, 56% didn't know.

Despite the wide range of malnutrition screening tools available, 64% of the respondents reported using only common sense for assessing undernutrition.

According to Sara Stanner, nutrition communications manager at the British Nutrition Foundation (BNF): "Nurses need to be confident in the use of appropriate screening tools to identify and monitor those at risk and have a good understanding of nutritional support and practical measures for helping to treat loss of appetite or poor food intake. These results reflect what nurses have been telling us for some time - that they need more education and training in many aspects of nutrition."

Sarah Schenker, dietitian at the BNF, concludes: "This survey underlines the need for serious action to raise the awareness of nursing staff of the causes and consequences of poor nutrition. Recognising the risk of malnutrition and then acting quickly is paramount. We do not have to turn our nurses into nutritionists, but there must be a mechanism in place to take action that is simple and effective."

Click here to read the full report.


  1. Nurses to get nutrition assessments. 2007. Available from: /article_5925
  2. RCN. Improving nutritional care: evidence for practice. Available from:
  3. Schenker S. Undernutrition in the community. NiP 2006;30:76-80.

Do these results reflect your experience? Tell us what you think. Your comments: (Terms and conditions apply)

"I have newly joined a practice in Swindon and I was given the job of advising someone  to go on a low-cholesterol diet; I never have any training apart from my past experience and reading up and interest in diets. I felt a bit out of my depth and was not sure whether I did a good job or not." - Lai Kuen Foster, Swindon

"This headline could be used for almost every aspect of primary care. If the training cannot be accessed freely then it probably will not happen. The global sum may include money for training but it certainly isn't earmarked for practice nurses and healthcare assistants. Our PCT doesn't have funding for practice nurses or HCAs. More than 20 practice nurses locally have expressed interest in attending an ear care course, but we cannot get funding from companies who manufacture ear care medication or the PCT. If enough GPs will not fund their nurses then we cannot run the course. Obviously if this had been a more trendy problem we might have been in with a chance. Primary care nurses are being asked to take more and more on and they largley depend on a small number of their colleagues who fight the battle for recognition. It is time someone bit the bullet and demanded standardised education requirements for PNs and HCAs. There are only three areas of mandatory training for PNs -  immunisation, smear taking and resuscitation. The public depend upon the enthusiasm and dedication of their
nurses to seek out training, often in their own time. Those of us who have supportive GPs are indeed a lucky bunch." - Janet Holliday, Scarborough

"In part, I have basic training in weight management and basic dietary needs but have never been given a nutrition tool to use. However, my patient base is very different to the average UK practice base. My patients are rarely over the age of 50 and are reasonably fit military patients." - Jeanne McComasky, Germany