Care home nurses unable to take breaks and working while sick, RCN reveals

Care home nurses across the UK are working while unwell, taking on heavy unpaid overtime and caring for an unmanageable number of residents, new research from the Royal College of Nursing (RCN) shows.

The preliminary findings from the RCN’s latest employment survey, completed by more than 20,000 nursing staff across all health and care settings, reveals that 66% of all nurses had worked at least twice in the past year when they should have been on sick leave, the highest level in eight years and up from 49% in 2017.

Stress is now the main cause of illness among nursing staff, reported by 65.1% compared with 50% in 2017.

The RCN says both figures highlight the intense pressure facing care home staff as well as colleagues in the NHS.

‘Dreading going to work’ 

Seven in 10 respondents said they work beyond their contracted hours at least once a week, and around half of these extra hours are unpaid.

Care home nurses who responded to the survey described routinely staying late to complete essential tasks because staffing levels made it impossible to finish on time.

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One nurse working in an independent care home in England said they were ‘just dreading going to work knowing we’d be short staffed’ and would ‘inevitably have to work over my hours unpaid just to get everything done’.

Another nurse in Northern Ireland said they were responsible for 16 to 18 residents with complex needs and warned that without set staffing ratios, ‘nurses are spread too thin with potential for disaster’.

Other care home staff told the RCN advice line that they were unable to safely take toilet breaks, with only one healthcare assistant on duty to help care for more than 100 residents.

Calls from members about unsafe staffing levels are averaging 181 a month this year and are expected to reach 2,175 by December, higher than in both 2023 and 2024.

‘Cold, hard evidence’

Some nurses reported panic attacks, nightmares and hyperventilating at work because of staff shortages.

One nurse said her unit was so understaffed she felt scared to go to work. Another trainee NHS district nurse in Scotland said that a single nurse was left responsible for up to 100 patients in the community, leading to a serious pressure ulcer being recorded as a major adverse event.

The RCN says the escalating pressures represent ‘cold, hard evidence’ of dangerously low staffing levels across both care homes and the NHS, where more than 25,000 nursing posts are vacant in England alone.

‘Already broken’ 

RCN general secretary and chief executive, Professor Nicola Ranger, said: ‘Nursing staff are being driven to ill health from working in understaffed and under-resourced services.

‘And what’s worse, many feel they cannot take time off for fear of leaving their colleagues at the mercy of brutal pressures. This simply isn’t sustainable.’

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Professor Ranger is warning that nursing staff are being ‘left with the possible task’ of caring for sometimes over a 100 patients at a time.

‘This is hugely detrimental to patient outcomes, but there also needs to be action to address the devastating impact on staff themselves. The reality is they’re not breaking; many are already broken,’ she warned.

‘These findings are yet more cold, hard evidence that there are simply too few nursing staff to meet growing demand.

‘New and urgent investment is desperately needed to grow the nursing workforce, ensuring staff are able to work in a safe environment and that patients get the best care,’ Professor Ranger stressed.

The RCN head also doubled down on the union’s calls for safety critical nurse-to-patient ratios to be implemented across all healthcare settings.

In other parts of the world, like California, mandatory nurse-to-patient ratios exist to protect nursing staff and patients.

The full findings of the RCN’s survey will be published next month.

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A Department of Health and Social Care spokesperson said: ‘We hugely value the work of talented nurses, and through our 10 Year Health Plan, we are taking action to improve conditions for the overworked and demoralised workforce we inherited.

‘That includes rolling out high-quality occupational health support, introducing new staff standards to make sure flexible working is more widely available, and cracking down on violence, racism, and sexual harassment in the workplace.

‘We are also providing better job opportunities for qualified nurses and midwives with a new Graduate Guarantee to make sure thousands of new posts are easier to access, helping to further reduce the burden on existing staff.’