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Watchdog finds nursing shortages at children's hospital and staff feeling 'they're not listened to'

The Royal Belfast hospital for Sick Children in Belfast
Seanín Graham

NURSING shortages on a "substandard" ward in Northern Ireland's only children's hospital have severely impacted on morale and workload, a watchdog has warned.

Staff at the Royal Belfast Hospital for Sick Children revealed their "frustration" at a failure by senior management to address their concerns about one of the busiest wards in the regional facility - saying it had "left them with a feeling that their problems were not being listened to".

Inspectors from the Regulation and Quality Improvement Authority (RQIA) praised nurses and doctors for responding "compassionately to the needs of children and their relatives" but were scathing about how the hospital was managed.

A lack of overnight cover on the Barbour ward - which provides care to children who have had surgery as well as general medical treatment - led to difficulties in responding to all the young patients' needs, while IT problems led to it being a "paper heavy" facility.

"There was no clear nursing leadership within Barbour Ward. There has been no clinical nurse lead since December 2016 which has clearly impacted on the effective functioning of the ward," the review team found.

"Challenges... related to the management of the complex mix of patient age, dependency and medical conditions which is exacerbated by the substandard ward environment.

"Nursing staffing levels and middle grade doctor staff shortages had impacted on overall workload, morale and reduced the ability of staff to avail of educational opportunities... The hospital was described as having a disconnected leadership."

The three-day unannounced inspection took place in May and also examined conditions in the children's A&E department as well as a nearby 'short-stay' assessment unit, where children are observed for 24 hours.

Nursing staff based in the casualty unit told the watchdog they felt "supported and valued" by their senior colleagues and "morale was good".

The RQIA noted "excellent skills" when staff dealt with "distressed and crying children".

However, the team also discovered that admissions to the short-stay unit "were not always in line with the trust guidelines".

Inspectors raised concerns about staff shortages in the unit and noted that despite approaches to bosses 18 months ago about the need for extra nurses, it was still "under review". A lack of leadership was also criticised.

"It is not clear who is operationally responsible for the overall functioning of the short-stay assessment unit. Clear pathways for access, referral, admission to and discharge from to the unit were not in place," the watchdog said.

"The physical environment of the unit was not initially designed to address the needs of all infants, children and young people."

A spokeswoman for the Belfast trust, which is responsible for the children's hospital, said it accepted "there are areas that would benefit from improvement".

She confirmed an additional six nurses have been recruited while a senior nursing post has been filled with a temporary member of staff. The post is currently being advertised.

"Belfast trust is fully supportive of RQIA's inspection process and will continue to work with the regulator to improve and enhance patient safety and experience."

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