Rheumatology care compromised due to overworked NHS nurses

The excessive workload for NHS rheumatology nurse specialists is compromising patient care, according to a new report.

A survey of specialist rheumatology nurses found that workloads are negatively impacting on patients. More than eight in ten nurses (85%) surveyed said that there were aspects of care that their team was either unable to provide or was much delayed because of excessive workload. Examples of delayed care include providing urgent access to clinics, responding to calls on advice lines, joint injections and prescriptions.

The joint report by the British Society for Rheumatology and the charity National Rheumatoid Arthritis Society (NRAS), called Specialist Nursing in Rheumatology: The State of Play, provides a complete picture of rheumatology nursing services in the UK including care, workload and workforce recruitment.

Rheumatology covers all musculoskeletal conditions that affect the joints, bones and muscles, and also includes rarer autoimmune diseases and back pain. Specialist nurses stated in the survey they felt ‘overwhelmed’, ‘stressed’, ‘tired’ and ‘lacked support’.

Ali Rivett, chief executive of the British Society for Rheumatology, said: “Excessive workloads put intense pressure on nurses which can compromise patient care. It’s unacceptable that rheumatology teams are so under-resourced. Nurse specialists are caught up in admin with many putting in extra hours of unpaid time just to keep basic services running.

“Nursing staff are pivotal to providing care to the more than 10 million people affected by rheumatic conditions in the UK, who that need support to manage their symptoms. We must increase staffing numbers and make sure that our specialist nurses are provided with proper training and support.”

Many rheumatology nurse specialists have sole responsibility for parts of patient care. The role incorporates many elements, including making diagnoses, physical examinations, starting treatments, prescriptions of medicines, improving physical, psychological and social functions and referrals for investigations or to a relevant specialist.

The report reveals that patients have stated a declining ability to schedule appointments sooner than six months in advance. Long waiting times can lead to irreversible damage for patients with conditions like arthritis, where prompt treatment is vital.

Ailsa Bosworth, chief executive of the National Rheumatoid Arthritis Society, said: “Patients tell us that rheumatology nurse specialists are a lifeline for them, helping them to manage and alleviate both the physical and psychological suffering. Currently nurses are struggling to deliver even a core service and don’t have sufficient time to innovate or develop professional practice. We need to act now to avoid a crisis of care in patients with these lifelong, painful and debilitating diseases.”

David Pickles, BSR member and a trainee advanced nurse practitioner, said: “There are significant challenges threatening our ability to provide the best and most timely care for our patients. We need better acknowledgement of the work nurses do, and to ensure that we can access the best training and be properly supported by our employers to maximise our clinical impact.”

Zoë Ide, an NRAS supporter living with rheumatoid arthritis, said: “My nurse specialists have always been hugely responsive and supportive. Their expert knowledge means I receive quickly the help I need to manage changes in medication, unexpected symptoms and sudden flares. They give me invaluable peace of mind to help manage my condition.”

Other key findings from the report include:

  • More than seven in ten (78%) of departments surveyed reported that their rheumatology caseload was more than 1000 patients
  • A third of nurses (31%) said they were unable to take study leave and eight respondents said they had self-funded training and used annual leave to cover days missed from work
  • Almost half (44%) of nurses said there was demand for new roles in their department, but that there were not enough skilled nurses available.

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