Short staff dilemma

Recently there was a case in the press of  a nursing home manager jailed due to poor care arising from short staff. So what could or should she have done?

Stonedale Lodge Residential & Nursing Home
Stonedale Lodge Residential & Nursing Home

Whilst it may still be due to staff sickness or holidays; it seems to have been a regular occurrence. This may mean that she has tried bank staff and none available. Has she tried agencies? Too be honest, it is more  difficult to obtain care assistants from agencies. I have actually known  a  care home which paid  an agency nurse to work as a care assistant, so it is not all bad. But then, the regular staff need to assist them as they are unfamiliar with the  establishment. Whether or not she rang agency, depends if her regional manager( in this case it was a company home) allowed her to ring them. Sometimes they do but use delaying tactics when it is too late to get anybody. However, by delaying, sometimes they do save  a couple of hundred pounds because a usual member of staff finally decides do work overtime. So what proof would she have of this?

Managers- always keep emails and keep replies. If this keeps happening, it is your DUTY as registered manager to inform the CQC. They will monitor the staffing levels. However, it has been known (anecdotal) for some homes to invent the names of staff and display them on the off duty-. There are also cases of dependency levels of patients in hospital or care home, being falsified since they indicate the required staff level; the Francis report gives us published evidence of this. Yes you also need to be  in a union but according to the Francis report (2013) and anecdotal evidence, they too may not be effective. Indeed anecdotal evidence, nobody will publish it nor write it, tells us that some staff are dissuaded from joining a union.

This is the difference to an NHS hospital- the care home manager is REGISTERED. Yes there is a dilemma between beds, budget and quality of care. But get your priorities right. Yes I know you may lose your job if you ring the CQC- but it is better than going to jail. Although why that should be the major factor I do not know. Yet today, everybody does need to work I know. Consider also dilemmas faced by overseas nurses. I explore this elsewhere.

On a hospital ward of course, the ward manger or person in charge would ring round other wards who may have somebody but not always. So then you alert the manager. Again if it keeps happening, keep records and inform even higher managers. Yes you too may need to approach the CQC.

Evidence is crucial. This is not just for managers. Keep incident forms (take a copy) of shifts when staff levels are low. note what tasks you are unable to do due to low staffing such as baths, how can you bath in an EMI home with 3 staff and 30 residents? Otherwise, you have no clear record of why these tasks were not done on your shift so you are in trouble. If it is  a certain resident /patient you cannot meet the needs of, note it in the care plan. Also put a note in the diary. Today there were only 3 staff on not 5, so we could not bath residents.

Talking to staff and students I am constantly amazed when they say you can do nothing about it. Students need informing of what to do in these situations in preparation for their qualification. Let us not forget senior care assistants in a care home. I am going to end with a scenario because it makes me smile and we all need to smile. At an interview once, I was asked by the higher manager, if I told you to use less staff than the inspector recommends what would you do? He did not like my answer and I am proud to say, I did not get the job. Wrong person, wrong question. Remember- there are no actual specified staffing levels. We do feel that if  a minimum staffing level was established, whilst many may solely meet that and never go above it, it would be better than the present levels.

In this case the relatives informed senior managers , it is not indicated whether or not the manager informed them, so they too are involved. The question always is, do the regional mangers act alone- to what degree are they representative of the company? We do know that many companies pay managers a bonus for not spending the budget.. We do know that there have been cases of managers (and staff) being pushed out for failing to adhere to company ways. We also know that there is good practice and not all poor care is due to low staffing levels.