Queen’s Nursing Institute report

August 24, 2020

The Queen’s Nursing Institute (QNI) has published a major new report on the COVID-19 pandemic and its impact on care homes and care homes with nursing in the UK.

In May and June of 2020, a survey of the QNI’s Care Home Nurses Network was carried out by the QNI International Community Nursing Observatory (ICNO) to understand more about the impact of COVID-19 on the Care Home Nurse workforce within the UK.

The responses in the Queen's Nursing Institute report confirm that, for the majority of respondents, the pandemic has been a very challenging experience. They indicated that their work and wellbeing has been worse or much worse than at normal times, during the survey period.

Having to accept patients from hospitals with unknown COVID-19 status, being told about plans not to resuscitate residents without consulting families, residents or care home staff, lack of guidance on issues like personal protection and issues of poor access to pay if they became ill were some of the major issues the workforce faced during March and April 2020.

While two thirds of respondents said they ‘always’ had access to appropriate personal protective equipment (PPE) and most others said that it was usually available, a small minority were not provided with PPE and had to improvise, by obtaining it themselves or by making it. The need for appropriate PPE in care homes is of critical importance in staff and resident safety: 21% of respondents said that their home accepted people discharged from hospital who had tested positive for COVID-19.

Additionally, a substantial number found it difficult to access District Nursing and GP services and many indicated that they were not able to access essential training from other health professionals at this time.

Some respondents refocused work to consider how they could improve on their approach to end of life care. Worryingly, some who responded raised serious ethical and professional concerns, for example GPs, Clinical Commissioning Groups and hospital trusts making resuscitation decisions without first speaking to residents, families and care home staff or trying to enact ‘blanket’ ‘do not resuscitate’ decisions for whole groups of people.

Dr Crystal Oldman CBE, the QNI’s Chief Executive commented, 'The care being delivered in a home can at times be as intensive as in a hospital – in particular for end of life care – and it is hugely skilled work. As the majority of respondents to this survey indicate, the people living in their care homes need a combination of support for complex physical and cognitive needs.

'Overall, as would be expected, the picture presented is of an extremely stressful and anxious period for professionals working to care for and protect their residents. The positives represent a silver lining to this cloud and there are numerous testaments to the skill, dedication, professionalism and teamwork that care home nurses have displayed in 2020. In addition, this brief insight into the experiences of the nurses provides an opportunity to consider and plan for the support systems that may be needed in the anticipated second wave of COVID-19.

'More needs to be done to understand the effect of COVID-19 on the workforce and residents in care homes. Urgent attention must be paid to the sector if the workforce is to withstand the additional demands of the pandemic, particularly in planning, guidance and employment practices.'

Professor Alison Leary MBE, Director of the ICNO and Professor of Healthcare and Workforce Modelling at London South Bank University commented on the Queen's Nursing Institute report saying, 'It is clear from this survey that the care home workforce has faced very challenging issues. Many have felt unsupported and their wellbeing has suffered. We need to support this workforce to face the challenges ahead.'

Other key findings of the survey include:

  • 70 respondents (43%) reported receiving residents from the hospital with an unknown Covid-19 status during March and April 2020.
  • Around 20% of responses reported positive or mixed sentiment around the experience of working through Covid-19, for example pride in their colleagues or new workforce opportunities. 80% of responses reported very negative experiences.
  • 56% felt worse or much worse in terms of their physical and mental wellbeing, while 36% reported no change.

The full report is available on the Queen's Nursing Institute website.


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