A study from the universities of Southampton, Portsmouth and Bournemouth has found that patient observations are not always completed at night, as some nurses felt that that it was preferable to allow patients to sleep to aid their recovery.
This practise is a deviation from the National Early Warning Score systems and, the study found, could potentially be posing a risk to patient safety.
The study was carried out involving an unnamed hospital in England and based on interviews with only 17 nursing staff. However, the nurses involved reported using clinical judgement to determine how often a patient should be disturbed, and felt that the value of allowing the patient to sleep was an important part of their recovery. They also took into consideration non-clinical reasons such as not wishing to disturb patients with dementia or COPD who would then disturb the rest of the ward or increase workload. Patients who were also judged to be nearing the end of their lives may not be monitored as closely, as it was felt by some to be too intrusive.
However, it was noted that the taking or monitoring of patient observations was a key part of the nursing role but that some nurses actively dissuaded staff from waking patients.
The overriding concern from this research is that the question of whether a patient should be closely monitored can be left to unqualified staff, or that deviating from the required observations could threaten patient safety. It was commented that changes at ward level often became “socially acceptable” which undermined the existing protocol.
The clear recommendation to nurses was that they should involve other professionals when making clinical judgments about the frequency of observations, and that any discussions and decisions should be clearly recorded.
As specialists dealing with NMC investigations on a daily basis, our team have significant experience of assisting nurses and midwives accused of a range of misconduct and competence issues, including failure to complete appropriate observations and failure to recognise and act when a patient is exhibiting a NEWS result requiring action. We have found that registrants often do not realise that failure to follow the appropriate protocol can result in charges of misconduct being brought by the Nursing and Midwifery Council. It is important that any healthcare professionals involved in investigations by their regulators seek immediate legal advice in order to best protect their position and retain their registration.
If you do require assistance in dealing with concerns in respect of professional discipline our dedicated and experienced team are on hand to assist you. For more information, visit our professional discipline and regulation page or call 0175 321 6399.