Burnout, shame, heartbreak: nurses are being crushed by our broken NHS | Sonia Sodha

I’ve never read a report quite like it. Last week the Royal College of Nursing (RCN) published accounts from the frontline of corridor care in NHS hospitals. There are next to no charts or statistics, no lists of recommendations or thematic analysis: just page after page – more than 400 – of testimony from nurses about patients being treated in appallingly undignified conditions in corridors, cupboards and storerooms across the NHS.

Astonishingly, there is no official data on how many patients are affected nationwide. So the RCN has filled the gap, sending out a member survey at the end of December and collating this report in a matter of days. It presents the raw, unvarnished truth about standards of care that once, in normal times, would have raised all kinds of official red flags. Today, they have become routine in every corner of the country, with some NHS trusts even advertising roles in corridor nursing.

One nurse describes how a patient died alone on a corridor, and wasn’t discovered for hours. Another how, when she started her shift, there were 30 patients on one corridor; four were crying because they needed to use a bed pan, several others were in already-soiled blankets, and there was only one cubicle available for all these patients for examinations and toileting. Others recount lifesaving CPR being performed on patients in corridors – or delayed because patients had suffered a cardiac arrest and were being blocked in by other trolleys in overcrowded spaces.

This is the product of a health system that has been consistently underfunded for 15 years, in which internationally low numbers of hospital beds and doctors per person, and a lack of social care for patients who would otherwise be discharged, result in hospitals operating at dangerously high capacity in winter. It is dreadful that ill and vulnerable people are being cared for unsafely and with such little dignity. What also very clearly emerges from the RCN report is the effect this is having on nurses. Account after account reads like a distress signal, sharing feelings of shame and heartbreak; one nurse described crying on shift because she simply couldn’t deliver the care people deserve.

There are various terms to describe what these nurses are undoubtedly experiencing. Burnout as a result of work-related stress. Compassion fatigue, sometimes described as the cost of caring for others experiencing trauma. Moral injury, the long-term distress that results from people being unable to provide ethically acceptable care. These are all phenomena that surfaced as never before during the pandemic. But for some NHS staff, the intolerable working conditions have never gone away. In the words of one nurse: “I worked throughout Covid-19 and although it was a horrendous experience this lack of care in the broken system is worse.”

From nurses who are seeing patients die on their watch as a result of services being so stretched, to care workers allowed pitiful amounts of time for home visits when they need to feed, toilet and dress their clients, to teachers in poor areas having to wash school uniforms and who can’t get vulnerable children the support they need: there are long-term costs to this under-resourcing of public services that go beyond the direct impact it has on people’s lives.

Some of these professionals may decide they can’t cope and leave; others will struggle on at great emotional cost, perhaps even becoming desensitised as a psychological defence mechanism, empathy and compassion dulled over time because what is being asked of you is simply too much.

It reminds me of the work of the psychoanalyst Isabel Ménzies Lyth, which I came across when writing about social care a few years ago. She conducted a seminal study of nursing in a London teaching hospital, published in 1960. Some of her unfashionably Freudian theories would today have little resonance. But her observations about the dynamics of postwar nursing remain profoundly relevant. She described how the hospital’s nursing service organised itself to prevent frontline nurses from developing emotional attachment to their patients, in order to reduce the stress and anxiety it might generate. Nurses would do the same, repetitive task for scores of patients, rather than care holistically for two or three. Procedures were heavily standardised to avoid the sense of too much responsibility. Patients were talked about in depersonalised ways, such as “the liver in bed 10”, even as nurses themselves deprecated this practice. “Little attempt is made positively to help the individual confront the anxiety-relating experiences,” she wrote. She reached the conclusion that not only did this system fail to alleviate anxiety, it made it worse.

This way of organising a hospital would of course be anathema to modern nursing and medicine. But Lyth’s work attracted renewed attention in the wake of the 2014 public inquiry into the appalling levels of care patients suffered at Mid Staffordshire NHS Trust.

And there are longstanding initiatives, such as those run by the Point of Care Foundation, that support clinical staff to provide the patient-centred care that is the very opposite of what Lyth observed in her work. One such intervention is the beautifully simple concept of the Schwartz Rounds: facilitated monthly meetings open to all staff to talk about and reflect on patient care; evidence suggests that attending these regularly helps to alleviate workplace stress.

The RCN report is a brutal reminder that for some clinicians and support staff in the NHS, working conditions become so terrible during its winter crises that truly patient-centred care becomes impossible. The NHS is far from perfect – Mid Staffs and the maternity scandals show how even in times of healthy resourcing there have been pockets of devastatingly terrible care. But many more patients have had very good experiences. That is what is at risk – not as a result of a pandemic, but of sustained political decisions not to fund healthcare at a level commensurate with rising demand. I don’t think we fully understand the long-term costs.