A recent BBC investigation had the headline "NHS 'haemorrhaging' nurses as 33,000 leave each year". It quoted a nurse as saying "I want to give my patients my best, but I feel that I can't do that at the moment because we're just too short-staffed, too busy".
All respondents in a recently completed doctoral study of hospital staff expressed views similar to these, spontaneously identifying insufficient staff as the greatest threat to patient safety and quality of care. Most felt unable to influence this situation directly and found working in this way very stressful, as the perceived threat to patients also threatened their own self-image as a 'good nurse', for whom patient safety was top priority. By remaining in post and assenting to lowered standards of care the study respondents needed to behave in a way which conflicted with these personal values. This threatened their own emotional peace of mind (cognitive dissonance).
Staff appeared to cope with the stress this caused in one of two ways:
1. Disclaiming personal responsibility: Most respondents appeared to tolerate the situation most of the time through a cognitive revision of their self image – " I’ve done my best. That’s all I can do". Such cognitive decisions were subject to change. Particular circumstances could trigger an emotional reaction and a staff member, previously acquiescent to the situation, might suddenly decide they "couldn't take it any more". This could usefully galvanise individuals into making determined efforts to bring about improvement, for instance by recording staff shortages as adverse events and/or complaining to management.
2. Altering their beliefs and values: Worryingly, for some respondents the dissonance between their behaviour and their value system had led to a permanently altered cognitive perception of the degree of risk involved in running wards with insufficient staff, and a real belief that the revised practices represented acceptable care. This was reinforced by organisational norms which reflected government pressures to meet financial targets
Arguably neither of these accommodations to stress is sustainable in the long term and may offer an explanation for the large number of nurses leaving the profession.