Emergency on the wards

Jane McCready, Nurse Bank manager at the Victoria Infirmary, Glasgow
I manage the staff who supplement the ward staff and do the odd shift myself. The main issue is that if you don't have the right number of nurses for patients, it's difficult to give patients the care they need. This can get really stressful. Someone who has been given a difficult diagnosis, for instance, will need to talk about their fears and to ask questions; and you just can't sit with them because you have other patients who need a dressing changed, or need to be taken to the loo or taken for an exam.

It can be very distressing when you know a patient needs you and you can't be there for them. It can be difficult to fill the shifts - even though we have a reasonable-sized bank, it can take time to recruit nurses to fill vacancies because there's such a shortage, and nurses have a great choice about where to go. In the meantime this means longer shifts and extra work - we'll do an extra half-hour waiting for someone else to come on duty, or another shift to fill in.

Most of us are quite good at managing this - we wouldn't put ourselves or patients in danger - but it can be difficult to fill a shift. Nurses have to spend a lot of time orientating each agency nurse (you often get a different one each day) and it's all time you could be spending with patients. This affects student nurses: mentoring is important, but if there's a shortage, you may not be able to spend enough time with the students and this can put them off nursing.

Gaynor Jones, A&E nurse at Prince Charles Hospital, Merthyr Tydfil, South Wales
We only use agency nurses as a last resort. We have our own internal bank using our own staff. This means we all work extra to cover. I probably do one and a half extra shifts most weeks. This doesn't stress me personally - we are not forced to do it, and I know I could say no, there's no pressure. Day to day, though, there just aren't enough nurses on the wards: we need two or three more nurses, really, on every shift. This means you're always on the go. Nobody minds being on the go - it's what we're here for - but it can be really stressful when you can't get to see all the patients who need you.

Some patients can be rude and difficult when they're made to wait, and this can make my job hard. I go off my shift feeling I've had no time to talk to the patients. There used to be time for this, but now it's changed. This doesn't affect the care the patients get, but there's not the same job satisfaction. You're just dealing with ailments, not people.

Shona Maxwell, lead nurse in cardiology, cardiothoracics and cardiovascular at St Mary's Hospital, Paddington
There is a finite number of nurses out there, but it's all about how you manage vacancies: if you can pre-empt the coming shortages and plan your workforce, you can manage the situation well. There used to be significant vacancies in our area, but we looked at the peaks and troughs and were able to plan when we would need to get overseas staff in to fill vacancies and come up with creative ideas for recruitment. This has made a big difference.

It's a challenge being in central London with many other big trusts around, and we have recruited nurses from India and the Philippines. Representatives from St Mary's actually went out to India to interview and recruit nurses. These international nurses have to go through an "adaptation process" where they have to achieve "competencies" in certain areas, to make sure they're up to standard. While they're doing this it can be a bit like having a student nurse around, but we've had a lot of success bringing people over, and quite a few have stayed on.

We do still have to use agencies for shorter-term cover and it can be hard when people come in for one shift and then you never see them again: it puts a stress on wards in what is a pressurised job anyway. But generally I feel positive about staffing issues.

Vicki Cotterill, district nurse at Nottingham City Hospital
Agency nurses are really valuable - they prop up our system and they're absolutely fantastic. Working in the community, we are not affected so badly by the shortages - the hospitals are hit worse than the community - but it can be difficult for us to provide continuity of care to patients if they are seeing a different nurse every time.

Sometimes a patient just wants a familiar face. They get to know us, and if it's a different person they tend not to tell them things. My main worry is how we're going to recruit staff in future: I worry that when I'm old and need a nurse, there might not be anyone there! All of us work really, really hard - we give 110%. My hours are fairly regular (about 8.30am-5pm), but you have to be flexible in this job, and stress becomes a way of life. You want to feel you're managing things well, but sometimes I do feel as if I'm firefighting. You look at a patient list as long as your arm and you think, "Where do I go first?"

Mike Travis, paediatric intensive care nurse in Liverpool
We're nursing on the edge - juggling priorities and needs all the time. Because of the staff shortages, our shifts are chopped and changed at the last minute a lot, and it's hard to plan anything for your own life. I don't find this too bad myself, but it does have an impact on many of my colleagues.

When there are shortages we're often called in to work extra hours. It's very difficult to say no to the begging calls: we're in life-or-death situations here. It's almost a moral obligation to say yes.

The international nurses are excellent nurses, but they're not getting a good deal either. You need a paediatric qualification to get promotion and many employers won't pay for extra training because they don't think they are going to stay. I have good coping mechanisms for the stress but there are times when the mechanisms are stretched to the limit.

I've always loved what I do and feel I'm contributing to society by doing it, but I'll be retiring soon - in my unit lots of us are coming up for retirement - and I worry about who is going to replace us.

Chris O'Brien, third-year nursing student in Cambridge
I've noticed over the three years I've been training that the pressures have increased on nurses, and that's despite the fact that international staff have been recruited and they're often able to give a great deal and bring important skills.

The problem is, we're seeing far more chronically ill patients and our beds are at full capacity, but we don't always have full staffing complements. I think we're all aware that we're not always able to give the level and intensity of attention that we'd like, or to go the extra mile. It's not that we don't want to do that and it's not that we don't care, but the pressures weigh heavily.

I think in many ways becoming a nurse is similar to becoming a teacher: you've got to feel a sense of vocation in teaching, and you've got to feel that in nursing too. But the problem at the moment is that it's what draws you to nursing that's being eroded, which is that chance to make a real difference and offer holistic support to someone. The feeling you get when a patient says thank you, you being here was really important to my recovery - that's so special. I'm optimistic about my career, but at the same time I know I'm going to have to be vocal and an advocate for patients in the years ahead, because I think a lot of things are under threat.

Thanks to guardian.co.uk who have provided this article. View the original here.