Registered Oncology Nurse, United Kingdom

I've never seen staffing as bad as it is right now. If I think back to when I was a charge nurse, the ratio was on average one registered nurse for every four to six cancer patients. Today the ratio is closer to one registered nurse for every eight to ten patients and on occasions worse.

I think COVID created a huge issue for us. I think a lot of staff got burned out and that has partly resulted in the crisis that we're in now. It’s not unusual to see increased errors, increased pressure ulcers, patients not receiving their medication in a timely manner or not having their nutritional needs met. These all have great implications for outcomes in cancer care. We often cannot schedule a patient's chemotherapy when they need it because often there's not enough trained chemotherapy nurses to look after that patient and administer treatment.

This is a 2-pronged issue for me. You've got the impact on the registered nurse, and you've got the impact on the patient. It's not unusual to see nurses visibly upset at work because they can't deliver the care they want to. And that really is frustrating and has a very detrimental impact upon the well-being of nurses.

It is still a privilege to work in cancer care and to look after patients. But more and more nurses are trying to leave the in-patient area so that they don't have to deal with the daily concerns of working on a ward where they'll be doing a 12-to-13-hour shift with less staff: It means going home feeling frustrated because you've not delivered the care that you are trained to deliver. I frequently see the impact this has on many of my colleagues; they don't stay working in the area for long. They're often seeking ways to leave their positions, whether to work in universities or to work as nurse specialists, or sometimes leave the profession entirely. We’re also seeing UK nurses leave to work overseas in countries where pay and conditions are more favourable.

The public doesn't see what's happening. They've got a completely skewed perception. Patients today often arrive at hospital with more than their cancer diagnosis. They have multiple other problems, and there isn't the level of expertise in nursing or medics on the shop floor to look after these patients. Often they are cared for by junior nurses, and junior medical staff, and the public is blissfully unaware.

Making matters worse, we're facing an issue with retirement. There are 43,000 Registered Nurses left the NMC register and over 45,000 vacant nursing posts within the UK. This demonstrates the magnitude of the problem. It has equally been reported in the UK that applications to study nursing are down 16% this year.

We talk a lot about recruitment issues. For me, the biggest issue is not recruitment it’s retention, and that goes for most areas of healthcare. We need to ensure that nurses get paid appropriately, that they have paid breaks and access to professional/career development. These are just a few examples of issues that could be addressed quite easily. But this workforce crisis in cancer care is profound and will require a much more concerted and ambitious effort.