Image caption Nurses were asked about 'missed care'

Nurses in England say they are having to "ration" care because of time pressures, a study suggests.

The paper in BMJ Quality & Safety found areas that suffer include monitoring patients adequately.

The fewer nurses there are, the higher the risk care will be compromised, according to the study which involved almost 3,000 nurses.

The Department of Health said it was down to each hospital to decide staffing levels.

The researchers from the Florence Nightingale School of Nursing and Midwifery in London surveyed nurses from 400 general medical or surgical wards in 46 hospitals across England between January and September 2010.

They were asked about "missed care" - care that nurses deemed necessary, but which they were unable to do or complete because of insufficient time.

The 13 areas covered included adequate patient monitoring through to adequate documentation of care, and pain management.

'Talking and comforting'

The researchers wanted to find out if there was any association between nurse staffing levels and the number of these episodes, and whether these were linked to overall perceptions of the quality of nursing care and patient safety in a ward.

They found 86% of the 2,917 respondents said that at least one of 13 care activities on their last shift had been needed, but not done, because of lack of time.

On average, nurses said they had been unable to do or complete four activities.

These are depressing findings and unfortunately not surprising Dr Peter Carter, , Royal College of Nursing

The area that suffered most was talking and comforting patients, cited by 66% of the nurses.

Educating patients and developing or updating care plans were identified as not being adequately performed by around half of those questioned.

And pain management was reported as not being done by 7%.

The more patients needed assistance with routine daily tasks, or particularly frequent monitoring, the more likely staff were to say there were "missed care activities".

Staffing levels varied considerably, but the average was 7.8 patients per nurse during day shifts and 10.9 at night.

'Something has to give'

Jane Ball, who led the research, said: "The study not only reasserts the connection between staffing levels and patient outcomes, but provides an indication of the scale of the staffing problems we face.

"The majority of general medical/surgical wards have staffing levels that are insufficient to meet patient needs on every shift."

Ms Ball said publication of the survey had taken three years because "that's the nature of academic work".

Asked if the situation could have improved since 2010, she said evidence suggested "nothing is better" and "if anything, we have had more cuts to staff posts".

Dr Peter Carter, general secretary of the Royal College of Nursing, said: "These are depressing findings and unfortunately not surprising.

"When nurses are overloaded with tasks, and have extremely limited time to complete them, something has to give."

A spokeswoman for NHS England said it was committed to ensuring that "all patients receive compassionate and competent nursing care".

"We welcome this report and expect providers to use the evidence available to ensure they have sufficient staff on wards with the right skill-mix to provide high quality services to patients."

She said the new chief inspector of hospitals would work closely with the Care Quality Commission to ensure units met standards of care.

A Department of Health spokesperson said: "Hospitals themselves must decide how many and which staff they employ.

"But we have been absolutely clear that these decisions must be based on providing the best patient care."