P-221 Staff wellbeing and acuity in hospice care: a mixed-methods study of frontline experiences and interventions for sustainable practice

<h3>Background</h3> Hospice inpatient units (IPUs) are managing increasingly complex, high-acuity caseloads. Yet, the physical and emotional demands placed on staff and their impact on wellbeing and team functioning, remain under-recognised in service planning. This mixed methods observational study explores how staff experience and perceive the burden of acuity and how their insights have shaped meaningful, responsive interventions. <h3>Methods</h3> In October 2023, 59.17% (n=71) IPU staff completed the Teamwork and Safety Climate Survey to assess psychological safety, communication, and workload. In-depth qualitative interviews (n=10) followed between December 2023 and January 2024. Thematic analysis identified stressors related to under-measured acuity and gaps in wellbeing support. <h3>Findings</h3> Survey and interview data revealed significant variation across roles. Respondents described diminished psychological safety, intense workloads, and inconsistent staffing patterns that hindered their ability to deliver holistic care. Increased admissions contributed to heightened pressure and moral distress, while escalating demands led to a more task-focused approach to care. Many staff reported physical exhaustion and emotional depletion, exacerbated by limited access to wellbeing initiatives due to workload constraints. These findings reflect national trends of growing burnout, emotional exhaustion, and reduced retention in palliative care roles (Royal College of Nursing. Nursing workforce standards. RCN; 2023; Gómez-Urquiza, Albendín-García, Velando-Soriano, et al. Int J Environ Res Public Health. 2020;17(20):7672). <h3>Interventions</h3> In response, implemented targeted initiatives include: Development of a new hospice-appropriate acuity tool. Review of staffing models to better reflect patient complexity. Multidisciplinary quality improvement subgroups improving staff and patient experience. Clinical skills training in complex care to build staff confidence. A revised induction framework with peer support for early retention. Reflective practice and resilience sessions to support emotional wellbeing. <h3>Conclusions</h3> Recognising the emotional and operational toll of high-acuity care is essential for sustainable staffing. Embedding staff voice into service development fosters morale, improves retention, and ensures person-centred care remains achievable even in pressured settings.