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13.12.17

The future of the nursing workforce: what next?

Janet Davies, chief executive and general secretary of the Royal College of Nursing (RCN), argues that the evidence of the importance of prioritising safe staffing numbers in the UK is both compelling and urgent.

When I speak to RCN members, nurses and healthcare assistants, they are worried. Worried that there aren’t enough nurses on our wards and in our communities.

The King’s Fund has recently shown that nurse and health visitor numbers have fallen year-on-year since 2013. Its analysis points to dwindling numbers of EU nurses joining the workforce and increasing numbers of EU workers leaving the NHS as one of the primary causes for this fall.

Nurses from the EU and EEA make an enormous contribution to the UK’s health and social care system, and we rely on them to fill the gaps left by years of poor workforce planning. But these highly valued colleagues are facing uncertainty over their status in the Brexit negotiations, and we have seen a 96% drop in the number of EU nurses joining the register since the referendum.

The collapse in EU nurses is just one part of a lethal cocktail of factors that is causing the nursing profession to shrink. Increasing pressure in the NHS, the changes to student funding, difficulties recruiting and retaining nurses and falling pay levels have left the profession demoralised and people heading for the door.

We know the 1% pay cap has made it very difficult for nurses to keep up with the cost of living. The latest Nursing and Midwifery Council figures show the numbers of UK-trained nurses leaving the workforce has increased by 9% last year. With £3,000 missing from nurses’ pay packets annually, it’s understandable why many are choosing to move abroad or leave the profession altogether. 

The announcement by health secretary Jeremy Hunt that the pay cap has been scrapped was very welcome, but our work is not over. The next pay offer must not come in below inflation, and cutting funding to other NHS services to cover the costs cannot be justified.

Questions are also being raised about where we will find the next generation of UK nurses, as they are deterred from entering the profession by low pay, work pressures and new training costs.

The Health Foundation has recently highlighted that applications to nursing courses had also fallen by 23% in England this year following changes to student funding.

To tackle shortages across the country, new routes into nursing are being introduced. This includes further funding to train nursing associates and new graduate apprenticeships. It is important that these new frameworks provide good-quality education and skills development so people can have lifelong nursing careers. However, nursing associates must not be used to plug gaps left by trusts failing to recruit fully trained nurses.

The bottom line is that not enough nurses are being trained, recruited and retained. This is putting extra pressures on frontline nurses.

Our latest research surveyed over 30,000 nursing shifts across the UK. Over half of respondents told us that their shift was not staffed to the level planned and that care was compromised. One-third report having to leave elements of patient care undone due to a lack of time, while two-thirds are working extra time – on average another hour per shift, for which they are hardly ever paid.

This work and analysis such as the King’s Fund’s reinforce the need for mandated staffing levels and investment in nurse education. The RCN wants to see guarantees on safe and effective nurse staffing enshrined in law in each country of the UK.

The evidence is compelling: sufficient numbers of registered nurses lead to improved patient outcomes, reduced mortality rates and increased productivity.

Legislation is a necessary step to improving patient safety alongside increased funding to health and care services so they can meet demand, and so nurses’ pay can be increased to keep people feeling valued and in post.

It’s clear the shortfall of staff is impacting on patient care. We cannot overlook the accounts of 30,000 professionals; the government needs to prioritise safe staffing and close the gap on nursing pay if we are to reverse the spiralling numbers leaving the profession.

Top Image: Martin Prescott

FOR MORE INFORMATION

W: www.rcn.org.uk

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