I left my permanent clinical practice role in 2005, since then I have watched in dismay the situation developing for colleagues still working in the NHS. Morale is at an all time low and in my 30 plus years as a nurse I have never listen to stories from friends and colleagues that leave me feeling so dismayed and disempowered.

One colleague who regularly works hours over her 37.5 hours per week was disciplined for leaving her place of work 10 minutes early (with a doctors permission, her line manager was not available – she had gone home early), she was given a written warning to be placed in her personal record for two years.

In the last month I have received calls from students who are unable to submit work due to:
• Inability to have time away from the work environment for clinical training aspects required for certain courses;
• Having to cover shifts for colleagues on sick leave as they are unable to use NHS professionals due to cost implications;
• Working 12 – 16 hour shifts as there was no one else to work;
• Not being able to take holidays and time owing as there are no staff to cover;
• Unable to use their time off to write their assignments because they have been called into work;
• Being on sick leave for stress and other illnesses.

There is already awareness that there are 100,000 nurses aged 55 or older on the Register this equates to 1 in 4 nurses (RCN 2002). It is hardly surprising therefore that nurses over the age of 50 years are prepared to walk rather than work in the present environment. Many friends and colleagues have made me aware of their feelings and I would be surprised if the number of nurses over the age of 50 leaving the NHS in this area is not seen to increase dramatically.

According to Kings Fund (2005) Nurses are the single biggest group of clinical staff, making up 30 per cent of the workforce, with some 400 thousand posts in the NHS. The NHS Plan (2000) encouraged the development of extended roles and nurses have trained and advanced their practice to enable them to provided care for patients as close to home as possible i.e. nurse led clinics and walk in centres. However advanced practice roles can be seen as expensive (32 – 42K per annum) and it is too early for the benefit of these recent role developments to be seen; therefore as a reaction to the financial situation in the NHS these advanced nursing roles are not being filled and any vacancies occurring are also being put on hold. This adds pressure to the already stretched nursing workforce.

I have been looking at the latest statistics from the Department of Health on public health issues and while doing this was interested to notice the nurses per head of population ratio’s across the South East region of the country. I personally was not astonished to find that there is a higher ratio of population to registered nurse in Kent and Medway than any other Strategic Health Authority in the south east. This may provide some support to the feelings of nurses in the area that they are disadvantaged in the ability to care for patients (see below)

The following table outlines the population and registered nurse ratio in South Eastern region per Strategic Health Authority pre 2006.

Workforce Strategy
The RCN (2004) in their document “The future nurse: trends and predictions for the nurse workforce” make very specific statements in regard to the UK’s nursing workforce. Their conclusions in this document are:

• There has been a welcome increase in nurse workforce numbers but this varies between grades and specialities and in some there has been an actual reduction in nurse numbers.

• Internationally recruited nurses have made a significant contribution to nurse workforce numbers but this rate of growth may not be sustainable in the longer term. In addition the registered nurse workforce is ageing.

• Choice and control over working hours and shift patterns is a major factor for nurses in determining the sector in which they are employed and their entry and exit routes into and out of the profession.

• There is extremely limited workforce information regarding the current and predicted number of nurses who work at an advanced level of practice and the type of work they and other registered nurses undertake.

• The numbers of new healthcare workers are not known including predictions or plans for any increase and impact on registered nurse workforce numbers.

• The numbers of health care assistants have increased overall.

However in the last two years due to the financial constraints in the NHS the positive aspects for nurses have diminished and the advanced nursing roles are those that are at risk. The RCN made several recommendations which although then seemed possible and were starting to occur in certain areas have not been adopted nationally.


The recommendations are:
• the four UK health departments with key stakeholders including the RCN develop a 10 year co-ordinated nurse recruitment and retention plan that incorporates the contribution of internationally recruited nurses

• employers review arrangements for determining shift patterns and shift allocations to improve the degree of choice and control nurses have over their working lives

• particular attention is paid to retaining older nurses including flexible working hours, salary protection, tailored return-to-nursing courses, and financial and pensions advice

• employers review the number of excess hours nurses are working and consider setting targets to reduce these

• employers urgently review ‘acting-up’ arrangements, pay staff appropriately who ‘act-up’ and make permanent appointments to posts

I thoroughly endorse the RCN recommendations but realise that Trust recovery plans may hinder the use of the recommendations in workforce development.

According to the NHS Confederation (Employers) (2005) Page 21, 4.14
“a higher than expected and unfunded pay award would lead to extended vacancies and freezing of posts with a subsequent reduction of services and developments. Indeed, in the recent recruitment and retention survey by NHS Employers, 10 per cent of respondents were anticipating redundancies in the next 12 months, most likely to be managers (43 per cent) and the wider healthcare team (30 per cent). A further 25 per cent indicated the potential for redundancies. This is against the backdrop of 39 per cent of respondents indicating that they had had recruitment freezes in the last 12 months of which nursing and midwifery (45 per cent) and AHPs (33 per cent) were two of the main groups.”

As the news article in the HSJ (2007) outlines it is false economy to reduce the number of nurses being trained and employed. I have been informed by nurses working for NHS Professionals that work is difficult to find. Nurses working across the area are also telling me that they are being advised by managers not to request NHS Professional nurses. They may be available but appear to used in very few areas.

Staff that I have spoken to are continuously being asked to do overtime and as always willingly provide the care to patients to the detriment of their health,
family life and pocket. Overtime is not being paid and nurses are being asked to take time in lieu –which they never get, so again the NHS is working on the good will of its staff.

Our Health, our care, our say (2006) outlines the way patients would like services to be provided, as close to their home as possible. The need therefore to increase the number of community based staff to provide the care should be of paramount importance. However the freezing of recruitment, the freezing of training for nurses and the PCT realignment has in this area caused great difficulty in providing anything but the basic care for patients.

One of the concerns nurses are voicing is the lack of communication from their line managers and other Trust personnel. It is well know that the NHS has a very deeply developed grapevine and the worst thing managers can do at the present time is not to keep their staff informed of developments. However having worked in the NHS for more than 30 years I am well aware and have heard voiced the comment “that staff don’t need to know that” and “they are only nurses, they won’t understand.”


I would therefore recommend that:
• Staff are kept continuously informed of the processes and development on a daily basis;
• PCT’s review their future service need and continue to develop the nursing staff;
• Talk to and listen to the staff – take the problems/concerns to them and listen to their answers;
• Nursing (all staff) should be told that they are important and valued members of staff;
• Decisions are not made without the inclusion of the staff they involve;
• Staff are not made to feel guilty for saying no.


References
DoH (2006) Our Health our care, our say . Department of Health.
DoH (2000) NHS Plan. Department of Health
HSJ (2007) SHA’s told they must plug shortfall of 14,000 nurses.
www.hsj.co.uk (04 January 2007.)

More Nurses, Working Differently: A review of the UK nursing labour market in 2002, Royal College of Nursing

http://www.kingsfund.org.uk/resources/briefings/nhs_workforce.html

http://www.dh.gov.uk/assetRoot/04/11/36/62/04113662.xls

http://www.statistics.gov.uk/census2001

www.dh.gov.uk

NHS Confederation (Employers) Company Ltd. 2005 NHS Employers Evidence to the Nurses and Other Health Professions Review Body 2006/07 http://www.imi.org.uk/afc/pay_review_nohp2005.pdf

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