What
is the right nurse -patient ratio on a ward; for a caseload in the community;
as a nurse specialist for diabetes or cancer? Of course, the answer depends on
so many variables: the skill and expertise of the nurse; the needs of the
patients, their age, capability, emotional distress, whether there have several
or just one condition that needs care and attention. And increasingly, whether
there is a friend or relative close by able to help and support.
What
we do know is that there are not enough nurses. Poor workforce planning over
many years means that, according to the RCN,
there are already around 24,000 vacant nursing positions in the NHS and post
Brexit we could see a potential shortfall of 40,000. More than 2,700 nurses
left the NHS in 2016, according to freedom of information requests compiled by
the Liberal Democrats – an increase of 68 per cent since 2014. According to the
Health
Foundation, half (49%) of nurses don’t think there are
sufficient staffing levels to allow them to do their job properly.
This
together with the loss of nursing bursaries which has caused a sharp drop in
student nurse applications means that decisions about how many patients should
be cared for by one nurse in hospital are likely to be flexed to what is
possible rather than what is safe. Discussions have centred around one nurse to
eight patients – doable if all patients are reasonably well and mostly self-caring.
Quite impossible if they are all fully dependant. Australia
introduced nurse patient ratios in 2015; whilst there are variations depending on
the type of hospital, in general the numbers are one nurse to four patients
with one nurse in charge; one nurse to eight patients at night.
In
England, to try and combat the nursing shortage, the government has introduced
the idea of nursing associates which, if you trained as a nurse many years ago
you might recognise as a new version of enrolled nurses – often highly skilled
people who did two years training instead of three and were relied upon to
deliver the same quality of care as registered nurses but paid less and had no
clear career path. Most ‘converted’ at a later date to be RNs in order to
progress. We could end up in the same situation with nursing associates.
The erosion of pay means that
nurses at Agenda
for Change band 5 and above will have seen their pay cut by 12% in real terms
over the decade from 2010/11 to 2020/21. Another reason why it is proving
difficult to recruit to the profession.
Apart
from numbers the other big issue that gets overlooked is the increasing
complexity of nursing. It is a job that requires thought, planning, knowledge,
diplomacy and intelligence, speed and agility of decision making and yet it is
poorly regarded. Nurses themselves are often deprecating about their work,
remembering only the drudgery and not crediting themselves with their plate
spinning ability and skilful management. Nursing is not simply a series of
tasks. It is complex and its contribution to the service and to patients
individually needs much better recognition inside and outside of the
profession.
The Health
Select Committee will look at the current and future scale of the shortfall
of nursing staff and whether the Government and responsible bodies have
effective plans to recruit, train and retain this vital workforce.
This
inquiry will assess the impact of new routes into nursing (including student
funding reforms, the Apprenticeship Levy, Nurse First and nursing associates).
In particular the inquiry will examine the effect of changes to funding
arrangements for nurse training, including the withdrawal of bursaries, and
consider alternative funding models and incentives.
The
Committee would like to receive suggestions for how policymakers could optimize
the potential of new routes into nursing, as well as how they might retain and
deploy existing staff more effectively.
However, the Health Foundation
is clear that no one profession should be picked off on its own. It is the combination
of different roles and skills that creates a good health service. Proper
workforce planning is required that looks across different staff groupings to
evaluate impact.
This requires more than looking at nursing skill mix which too often means
wards are polarised between untrained nursing assistants carrying out
increasingly skilled work and RNs distanced from the caring element of the job.