Disposable expertise: how nurses and teachers get taken for granted

Fiona Johnson looks at the similarities between the two professions, argues we underestimate their expertise at our peril, and suggests why they’re not appreciated enough.

Blog post

Published: 31/10/2017

Four out of 10 teachers have left the classroom within five years of qualifying, according to research by the Institute of Fiscal Studies and funded by the Nuffield Foundation.

Here at the Nuffield Trust we are preoccupied with the workforce challenges in the NHS, all of which are set to be aggravated by the consequences of Brexit and which we argue are at least as serious as the financial problems besetting the NHS. The shortage of nurses is now so severe that the Health Select Committee is mounting an inquiry into its causes and possible remedies.

Are there common factors at play in these two major public services?

Both teaching and nursing are practice disciplines that require time for competence and confidence to develop. Patricia Benner wrote about this in 1982 in her seminal work, From novice to expert, and the analysis holds up well today.

Yet both schools and hospitals show a chronic inability or unwillingness to give newly qualified teachers and nurses the space and support they need to consolidate their student learning and develop their expertise. Too often, newly qualified nurses feel out of their depth, with more experienced staff too busy to mentor them. They get the worst deal on working patterns and they are moved around from ward to ward to plug staffing gaps, leaving them feeling they are just a number.

Newly qualified teachers (NQT) have a reduced teaching workload in their first year after qualifying, but many struggle to access the professional support that is supposed to be part of the package. And once that year is over, they are plunged in at the deep end and rapidly acquire additional responsibilities. Their fresh thinking, creativity and enthusiasm is eroded over subsequent years until they burn out and leave.

Both services seem more preoccupied with recruiting adequate numbers than with retaining the staff they have already trained at a considerable cost to the public purse. There are many different routes into teaching, which vary in cost from around £17,000 for a primary teacher following an undergraduate route, to £38,000 for Teach First entrants. As the Institute for Fiscal Studies points out, the longer-term costs rise to around £60,000 per teacher for Teach First entrants as retention is so low.

Routes into nursing are also proliferating with the advent of the nursing associate role, nurse apprenticeships and Nurse First. It might be salutary to learn some lessons from teacher training as these new options are rolled out.

Action is clearly needed as nurse vacancy rates are at record levels, creating a vicious cycle of pressure, burnout and more pressure for remaining staff. Yet the NHS appears to have no coherent retention strategy for its nursing workforce.

There may be more deep-seated reasons for this.

Institutional misogyny?

The high attrition rates for both nurses and teachers in their first five years of practice may be due to a systemic failure to understand and value the complexity of the work they do.

An accomplished primary school teacher will be teaching a class of mixed-ability children, supervising the work of one or more classroom assistants, dealing with parents and visitors, and will maintain a calm and orderly environment where learning can flourish. An experienced ward sister will be planning care for a group of acutely ill patients, marshalling medical input, supporting nursing staff, dealing with patients’ families, supervising drug rounds, arranging admissions and discharges, all in a calm and orderly manner that promotes patient recovery. 

What do these professionals have in common? They make a complex task look straightforward and they are (usually) women.  

90 per cent of nurses and 85 per cent of primary school teachers are women.

Institutional misogyny may be at work here. If work primarily undertaken by women is seen as simple rather than complex, the practitioners themselves may be regarded as both interchangeable and dispensable. As a result, less attention is paid to developing their skills, valuing their professional expertise and retaining their services.

Whether or not sexism is at play, there has been a persistent failure to understand the value of nursing and the vital contribution skilled nurses make to patient care and recovery. That failure of imagination has come back to haunt the NHS. In the wake of the Francis Inquiry into care failings at Mid Staffordshire, hospitals scrambled to recruit extra nurses in 2013, only to collide with the consequence of an earlier short-term decision to cut training places, which fell by 12.7 per cent (from 20,092 to 17,546) between 2010/11 and 2012/13.

With the further threat to the supply of nurses posed by Brexit, attention may at last be turning to retention. A nurse-led study in the West Midlands has received charity funding to research ways of supporting newly qualified nurses by “overcoming the feelings of isolation, low morale, extreme work pressure and lack of competence development that can impact on nurses early in their careers”.

About time too.

Fiona Johnson is Director of Communications at the Nuffield Trust. She was previously Director of Communications at the Royal College of Nursing and earlier at the General Teaching Council for England.

Suggested citation

Johnson, F. (2017) "Disposable expertise: how nurses and teachers get taken for granted" https://www.nuffieldtrust.org.uk/news-item/disposable-expertise-how-nurses-and-teachers-get-taken-for-granted