Frontline truths: nursing rhetoric and reality

With nursing staff increases not keeping up with demand, acute medical nurse Louise Taylor describes what it’s like to work at the coalface and why it’s time to stop the tall talk if we want to retain current staff.

Blog post

Published: 05/12/2017

Jeremy Hunt’s announcement that 11,000 additional NHS nurses have been employed since 2012 sounds promising. However, as an NHS staff nurse working in acute medicine, I find the mismatch between the political rhetoric and the reality of my lived experience frustrating.

The number of registered nurses employed by NHS England has increased by 2.8 per cent since Mr Hunt was appointed in September 2012, but this increase has been fast outpaced by the growth of demand for NHS services, with emergency hospital admissions rising by 15 per cent in the same time.

Mission impossible?

Working on the front line is physically and emotionally exhausting. In acute medicine we wash, dress, toilet and feed our patients. We plan and coordinate their care and liaise with families, therapies and services. We assess, monitor and treat acutely unwell people. We comfort families experiencing loss. We deliver health promotion and education. We look after confused and agitated patients and try to make them feel safe and cared for. We dress wounds. We handle complaints from distressed relatives. We risk assess to safeguard our vulnerable patients. We provide comfort and company to patients at the end of their life. We do all this and so much more in the face of competing service pressures and targets.

But we are relentlessly short staffed and to do all this can feel impossible. It is becoming increasingly difficult to fulfil our responsibilities and deliver the quality of care that we believe our patients deserve. We know our patients are suffering and it is a huge source of demoralisation. 

The challenges faced by frontline workers were highlighted by The state of care report, which warns that “staff resilience is not inexhaustible”. Perhaps an increasing number of nurses leaving the profession before retirement is evidence of this.

A survey of former NMC registrants revealed that 44 per cent of respondents indicated “working conditions” (which covers staffing and workload) as a top reason for leaving the profession before retirement. A further 27 per cent felt disillusioned with the quality of care they were able to provide. Nurses also reported that difficulty meeting the revalidation requirements (26 per cent), leaving the UK (18 per cent) and poor pay (16 per cent) had also influenced their decision to leave the service. 

It troubles me that the Department of Health has described the numbers of nurses leaving the profession as a “mere 0.2 per cent”. This rhetoric masks a reality of impossible working conditions and unfilled vacancies, and has provided a platform for policies that negatively impact on nurse retention.

Not all about the money

Much is made in the media of the public sector pay cap, which has seen nurses taking a real terms pay cut of 14 per cent since 2011. Many nurses are struggling to make ends meet, and years of refusing to pay nurses fairly says to me that our contribution is seen to be of little value. However, this is not the only discussion to be had – after all, compared to other reasons nurses are leaving the profession, poor pay ranks low. 

What worries me more than pay are the short-sighted cuts to workforce development that have translated to nurses’ continued professional development (CPD) funding being curtailed by up to 45 per cent. This cost-containment measure is having far-reaching, but less visible, consequences for patient care and nurse retention.

CPD enables nurses to acquire knowledge, practise new skills and develop confidence and competence, all of which can reduce workplace stress and improve job satisfaction. Perhaps most importantly though, CPD is a patient safety imperative and is required by the NMC as part of the professional revalidation process. 

The time to get real is now

The development of new routes into nursing (through the nurse associate role and Nurse First programmes) and the recent lifting of the 1 per cent pay cap are welcome efforts that demonstrate the Government is prioritising the nurse shortage. However, to me this isn’t enough – it feels like ‘fiddling whilst Rome burns’. The impact of new routes into nursing could take years to realise and wage increases are yet to be negotiated.

In the meantime, policy-makers must actively seek to retain the existing nursing workforce by understanding and addressing the reasons for leaving the profession. This cannot be postponed. A good place to start would be to change the rhetoric that so often undermines our incredible work and the enormous pressure we are facing.

Louise is an acute medical nurse currently on an academic placement at the Nuffield Trust.

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