New nursing blog for July from our Transforming Workforce Lead

Nursing a career for life, past, present and future.

Nursing has always been viewed as a job for life, a vocation that spans over 40 years that gives you the ability to grow, to diversify and offers the opportunities to have a flexible worthwhile career, where there is real potential to make a difference. This can be on an individual, national or international level. The possibilities are endless.

Back in the day when I was a student nurse, nursing was all about matrons and procedure manuals. Often feeling like an extra pair of hands, following doctors around, and rarely questioning anything that was said. Thankfully nursing has moved on from the medicalised model, not only nurses but student nurses are now empowered and leaders in their own right. It’s hard to believe that back then we had no access to internet or social media, all which without question has today catapulted nurse education and the profession as a whole.

As a student nurse you work alongside many nurses within a variety of different specialisms and you soon determine those who are role models. Despite having trained in the 1980s I can still remember those nurses who inspired me and as importantly those who did not. This often helps reaffirm the areas you wish to work after completion of your training.

The natural progression for the majority of student nurses is to go straight to a post within the NHS, however it is imperative that we expand the opportunities for newly qualified nurses to come straight into the social care sector. The sector offers a real potential to grow and develop your professional autonomy, clinical development and management.

Recent months have saw an influx of student nurses into the independent sector who previously wouldn’t have been placed within a care home, with this exposure being viewed by many as positive and insightful. I am delighted to say this has resulted in some third-year students due to take up their first staff nurse post within the independent sector. Despite these numbers being low in comparison to NHS placements there will be a concerted effort to extend student placements within care homes as we commence the new pre-registration nurse training.

Nursing without question made me who I am today. I grew up quickly, had never witnessed death or dying or what it truly felt like to be needed, respected and the pride you feel when people share their vulnerability and inner most fears. I do hope that every nursing student still experience these feelings, as I believe this is the foundation to being a professional nurse.

Being prepared to make the transition is something that many students worry about especially in today’s climate when everything appears to be under the microscopic. Preceptorship has never been more important and needs to be robust to ensure newly qualified staff have adequate clinical supervision, especially in the first 6 months after qualifying.

For many staff qualifying is a reality check and unfortunately staff continue to leave post registration within the first few years of qualifying. Recent figures in 2018 suggested almost half of all nurse who leave are under 40 years old.

As nurses we often hear the phrase ‘I couldn’t do your job’, the fact is it is probably true. I don’t believe anyone can be a nurse , it’s not a job that anyone can do if it’s not intrinsically part of you, in your heart to care, the desire to make change happen, ensuring improvement and keeping people safe. Unfortunately these qualities alone are not enough to cope with some pressures that are currently placed on staff. This is also apparent in the numbers of students who do not complete their training. According to figures released last year by the Nursing Standard, the attrition rate was around 24 per cent.

Looking back and I can’t believe where the years have gone. I never imagined when I completed my training the different roles I would’ve undertaken and that many of those I trained and work alongside continue to be in nursing today, as clinicians, nurse educators and senior managers, although I must mention approaching retirement fast.

Sadly, despite the satisfaction nursing offers it has unfortunately gone through many years of being an undervalued profession despite pre-registered nurses now trained to graduate and master’s level. We were seeing a reduction of nurses ahead, due to upcoming retirements, an increase in nurses choosing to take early retirement, and the exiting of EU nurses post Brexit. In addition we also had a workforce that was struggling with high level of staff absence due to mental health related absences,  often cited as a result of short staffing, and too many priority areas being placed on staff .This had undoubtably placed massive pressures on the existing workforce.

This makes an urgency to impress on staff the importance of being empowered and how promoting leadership with the sector will ensure better job satisfaction and peer support. I often come across articles where newly qualified staff express how overwhelmed they feel and question whether they can deal with the daily pressures. Nurses work at the coal face of a fast-paced health and social care system that can often feel dysfunctional, which is exhausting. It can often feel like you are on a rollercoaster as one thing is resolved something else comes behind to continue the pressure.

My response would be that nursing has always been challenging and this will never change and the reason its challenging is because it’s a job that really matters and is reliant on the right people to influence change, which can improve outcomes for people we care for, all the reasons for becoming  a nurse in the first place. Being part of a great team and peer support is crucial to ensuring you develop the coping mechanisms to grow strong.

In 2017, the 2030 vision was published. The aim of this document was about showcasing the work nurses do, to raise the profile, define competences and ability to develop in an evolving health and social care world. In this the ‘Year of the Nurse’ we have certainly highlighted the role of nurses, their ability to rise to challenges, be solution focused and be skilled to undertake a level of practice required to ensure patient safety during a time of the greatest uncertainty, and risk to their own personal health.

In recent months we have witnessed the dedication of nurses who responded to join the emergency register as well and the redeployment of nurses alongside other healthcare professional, none less than the high numbers of student nurses who came forward to be part of this dynamic professional workforce. In addition, we saw an increase in the nurse register as a result, however we must continue to see this now and into the future. As we approach the highest levels of staff retirements within the next 5 years it is imperative that we recruit and retain staff more than ever to be able to provide a sustainable health and social care workforce.

We have increased student placements and funding for students to assist in getting more people into the profession and post covid19 most universities have reached their admission targets with many over prescribed. However we must be mindful of the changes to the curriculum, and the extension of online training may result in higher dropout rates over the next few years, alongside the uncertainties that have been presented with this pandemic to staff welfare.

Staff burnout was already at an all-time high therefore it is paramount that staff receive appropriate support to ensure they are fit to practice, and part of this is to ensure their physical and mental wellbeing. Nurses often view stress as normal therefore if we genuinely care about our staff, we must look to ensure we hold onto them and avoid the risks of putting additional pressures on those staff who are left on the ground.

We must reflect that for many staff who made the decision to leave that this was not necessarily because they really wanted to let their registration lapse, but that they felt defeated or that they were no longer doing a job in the way that they wanted to , were not valued or understood and most importantly not listened to. It’s important to note that this is rarely a reflection on ability but more likely to be due to professional frustration. Nurses need to know this is not the end and in nursing we all can face difficult situations that can push us to the edge. I challenge any nurse to say they haven’t had a period in their career that they didn’t want to throw in the towel.

In a career that could and should be for life, we need to change thinking to be inclusive of all aspects and sectors and ensure there is a real determination to work together to prevent boundaries and assist staff wishing to work across these sectors. There is a real benefit to working in collaboration having shared national approaches and systems across NHS and the independent sector, not as a joint entity but as a respectful partnership which is mutually supportive.

Recent months have without question pushed the transforming nursing roles agenda by identifying the current roles being undertaken by nurses and how these can evolve to improve practice, data collection and ultimately job satisfaction to improve staff recruitment and retention.

Each sector offers the potential for each individual nurse to work to the top of their license and the social care sector ensures gerontology nursing is given the credibility it has not always been given in the past. The access to future funded post registration educational programmes within the sector will ensure this.

This specialism is going to evolve rapidly in light of the increasing ageing population and the fragility of our older people. This will require significant knowledge and skills to care for people who have debilitating long term conditions and therefore the workforce development will require significant focus and centralised investment. Rehabilitation and recovery will play a significant part moving forward post covid19, ensuring those people requiring 24 hour care are not excluded from the right care at the right time by the right person.

Every role needs to have scope to grow and the more exposure to the independent sector by student nurses, NHS boards and higher education institutes the more we will work inclusively which will without question ensure student nurses will have a more rounded experience and career trajectory, and we will hopefully see more newly qualified nurses coming straight to social care nursing, or considering this as a prospect at some point in their career. Personally, I believe rotational peripatetic posts and taking up posts across all sectors throughout your career can significantly enhance knowledge and skills and empower staff to think more strategically.

This is the ideal time for many who may have left to return. As previously highlighted nurses leave for many reasons and perhaps this is something that the NMC as the registering body should consider recording as a means of anticipating the potential to offer an alternative to coming off the register as often this is due to a negative set of circumstances and can often be a reactive response. Within the independent sector we may have staff who decided to let their registration lapse and work as in a care role rather than a nurse and may now wish to return to practice.

There are two new return to practice programmes being offered in Scotland later this year and at the beginning of 2021 which will support staff to return to the practice by taking into account their experience and placing them ideally within future staff nurse roles, assisting the issues we currently have in unfilled vacancies. This is something I encourage providers within the sector to consider supporting the current recruitment processes.

There is no question the future has some uncertainty, but we have the real potential to have a workforce which will be skilled and fit to cope with the challenges ahead and beyond. Staff have always shown significant resilience, but this has been none more evident than over the last few months, with those student nurses who took up the paid placements being testimony to this.

It is every single nurse’s responsibility to do everything in their power to encourage, support, mentor and make others understand the importance of being a nurse and recognise what the new workforce must look like.

In this the year of the nurse the profession has without question been tested , despite our staff having given their all ,within a political climate that has been less than supportive and at times downright derogatory to our nurses we will end this year stronger .

This is our year to be strong, be a collective and demonstrate what a privilege it is to be a nurse and the crucial role we play and will continue to play as the backbone of our health and social care sector.

Jacqui Neil

Transforming Workforce Lead