Matter for Discussion: Workforce

Members can view a recording of the debate here.

The need for nurses with the right skills, in the right roles, at the right time and at the right cost is paramount to achieving quality health care, and so investing in nurses and midwives is good value for money – it makes good business sense. Invest in nurses and you are investing in a healthy economy (Kennedy, 2019).

The chief nursing officers have conveyed many times that the nursing workforce is considered to be one of the most trusted professions, yet it is a profession that is undervalued and deemed unimportant by the UK governments. The lack of investment in our domestic nursing workforce is reflected in the latest Nursing and Midwifery Council data on the proportion of nurses joining the register. As of 30 September 2021, 50% of nurses entering the register were internationally trained (18,325), up from 31% in 2020 (10,402). In contrast, the number of nurses joining the register whose initial registration was in the UK, decreased from 22,948 in September 2020 to 18,432 in September 2021 (a 20% fall).

During the pandemic, nurses have been burdened with increasing workloads, insufficient staffing levels and delivering care within strict infection control measures – without adequate personal protective equipment. Consequently, they have faced an increased threat to their own personal safety and, indirectly, to their families.

Organisations consider their nursing workforce as one of the costliest when planning their health care provision – nursing numbers are higher than other health care professionals and as a result, they are often targeted for cost-cutting policies. Over the years, we have seen employers utilising alternative staff arrangements, such as nursing associates and health care support workers to
undertake duties previously done by registered nurses; this implies that the financial cost of the nursing workforce is considered by health care providers before the needs of patients.

Unsafe staffing levels result in an increased risk of negative outcomes for both patients and nurses.

We are seeing an increase in burnout, job dissatisfaction and a desire to leave the profession, as the pressures are unsustainable.

The RCN’s Nursing Workforce Standards details what is required to achieve staffing for safe and effective care. The first of the 14 standards sets out the nursing leadership required to set nursing workforce establishments. Standard 1d describes how the establishment should be determined by the demand for services and the need to provide safe and effective care. 1e builds on this and states “setting the workforce establishment should explicitly inform the organisational financial planning and be funded by the revenue allocation, rather than fitting a prescribed financial envelope.”

Health care organisations need to be cost effective and operate in ways which respond to patient needs and economic constraints. However, this should not be at the detriment of patient safety nor the reduction of the appropriate number of nursing staff for the delivery of safe and effective care.

Reading lists for each agenda item can be found here.

References

Kennedy A and Plenary I (2019) Beyond healthcare to health: opening remarks, International Council of Nurses

Nursing and Midwifery Council (2021) Registration statistics: September 2021. Available at: www.nmc.org.uk/about-us/reports-and-accounts/registration-statistics (Accessed 13 April 2022).