Nursing has been making headlines again, this time over the use of agency nurses which has risen by 150%. The gist was that the NHS is in crisis funding the high costs of agency nurses and the fat cat private agency owners were making mega profits from the publically funded NHS.
When the furore subsided, the blatant truth emerged – we have a nursing crisis. Nurse vacancy rates are higher than 7% and healthcare demand is growing by 4% annually. Nationally required safe staffing levels in hospitals from June 2014 fuelled the nursing shortages on acute wards with over 70% of trusts not meeting the required ratio of one nurse to eight patients. The nursing home sector have continually struggled to attract and maintain a workforce; one in ten of all nurses work in care homes but we still have a 9% vacancy rate. This is where the agency nurse steps in, albeit at a huge cost.
Agency nurses may be in demand but I have never met one who set out on a career pathway to be an agency nurse. Most work for an agency because the hours are more flexible and the hourly pay is better – but it is a lonely life moving to different organisations and working cultures. You rarely belong to a team.
We need more nurses, not agency nurses. We are an aging workforce: a third of us will retire in the next five years. Many of us leave earlier than once planned: staff shortages have lowered standards, created poor job satisfaction, low morale and burnout.
How did this happen? The NHS have not invested in training enough of us. Nurse training was determined by what was considered affordable not what was needed, therefore cumulatively fewer training places have been made available. At a time when we need more nurses, we are training 13% fewer now than in 2011. District nurse training has been reduced by 40% during the last 10 years and only 265 qualified in 2013, nowhere near the numbers we need to replace leavers. And what did we do when we needed more nurses? Recruited over 6,000 from overseas, depleting other countries of their valuable asset.
What should be done? Here are a few of my suggestions:
Health Education England must take responsibility for the overall collective national nursing workforce recruitment and training. It should not be the responsibility of individual trusts: as nurses are a national commodity that move around within speciality and geographically. GPs and nursing homes, and all other private employers that use NHS trained nurses, must proactively contribute to nurse workforce planning.
Invest in permanent posts. It is estimated that the £980bn per year spent on agency nurses could fund 28,000 permanent nurses.
Pay nurses more. Money found by organisations for the current agency fees should be invested in a better paid workforce.
Ditch the national pay structure that determines all nurses are paid the same wherever they work in the country.
Attract nurses back into the profession with more return to practice schemes and flexible working schedules and recognise that 90% are female with caring responsibilities.
Redirect the millions it costs to recruit overseas nurses into a major national nurse recruitment drive with golden handshakes and financial incentives for new or returning indigenous nurses.
The government should review the new immigration rules from April 2016 that stipulates all non EU workers who earn under £35k after six years in the UK will be deported. Many overseas nurses don’t earn this, so why waste the investment we’ve already made in these experienced nurses?
Recognise that specialist nurses are the key to seven-day services through their expertise, decision making and supervision of others so retain them with a fair wage and role security.
Improving nursing numbers in organisations improves patient care, morale and job satisfaction – great incentives for nurses to return and others to make it a career choice.
Roy Lilley a respected health and social care commentator stated “the shortage of nursing has become toxic’’ and we need to ‘protect the front-line of care, fund it properly and make it fun to work there’. I couldn’t agree more – and I think most agency nurses would too.
BA(Hons) PGCE RN RM RHV FWT NP
Nurse Adviser and Independent Trainer
As well as working on the Nursing in Practice advisory board, Marilyn is also Lead Nurse for a teaching PCT, supporting nurse-led services and the development of practice nurses and healthcare assistants. She enjoys being a respiratory trainer and a nurse opinion leader and is passionate about expanding and blurring nursing boundaries in primary care.
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