A lack of support has left newly registered nurses and midwives feeling unable to practise safely and questioning whether to stay in their profession, a new report from the nursing regulator has warned.
The research, published today by the Nursing and Midwifery Council (NMC), found there was ‘undue variation’ in preceptorship and that poor preceptorship ‘negatively affects psychological safety and contributes to early leaving’.
These findings come as part of the NMC’s inaugural ‘Spotlight on Nursing and Midwifery’ report published today, which aims to provide annual insights from its work to support ‘sector wide learning and improvement’.
The NMC’s research found that preceptorship programmes – a period of structured transition and support to guide new professionals to become autonomous registrants – were being delivered ‘haphazardly’, with significant variation in how they are delivered.
Of the newly registered professionals that engaged in the NMC’s qualitative research, around three quarters had experience of preceptorship and felt ‘it could be extremely helpful’.
However, ‘only a minority’ felt ‘highly satisfied with their experience and there was a feeling that its potential was not always being met’.
‘Participants felt that the length, supervision and organisation of preceptorships were inconsistent across employment settings,’ said the report.
It added that newly registered professionals in Scotland and Wales were ‘slightly more positive’, although the experience of preceptorship support and supervision in England were ‘widely varied’.
The experiences of internationally educated nurses of preceptorship appeared even more varied, with some nurses lacking any form of induction upon starting work in the UK, the report said.
A survey of 1,512 internationally educated professionals found that one in six had not received a preceptorship.
Results also showed that half of those surveyed received an induction of less than one month and just under one in 10 received no induction at all.
‘We found a statistically significant link between survey respondents receiving little or no preceptorship and having feelings of being unable to practise safely and of questioning whether they intended to remain practising in the UK,’ the report said.
‘Those who had not received an induction or preceptorship of at least a month were nearly twice as likely [15%] to tell us they intended to leave UK practice in the next three years, compared to those who had [8%].’
And some 15% of internationally educated professionals who had no induction or preceptorship of at least one month said they ‘rarely or never feel able to practice safely’, compared with only 1% of those who had an induction or preceptorship.
Other findings within the report suggested that newly registered nurses were struggling with staffing levels, workload and workplace culture.
Many new entrants told the NMC they felt ‘shocked and overwhelmed’ by the demands of practice as a newly registered professional and reported feeling ‘tired’, ‘burnt out’, and ‘overwhelmed’ by demands.
Further qualitative research involving 72 newly registered nurses found that staffing pressures were exacerbated by poor workplace and management culture.
The NMC heard how newly registered nurses face ‘unrealistic expectations from managers that they could fulfil duties outside of their scheduled hours or experience’ and ‘an emphasis on getting on with the job at the expense of personal wellbeing’.
NMC chief executive Andrea Sutcliff said: ‘New starters across the professions aren’t always getting the standard of support they need to feel confident in their roles.’
She added: ‘There are more than 788,000 professionals on our register, whose knowledge and skill are vital to all our health and wellbeing.
‘But on the rare occasions that care goes wrong, it’s often down to common factors getting in the way of the safe, effective and kind care people have a right to receive.’
Other issues raised in the report include the experiences of internationally educated nurses who are leaving the register sooner than their UK educated counterparts. Internationally educated nurses also said that workloads and staffing levels were worse than they had expected on arrival in the UK.
Additionally, the NMC report details the discrimination and racism faced by many international recruits upon starting work in the UK.
A Department of Health and Social Care spokesperson said: ‘We are hugely grateful for the contribution overseas NHS staff make to the NHS. Ethical international recruitment, in line with the UK’s Code of Practice, is just one way we are growing the workforce.
‘It is extremely promising to see record numbers of nurses, midwives and nursing associates registered to practice in the UK, with numbers of homegrown UK-educated staff increasing, alongside talent from overseas.
‘The first ever NHS Long Term Workforce Plan, backed by over £2.4 billion of government funding, will deliver the biggest homegrown training expansion in NHS history and recruit and retain hundreds of thousands more staff over the next 15 years.’