A rise in demand for residential nursing home care combined with widespread shortages of care home nurses is having a ‘significant’ impact on the stability of the sector in Wales, nursing leaders have warned.
A new report from the Royal College of Nursing (RCN) Wales has called on the Welsh Government to ‘urgently’ invest in care home nursing if more care is to be provided in the community.
According to the report published this week, addressing staff shortages and mounting pressure on care homes will require investment into the workforce, as well as work to raise the profile of care home nursing.
RCN Wales director Helen Whyley said that the increased pressure on care services was a consequence of the Welsh Government’s ‘strategic objective to deliver care closer to home’.
Ms Whyley said this meant that people were now entering residential care at a more ‘advanced stage’ in their health condition and had greater and more complex needs.
‘This, combined with the high number of registered nurse vacancies in residential care homes in Wales and the downward trend in the number of qualified nursing staff working in social care, has a significant impact on the stability of the residential care sector and is deeply concerning,’ added Ms Whyley.
The report – Caring for older people: The essential role of the care home nurse – stressed that urgent investment and action was now needed by the Welsh Government, to ‘tackle the critical nurse staffing challenges’ facing the care home sector as demand for services increases.
The number of care home nurses in Wales has fallen year on year since 2018, according to data cited by the RCN Wales report.
In 2021, there were 1,119 registered nursing staffed employed by commissioned care providers in Wales, down from 1,545 in 2018 and 1,438 in 2019, it said.
In addition, the report raised concerns over the ageing care home nursing workforce. One in three nursing staff in social care were over the age of 56, while a further 30% are over the age of 46, it said.
The report’s authors note that this has ‘significant implications for future years as many may consider retiring or reducing their hours’.
Both terms and conditions and the perception of care home nursing as a career were cited as important factors for this ongoing decline in the workforce.
‘The care home sector continues to face significant challenges for recruitment and retention,’ the report said. ‘They are at a disadvantage in an increasingly competitive labour market dominated by the typically better terms and conditions the NHS can offer.’
Meanwhile, nurses working in care homes ‘commonly express views of not being valued, not being seen as “equals’, and in some cases, being seen in some way as “second class” by the NHS’, added the report.
In addition, the report said that ‘nursing in care homes is not currently seen as an attractive role and career path for student nurses’.
RCN member and care home education facilitator Sarah Kingdom-Mill said that the role of care home nurses ‘cannot be underestimated’.
‘Nurses in care homes are committed, skilled professionals, who have exceptional clinical decision-making and communication skills that they use in their autonomous roles,’ she said.
‘They play an imperative role in the wider context of our health and social care systems.’
The report also includes a number of recommendations for the Welsh Government, which the authors claim would help to tackle the ongoing workforce shortage.
These include a call for better evidence to be gathered on the nursing workforce in residential care settings, as well as to give a ‘higher profile for nursing in care homes’.
What has RCN Wales recommended?
Better evidence
– Create a national data set to improve information on the nursing workforce in residential care settings
Improve supervision arrangements
– Improve clinical supervision by implementing the recommendations of the chief nursing officer in full
Effective legislation
– Strengthen existing legislative frameworks for inspecting and commissioning services
Higher profile for nursing in care homes
– Welsh ministers should support work from the RCN to raise the profile of nursing in care homes with ‘video stories’
National nursing apprenticeship scheme
– A national nursing apprenticeship scheme should be created
Continuing professional development
– The Welsh Government should work with the care home sector to ensure that registered nurses are able to access Specialist Practice Qualifications for social care
The report is also accompanied by the release of a short film ‘designed to celebrate and educate on the vital role of registered nurses in care homes’, which can be viewed here.
A Welsh Government spokesperson said: ‘We recognise the incredible role care home nursing plays in someone’s recovery. We are committed to ensuring people receive care as close to home as
‘Staffing pressures are being felt cross the social care sector. We will continue to work with partners including the RCN to identify what further steps can be taken to improve employment terms and conditions and address to address challenges in this sector.’
