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It’s not about the money

We know the reasons why nurses are leaving the profession and it’s not all about money: woeful national workforce planning and nurse training, inadequate NHS funding, the Brexit effect, working conditions and low staff morale.

The Nursing and Midwifery Council (NMC) has just published the latest figures regarding the number of nurses on the professional register. It makes for depressing reading.  

From October 2016 to September 2017, there were 27% more nurses leaving the register than joining. Of those that left, 29,019 were UK nurses (up 9% from the previous year) and 4,067 were EU nurses (up 67%), who make up around 5% of the register. Non-EU staffing has remained virtually unchanged.

These figures are no surprise to nurses. We experience the shortage every day at every shift and in every establishment and organisation we work in. There are 40,000 nurse and 3,500 midwife vacancies. Around 85% of nurses on the register are UK nurses and there has been a year-on-year rise in them leaving.

We know the reasons why: poor pay plus a pay cap, woeful national workforce planning and nurse training, inadequate NHS funding, the Brexit effect, working conditions and low staff morale. This combination has created the exodus of nurses as well as discouraging returners and trainees.

Retention of staff is vital. Nurse leaving rates across the NHS vary from 9% to 43%, with organisations having an average of 16%. This is not efficient or cost-effective, creating staff disruption, organisational unrest and a risk to patient care.

We know more colleagues are leaving before retirement, with the average age dropping from 55 to 50, with the under 40s having increasingly high rates. An NMC survey of 4,500 leavers last year said that a poor working environment, including staffing levels, was the main reason for leaving. Of these, 27% specifically cited disillusionment with the quality of care they could provide to patients, with only 16% saying pay was the main reason for leaving.  

The NHS has explored ways to retain valuable and experienced staff – but is it too little, too fragmented and too late? Can we stem the flow with new actions and reinvigorated approaches that cost little or nothing? Here’s what I’ve picked up that matters to nurses:

  • For team leaders and managers – being thanked and appreciated would boost morale hugely. A supportive team generates job satisfaction; a happy workforce is productive. Feeling bullied by management or colleagues polarises roles and attitudes. 
  • For directors of nursing – be inventive with career pathways, such as guaranteeing jobs on qualification, fast tracking bands 5 to 6 in difficult-to-staff areas (such as elderly care), enabling swapping jobs that avoids lengthy recruitment processes and offering trial experience in different clinical areas. Grant service breaks for long-serving staff, they may resign if given no choice. This just requires a change of approach.
  • For organisations – rejig the money you have. Instead of escalating agency fees and vast overseas nurse recruitment costs, offer market rates of pay in difficult-to-staff areas, or reimburse pre-registration training fees on a sliding scale per year of service, or cover the annual NMC fee, or welcome nurses with a ‘golden handshake’. 
  • Note for the Government – your spokesperson keeps repeating that the NHS has 13,500 more nurses since 2010, yet 55% of nurses are not employed in the NHS. The NMC register report indicates that overall, we have a reducing nurse workforce for a growing population with increasing demands. Reality is overtaking the rhetoric.