Nursing Recruitment and Retention: Skating on Thin Ice?

Yesterday I saw the BBC’s advertisement for the forthcoming Winter Olympics. It was stunningly different and attention grabbing – well at least for the first time it’s watched.  All sport is a challenge but I think that the Winter Olympics are something special. Athletes have to not only be physically fit, expert and skilled in their chosen sport but must also contend with the unpredictability of snow, ice and the cold. Something I found to my cost last week. Not that I am winter sportsman, but simply my #WalkEveryDay was a challenge. I have never experienced icy conditions like it. It was literally not possible to stand up, let alone walk.

I was one of the fortunate ones. I didn’t have to commute to work, and didn’t need to be anywhere on any particular time. Up here in my part of Scotland we had a great deal of snow and 4 days ago over 200 drivers were trapped overnight on the nearby M74. Conditions were challenging indeed. It wasn't just for those keeping us safe on the roads by gritting, and clearing the snow, but for also for those responding to breakdowns, and the emergency services, who in all weathers and at all times, come to our aid whatever the cause. Ambulance services in particular were under great strain. Across England, the 10 Ambulance Services operate using a Resource Escalation Action Plan (REAP) which has a range of (1) indicating no problems through to (4) indicating extreme pressure and demand on services. Last week only the London Ambulance Service was at level (2), all the others had declared they were operating at level (3).

That said, the enormous challenges Emergency Departments have been experiencing throughout December and early January, eased marginally last week. The critical point of exchange at the ambulance handover to the A&E department showed some improvement. Whilst it’s still the case that 1 in 8 patients continue to experience ambulance handover delays, there was a reduction of 4000 (down to 12600) last week in those having to wait more than 30 mins just to get into the A&E department. Hospitals were reporting that bed occupancy was down from 95% to 94.9%, but this is still well above the recommended safe limit of 85%. So there is some way to go yet before we can feel confident that the surge in demand is beginning to slow down.

Unfortunately some of the media last week made great play that in its 70th year the NHS was facing a crisis like never before. Absolutely those on the front line, nurses, doctors, other health care professionals, support workers and volunteers have had to deal with an almost exponential rise in the demand for services. The Daily Mail, in its own inimitable and sensationalist way, reported on the possible consequence of these extraordinary demands on the wellbeing of the nursing profession – describing the current situation as the ‘NHS haemorrhaging nurses at the rate of 1 in 10’. The BBC also joined in. The facts are true – see here on the NHS Digital site – some 30,000 nurses left the NHS last year. Interestingly the statistics also reveal that the rate of those leaving the profession in percentage terms, hasn’t essentially changed over the last 5 years as the overall number of nurses has steadily risen over the same period.

What has changed is that the numbers of those choosing nursing as a profession have fallen. There is now a negative gap between those leaving and those joining the profession which might lead to some shortages in the near future. What I found challenging was the way the reports chose to deal in generalisations. Not helpful I felt. More pertinently, nursing staffing challengs in UK hospitals has been a reoccurring issue even before the NHS was created back in 1948. The reasons given for nurse shortages has been the subject of numerous governmental inquiries. These almost with out exception have blamed; poor pay, poor training opportunities, and in times gone past, the so called ‘marriage bar’.

Way back in the 1950s the most common shortages were in hospitals for the elderly, mental health and what we now know as services for those with long term conditions. In 1949 the Ministry of Health, the General Nursing Council and the Royal College of Nursing went to the Caribbean to recruit nurses. Over the next 20 years the British colonies (and former colonies) provided the NHS with many of its nurses. By the time I started my nurse training in 1975, it was estimated there were 10,500 students recruited from overseas, and 66% coming from the Caribbean.

The 1980s saw the NHS facing severe nursing retention and recruitment problems. Nursing as a career choice for young people had declined markedly. Changes in social aspirations and more generalised public sector financial constraints resulted in many new entrants to the job market seeking alternative employment opportunities. The abolition of work permits in 1983 for overseas nurses added to the difficulties. By the late 1990s, some 30,000 nurse were leaving the NHS every year (sounds familiar doesn’t it). Interestingly, they were said to be leaving because of perceived low pay and the unrelenting pressures of the job. Like the predictable unpredictably of the snow, ice and cold of winter time, planning, delivering and managing the NHS workforce will take the skills, confidence and experience of Olympic proportions.