Is developing a resilient workforce ever going to be possible in the NHS?

Last week was National Work Life Week. This is an opportunity for employers to showcase what they are doing to ensure a healthy work/life balance for their staff. If you missed this, you can find out more about it here.  Interestingly, I noticed there was a lot of talk last week on many of the nursing twitter sites of ‘what is meant by resilience’, ‘can resilience be taught’ and so on. This is a discussion that appears to be one of those perpetual subjects that comes to the surface on a regular basis. I guess those in the front line of providing care probably feel that pressure more than others. Last week, many of the tweets came from students who were feeling the pressure of their learning placements. I know from my time as Dean of School at the University of Salford that it was students undertaking the children’s field of practice who were most likely to cease their studies after their first or second clinical placements. 

It is perhaps understandable. Often these were students who were younger in age – pre bursary changes there were always more mature students in the other fields of practice than in children’s nursing. Children’s nursing appeared to attract a younger cohort of students, and maybe the reality of not only dealing with a distressed and ill child, but often distressed and angry parents too was not a reality they anticipated having to work within. Arguably working in such situations requires great resilience, patience and experienced based knowledge. 

However, it isn’t just children’s nurses who fail to complete their nurse education and training. Some 30% of all students fail to complete their programmes. Health Education England, (HEE) is the body charged with ensuring that the health workforce of today and tomorrow has the right numbers, skills, values and behaviours, at the right time and in the right place. Early indications from the HEE Reducing Pre-Registration Attrition and Improving Retention (RePair) project support these high levels of attrition. While HEE needs to factor such attrition levels into future workforce planning, universities and health service providers also have a role to play in reducing this loss of potential talent and experience. 

Linked to this loss of our potential workforce was the scrapping of nurse bursaries to pay the fees and support students through their studies. The bursaries were funded by HEE (which is, in turn, funded by central Government) and in the past the number of students ‘allowed’ onto nurse education programmes was limited by the amount of money available for bursaries. This artificially kept the numbers of nurses capped and there had been little growth in overall numbers since 2010. Removing the bursary had an immediate impact upon applications for nursing programmes, particularly amongst the more mature students. The evidence suggests that not only do mature students enrich the workforce by bringing a broader life experience to bear, they also tend to stay within the field of practice for which they trained. 

Brexit, bursaries and a growing demand for health care have created a perfect storm where many NHS provider organisations - both hospital and community services - are now running with chronic and punishing understaffing. Vacancies are difficult to fill, and shortfalls in nursing numbers are often filled by agency staff. The all-party House of Commons Health Committee 2^nd Report published earlier this year notes that the consequence of such shortages has meant many nurses and healthcare professionals have been subject to a very unhealthy workplace. Their report noted that 44% of all nurses leaving the profession do so because of poor working conditions. 

There were lots of factors involved in the descriptions of ‘poor working conditions’. These ranged from no microwave for staff; no access to hot food during the winter; limited access to funding for CPD courses; a lack of flexible shift hours available; having to come in early and stay late because of staff shortages; a lack of wellbeing programmes for all staff; working too often with agency staff rather than regular staff; and most importantly, not feeling they could deliver the quality of care they felt patients needed or they knew was required. The results of these factors that contributed to perceptions of poor working conditions were, more often than not, higher rates of sickness and absence due to stress and, for many people, a decision to leave the nursing profession.  

Will becoming more resilient help deal with these issues? I think not. Being resilient is not a solution to fundamental flaws in the organisation of national health services. I don’t think it is a solution that as individuals we should shoulder anyway. Resilience for me is not something that we can teach. It is something we acquire through experience, reflection and application. It enables us to deal with situations and issues that, as professionals, fall within our reason for being, but where for others perhaps such situations and issues would be too challenging and distressing. If we can develop our own resilience store then there is more chance we might get our work/life balance right.