When is a nurse not a nurse?

12 days ago Dylan went in for the biggest operation of his young life. He was very brave and went off with his nurse without a backward glance. The operation was a success and as it was a day case, he was discharged home, complete with his post-operative painkillers, later the same day. Last Friday he had his out-patient appointment. I got a phone call early on the morning to say that his nurse had rung in sick and his appointment would have to be rearranged for another day. Dylan was naturally disappointed, and I was cross at the inconvenience. However, it couldn’t be helped. It seems the world of veterinary nursing might be just as fraught with sickness as it is in human health care.

Of course, Dylan’s well-being wasn’t compromised by the cancellation. He is a young, healthy dog, and he was after all being looked after by myself, a qualified nurse. In the UK anyone can call themselves a nurse. However, the title ‘registered nurse’ is a protected one, although in an everyday sort of way, it’s not a common term. The more familiar term, ‘nurse’ is not protected by a regulator or by law. It’s important as a protected title represents a contract between the State and a profession – so that the public can be assured that anyone using that protected tile has been appropriately educated, properly trained and regulated. These days, I am no longer registered as a nurse with the regulatory body, the Nursing and Midwifery Council, so I cannot practise as a qualified nurse any more. However, that knowledge and experience of being a nurse is still there. 

So the slightly (?) existentialist question is ‘when is a nurse not a nurse?’ The word ‘nurse’ has become embedded over hundreds of years in society’s collective psyche. It has many meanings. Have I stopped being a nurse because I have let my registration lapse?  I don’t think so. However, I don’t think I would want to work in clinical practice any more, although I do miss the teaching. Most of my remaining PhD students are nurses and their studies focus on the everyday problems of practice, both here in the UK, as well as overseas. And clinical practice can be quite a fraught place these days. The demand for health care continues to grow exponentially, and the how and where services are being provided gives rise to a different set of challenges for nurses than possibly the ones I faced in my day.

Perhaps the more prosaic question ought to be ‘where have all the nurses gone?’. We know that many older, more experienced nurses are leaving the profession in greater numbers than ever before. Uncertainty over Brexit and the removal of the student bursary have had a huge impact on the supply of registered nurses into the NHS. Today there are over 100,000 vacancies across the NHS. The projected gap between the number of staff needed and those available is likely to rise to 250,000 by 2030, if nothing changes. Of the 100,000 current NHS vacancies, over 41,000 are nursing vacancies.

Dealing with these international challenges (yes, it’s not just the UK that’s affected) is a problem of King Canute proportions. But, there is someone waiting in the wings who might have some answers. Cue RCN Anne-Marie Rafferty. Now I have only had one remotely intimate conversation with Anne-Marie, and that was over breakfast at a Council of Deans meeting many years ago. I don’t think she chose to sit with me, as much as the seat at my table was the only spare seat in the restaurant. It was a breakfast conversation that I will never forget. She had (has) a passion for the promotion of the nursing profession that I’m sure others saw in electing her as President of the RCN in 2018. 

It was Anne-Marie, along with other colleagues who undertook some research into the connections between nursing skill mix, mortality, patient satisfaction and the quality of care – see here. It was an interesting piece of research, undertaken before the new role of Nursing Associates had become embedded in the UK health care system. There were limitations on the research process which need to be taken into considerations when considering the findings, but essentially there was a clear connection between enhanced levels of patient satisfaction, the quality of care, the level of mortality, and the numbers of registered nurses on a shift at any one time.  

Now I don’t know what solutions Anne-Marie might have up her sleeve in terms of solving the nursing shortage, but maybe she could look at what’s happening in the world of veterinary nurses. Back in 2015 the Royal College of Veterinary Surgeons (RCVS) recognised that they were losing too many veterinary nurses due to poor pay, stress, and the nurses not feeling valued. Before anyone shouts at me for saying there are only 12,500 veterinary nurses compared to the 287,000 whole time equivalent registered nurses (and Health Visitors) working in the NHS across England, I know I’m not comparing apples with pears. The point is they did something about these issues and have turned the situation around. 

Whilst there is a perceived shortage of vets in the UK (another victim of Brexit), veterinary nursing continues to be a vibrant professional choice. As I was sitting waiting for Dylan after his operation, I looked at a Blue Cross advertisement aimed at attracting potential veterinary nurses. It was interesting in its similarities to registered nurse recruitment advertisements: 

‘working as a veterinary nurse is hard work, but it’s also extremely rewarding’ 

‘you need to have a strong stomach to cope with unpleasant sights and smells and the stamina to stand on your feet all day’ 

‘animals aren’t sick from 9-5, so nursing jobs involve evening, weekend and Christmas work’ 

‘it’s worth remembering that pets come with owners, so you need to be confident dealing with people too’.

There are no easy answers to the nursing workforce shortage, but there is much more we might do to increase the numbers of those wanting to join the profession.  In answer to my earlier question – when is a nurse not a nurse, I guess the answer is when they aren’t any registered nurses left.