More nurses leaving the profession than joining, figures show

My Post (10)More registered nurses are leaving the profession than joining, analysis by the Nursing and Midwifery Council (NMC) has revealed. First published in July, the data showed that the overall number of leavers has increased from 23 087 in 2012/13 to 34 941 last year (NMC, 2017a). By contrast, the number of initial joiners was 29 025 for 2016/17.

Jackie Smith, NMC Chief Executive and Registrar, said: ‘At a time of increased pressure on the healthcare workforce to deliver quality patient care, we hope our data will provide evidence to support government and employers to look in detail at how they can reverse this trend.’

Recent figures reveal that the number of registered nurses has continued to decline, with 27% more people leaving the register than joining between October 2016 and September 2017 (NMC, 2017b).

‘These alarming new figures represent a double whammy for the NHS and patients,’ said Royal College of Nursing (RCN) Chief Executive Janet Davies.

‘Not only has the number of UK nurses quitting the profession gone up, but significant numbers of EU-trained nurses on whom the health service depends are leaving and there’s been a huge drop in nursing staff coming to work here from EU countries.’

The number of nurses and midwives from Europe leaving the register has increased by 67%, while the number joining the register from the EU has dropped by 89%.

Although the NMC does not have separate figures for the number of practice nurses leaving the profession, records show that in March 2017 there were 15 528 full-time equivalent practice nurses. This represents a decrease of 225 since March 2016 (NHS Digital, 2017). The number of European nurses joining and leaving general practice is unclear.

Why are nurses leaving?

One of the key reasons nurses are leaving the register is because an increasing number are reaching retirement. Nurses of the ‘baby boomer’ generation are now able to claim their NHS pension, and many are choosing to do so. Under the NHS pension scheme, nurses who were working on or before 6 March 1995 have the right to retire at 55 without any reductions in their pension.

‘Nursing and midwifery are widely acknowledged to be ageing professions, with significant numbers on the register coming up to retirement age,’ said Ms Smith.

It is this factor, combined with increasing workloads, that is encouraging nurses to leave the profession early said Crystal Oldman, Chief Executive of the Queen’s Nursing Institute. ‘I think what’s happening is with the increasing demands on individual nurses in their areas of practice, those at that age—between 55 and 65—are saying, “you know what, this is not what I joined to do,”’ she said.

‘“I am not able to give the care that I used to be able to give, so I’m going to retire now. I’m not going to revalidate, I’ll come off the register, I’ll take my pension.”’

Jenny Aston, Royal College of General Practitioners Nurse Champion, agrees that retirement is the main reason for increasing numbers of practice nurses leaving. ‘The QNI survey that was done a few years ago suggests that there are about 30% due to retire in the next 2–3 years,’ she said. ‘That’s going to be a massive number, unless for some reason they wish to stay on or are encouraged to stay on.’

Valerie Ely, 58, is a registered nurse and senior lecturer at Huddersfield University who is in the process of taking voluntary severance. She went part time at 55, because to remain a manager she was required by the university to do a PhD.

‘I am sad about it and to some extent a bit bitter, but I am 58 so have to accept it,’ she said. ‘A PhD would be 6 years part time and it’s really performance managed.’

‘The irony of my redundancy date is that it’s the same day I would have had to renew registration and revalidate. I have not been clinical for some years and it’s unlikely I’m going to get a job at another university, so I don’t feel that I have many options to stay on the register,’ she added.

But not all those leaving are of retirement age. Of those who didn’t cite this as their reason for leaving, the average age has reduced from 55 in 2013 to 51 in 2017. Additionally, the numbers of leavers aged 21–30 years has increased from 1 510 in 2012/13 to 2 901 in 2016/17.

A survey of 4 500 nurses and midwives carried out by the NMC revealed that working conditions, a change in personal circumstances, and a disillusionment with the quality of care provided to patients were also cited as reasons for leaving.

Sarah is a lead practice nurse at a GP surgery in South Yorkshire. She has been a practice nurse for 9.5 years but is leaving to take up a respiratory nurse role at a hospital trust. She is hoping the new job will bring back her passion for nursing.

‘As nurses experience tougher work conditions, the importance of ensuring they are valued cannot be understated’.

‘Although I enjoy the variety within the role, I am increasingly feeling overwhelmed with the extent of the knowledge and skills I need to be competent to do my job,’ she said. ‘There are only two nurses at my surgery, so we both need to be able to do everything within the practice nurse remit.’

As nurses experience tougher work conditions, the importance of ensuring they are valued cannot be understated. Kathryn Yates, Professional Lead for Primary, Community and Integrated Care at the RCN, thinks that the feedback from patients, families and carers about the outstanding care they receive from general practice nurses is incredibly important.

‘We need to continue to raise the profile of general practice nurses and how valued they are,’ she said. ‘I think we need more evidence to support that.’

Additionally, Dr Oldman says that, due to increased workloads, many nurses are finding themselves no longer doing the job they were trained to do. This understandably causes frustration and a decrease in job satisfaction. ‘They may not be leaving if the conditions were suitable for them to give the best possible care they want to give,’ she said. ‘We have a lot of anecdotal evidence from nurses who say, “I would stay, but I can’t do the job I was trained to do.”’

This lack of being valued is at the heart of why Sarah decided to leave practice nursing. ‘There is a lack of understanding and awareness of what practice nursing involves, which has an impact on others’ expectations,’ she said. ‘It is viewed by the public and other nurses/health professionals as an easy job, with nice hours and none of the pressures that are obvious in hospitals, emergency departments etc.

Our contribution is usually overlooked or any achievements attributed to GPs.’

Combatting the problem

Central to the issue of recruitment and retention is a workforce plan that ensures there are sufficient numbers of nurses now and in the future. A clear workforce plan also allows for accountability when those numbers aren’t met.

Crystal Oldman said: ‘I think the issue is about having a robust workforce plan and also having accountability for that somewhere centrally. Each individual provider must have its own workforce plan, but we are a national health service. What I would like to see is a national workforce plan for registered nurses.’

Kathryn Yates supports this but adds: ‘If we signpost to one particular organisation, it may devolve responsibility. I think there is also a sense of being mindful of how organisations work together to try and come up with real-time solutions.’

For Jenny Aston focusing on training the next generation and making nursing an attractive career is key. ‘Nursing isn’t going to change over the next 10 years: there are still going to be injections, there is still going to be lots of wound care, there is still going to be a need to monitor patients’ health,’ she said. ‘The work is not going away. There may be bigger practices, but I don’t see the nursing activity changing and, therefore, there is going to be an ongoing need to train up the next generation because 30% are going to be retired in 3 years’ time.’

Additionally, there need to be incentives for nurses not to retire early. ‘What lots of people don’t realise is that there are ways to stay on, claim your pension and make your pension arrangements different, so you don’t lose out on the final salary [pension benefits],’ said Ms Aston. ‘But I don’t think many nurses have good financial advice on how they get the best out of staying in work.’

Most importantly, nurses have to be listened to, so their concerns are understood and they feel valued. According to Kathryn Yates, it may be unclear what their needs are: ‘Going forward we may have a workforce that wants to work differently, and we must continue to make nursing an attractive and first destination career.’ she said.

Maria Caulfield, former nurse and Conservative MP for Lewes, said: ‘While I welcome the fact that more nurses are entering the profession than ever before, I am concerned that we are losing large numbers of our most experienced nurses, who are retiring or leaving the profession early. As a result, overall nursing numbers remain static at a time when the demand and need for nurses are increasing. There are a variety of reasons why nurses are leaving and certainly the pay freeze and cap have not helped morale, but from talking to colleagues it is the lack of overall recognition and feeling of worth that has led to many walking away. This is why I have lobbied ministers to ensure nurses are recognised. Lifting the pay cap is one way to show this.’

Health Education England oversees education and training of NHS staff. It has identified the need for additional supplies of nurses and improved rates of employment for graduates. Closing current shortages will also help with moderating increasing workloads.

NHS Improvement has launched a programme to improve retention of NHS staff by 2020. It will look at reasons why staff are leaving to help understand how to improve retention rates.

References

NHS Digital. General and Personal Medical Services, England March 2017. https://digital.nhs.uk/catalogue/PUB30044 (accessed 13 December 2017)

Nursing and Midwifery Council. The NMC Register: 2012/13–2016/17. 2017a. https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/nmc-register-2013-2017.pdf (accessed 13 December 2017)

Nursing and Midwifery Council. The NMC Register: 30 September 2017. 2017b. https://www.nmc.org.uk/globalassets/sitedocuments/other-publications/the-nmc-register-30-september-2017.pdf (accessed 13 December 2017)

British Thoracic Society/Scottish Intercollegiate Guidelines Network. SIGN 153. British guideline on the management of asthma 2016. 2016. https://www.brit-thoracic.org.uk/document-library/clinical-information/asthma/btssign-asthma-guideline-2016/ (accessed 19 December 2017)

National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management. 2017. https://www.nice.org.uk/guidance/ng80 (accessed 19 December 2017)

Taken from Practice Nursing, published January 2018.

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Antimicrobial resistance is a ‘ticking time bomb’

The Chief Medical Officer Professor Dame Sally Davies has announced that global action is needed if we are to overcome the ‘catastrophic threat’ of antimicrobial resistance.

The warning, made in her second annual report, highlighted the lack of new antibiotics discovered in the past two decades.

Despite new infectious diseases being discovered on an almost yearly basis, very few new antibiotics have been developed.

This means that we have limited resources to manage the increasing number of infectious diseases that are ever evolving to become resistant to current drugs.

‘We need to work with everyone to ensure the apocalyptic scenario of widespread antimicrobial resistance does not become a reality,’ said Professor Davies. ‘This is a threat arguably as important as climate change for the world.’

The importance of preserving current antibiotics was also emphasized. Professor Davies argued that in order to retain the effectiveness of existing antibiotics, responsible prescribing must be adhered to.

‘All physicians who prescribe antibiotics have a responsibility to their patients (and public health) to prescribe optimally,’ she said.

To help meet the challenges set out by Professor Davies, the Department of Health is planning to publish a UK Antimicrobial Resistance Strategy.

This five-year strategy will focus on championing the responsible use of antibiotics by ensuring NHS staff have the necessary knowledge, skills and training to prescribe antibiotics effectively.

Professor Davies stressed that governments and organizations across the world, including the World Health Organization and G8, need to realize the seriousness of the problem.

‘If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics.’

Taken from Practice Nursing, published 19 Mar 2013.

NHS Diabetes calls for introduction of specialist foot care teams

A report published by NHS Diabetes has announced the NHS spent an estimated £639 million–£662 million on diabetic foot ulceration and amputation in 2010–11.

Each year around 6 000 people with diabetes have leg, foot or toe amputations in England, substantially reducing their quality of life.

However, many of these are avoidable. The NHS Diabetes report suggests rapid access to multidisciplinary foot care teams (MDTs) with strong links to community podiatry services could lead to faster healing, fewer amputations and improved survival.

The reduction in NHS expenditure on diabetic foot problems as a result of the introduction of such services would far outstrip the cost of having MDTs.

Lower-extremity amputation rates at James Cook University, Middlesbrough, fell by two-thirds after the introduction of an MDT.

In 2010-2011 it was estimated that the cost of an MDT was £33 000, whereas the annual saving to the NHS due to averted amputation was £249 000.

Currently, one-fifth of hospitals providing inpatient care for people with diabetes have no MDT.

Anne Morton, Director of NHS Diabetes said: ‘It is not acceptable that thousands of people with diabetes lose a limb each year because of poor quality care. It is even less easy to accept when we now have such a strong economic case for change.’

Taken from Practice Nursing, published 19 Mar 2013.

Why Brains Matter

The Neurological Alliance launched a survey entitled ‘Our Brains Matter’ as part of the 2013 Brain Awareness Week, 11-17 March.

Brain Awareness Week is a global campaign to increase public awareness of the progress and benefits of brain research.

The aim of the Our Brains Matter survey is to develop a clear picture of the experience of being diagnosed with a neurological condition in the UK. With the evidence gathered, the Neurological Alliance will push for improvements in the diagnosis of all neurological conditions.

The Neurological Alliance is the collective voice for 10 million children, young people and adults in England with a neurological condition. It is a membership organization consisting of more than 70 national brain and spine organizations.

The coalition of charities has warned that a ‘legacy of neglect’ is preventing an estimated 12 million people living with neurological conditions in the UK from gaining vital treatment.

According to the Neurological alliance this is due to a lack of specialist knowledge and haphazard services.

‘Around one in six people in the UK will experience a neurological condition in their lifetime,’ explains Arlene Wilkie, Chief Executive of the Neurological Alliance, ‘Yet little is being done to ensure that the NHS is fit for purpose when it comes to responding to these complex conditions.’

Taken from Practice Nursing, published 19 Mar 2013.

Australia introduces HPV vaccination for boys

Australian schoolboys have begun receiving vaccinations to protect them against cancers and disease caused by the human papillomavirus (HPV).

HPV is a common infection that is associated with cervical cancer and genital warts. It has also been linked with other cancers such as throat cancer, although not as strongly.

‘We’re confident that extending the program to males will reduce HPV-related cancers and diseases in the future,’ said Australian Health Minister Tanya Plibersek.

Following the introduction of the vaccine to girls in 2008 to help reduce the risk of cervical cancer, Australia has become the first country in the world to publicly fund HPV vaccinations in boys.

The action has resulted in organizations such as the Throat Cancer Foundation to urge the UK to follow suit. However, the Department of Health for England has held its ground, saying that due to the lack of scientific evidence, there was no plan to implement the vaccination of boys into the NHS programme.

According to the Throat Cancer Foundation, the vaccine costs as little as £45 per person, and treatment for throat cancer costs the NHS around £45,000 per patient, meaning there is considerable cause for discussion of the topic.

Taken from Practice Nursing, published 18 Feb 2013.

Community team improving the sexual health of vulnerable women

Two teams of community nurses in south London who give contraceptive help, sexual health advice and screening to vulnerable local women have been recognized for their contribution to sexual health in the community.

The Health Inclusion (Three Boroughs Team of Lambeth, Southwark and Lewisham) and Sexual Health Outreach team work in partnership in south London to give contraceptive advice and support to young women who are sex workers and at risk of unplanned pregnancies.

The teams provide health care services at hostels, hospitals and nurse-led clinics, and help those who find it difficult to access health services as a result of not having a permanent address.

Through training hostel staff and visiting hostels once a week, the Three Boroughs Team has provided significant advice and support for women in need. The provision of certain medications through patient group directions and information on available contraception options has helped reduce the number of unplanned pregnancies in young women.

The women staying at the hostels have given positive feedback on the scheme. ‘These women feel valued because specialists were sent in,’ said Amy Hall, a nurse practitioner at the Three Boroughs Team. ‘Many of these women don’t think of these ideas until it is too late and so it is great for them to have the option.’

Eileen Sills, chief nursing officer and CEO at Guy’s and St Thomas’ NHS Foundation Trust congratulated the team for their work helping vulnerable women. ‘The team make a real difference to the lives of the young women they see in the hostels, supporting them to make healthier lifestyle choices and to think about when to become pregnant. We’re very proud of their excellent work.’

Taken from Practice Nursing, published 18 Feb 2013.

Francis calls for cultural change

The public enquiry report chaired by Robert Francis QC concerning the standards of hospital care provided at the Mid Staffordshire NHS Foundation Trust has emphasized a need for cultural change within the NHS.

The 3-volume, 1782-page report highlighted the failure of the NHS system to detect poor quality care and to ensure that services meet the standards that the public expects. This failure to communicate concerns illustrates a betrayal of the trust that members of the public should be able to place in the NHS.

Francis called for a patient-centred culture, which has a commitment to serve and protect patients. His recommendations for achieving this include: a structure of fundamental standards, which identify the basic standards of care a patient can expect; an openness and statutory duty of doctors and nurses to be truthful with patients; compassionate, caring and committed nursing; and stronger healthcare leadership.

The report includes a number of recommendations for changing nursing training, regulation and professional support that, if implemented, will have an impact on nurses in all sectors of the NHS, including practice nurses. Francis identified that nurses are at the heart of patient-centred care, and stressed that training standards need to be strenghthened to ensure that qualified nurses are competent to deliver compassionate care to a consistent standard. These principles apply to nurses working in all sectors of the NHS.

‘Nurses throughout the NHS will feel devastated at the picture of poor and unsafe care that took place at Mid Staffordshire,’ said RCN president Andrea Spyropoulos. ‘What commentators often forget is that no one is more saddened or frustrated by stories of poor care than nursing staff themselves.’

The report has important implications for nursing leaders, particularly for the Royal College of Nursing (RCN). Francis found that nursing needs a stronger voice. According to the report, this can be achieved through strengthening nursing representation in the leadership of all provider organizations, enhancing the links with their professional regulators, and introducing a better appraisal system. It was also recommended that the RCN consider splitting its trade union and professional functions.

Taken from Practice Nursing, published 18 Feb 2013.