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Health service suffering drain in senior nurses, warns RCN

The health service has nearly 4,000 fewer senior nurses than it did just four years ago, according to a report by the Royal College of Nursing.

The RCN’s latest Frontline First report, published on Tuesday, warned that “reckless” cuts was “draining valuable leadership, experience and specialist knowledge” from the NHS.

It is the latest update from the Frontline First campaign, which was launched in July 2010 to monitor the impact of NHS efficiency savings targets.

The report reveals that hidden within wider nursing workforce trends is a “significant loss” of 3,994 fewer whole time equivalent (WTE) staff on Agenda for Change bands 7 and 8 – including senior ward sisters, community matrons, clinical nurse specialists and advanced nurse practitioners.

An RCN freedom of information request to the Health and Social Care Information Centre revealed that in 2010 there were 66,750 nurses in these bands in England, but this had fallen to 62,757 in September 2013.

The RCN said the NHS had treated staff with years of experience as “disposable” and a quick way to save money that meant knowledge and leadership was being lost when it was needed more than ever.

“Letting so many years of skills and experience vanish from the NHS is an utterly reckless policy”

Peter Carter

The college also criticised trusts for “downbanding” senior staff into lower pay grades, which it said sent a message that experience and leadership was not valued.

The Francis report into care failing at Mid Staffordshire Foundation Trust highlighted the importance of having sisters able to properly manage their wards, noting their role was “universally recognised as absolutely critical”.

Peter Carter, RCN chief executive and general secretary, said: “Nurses have been telling us for some time that workforce reorganisations are disproportionately targeted at more senior staff with key specialist or leadership roles. This is something which has a knock-on effect on all staff.

Peter Carter

“Senior nurses are ideally placed to act as a bridge between frontline staff and management, enabling resources to be used where they are most needed,” he said. “In the community, senior and specialist nurses often work with a great deal of autonomy and are often solely responsible for patients.”

Dr Carter added: “Just as worryingly is the loss of specialist clinical skills and experience which is inevitable when so many band 7 and 8 nursing posts are cut or left vacant. Letting so many years of skills and experience vanish from the NHS is an utterly reckless policy.”

“We also need to have a look at what skill mix gets the best outcomes for the patients”

Dean Royles

Dean Royles, chief executive of the NHS Employers organisation, said: “These simplified figures help to tell part of a very complex story.

“Cash is flat, demand is rising, the way we care for people is changing,” he said. “Local nurse managers and their employers are doing a remarkable job in challenging circumstances and developing new models of care.”

He added: “Judging the quality of care by the numbers of one particular staff group may be attractive, but we also need to have a look at what skill mix gets the best outcomes for the patients. That’s the sophisticated debate we need to be having.”

Professor Ieuan Ellis, chair of the Council of Deans of Health, said: “Senior nurses are vital for providing expert and specialist care, leadership,  educating and training students and supporting newly qualified staff through preceptorship.’

“The deep cuts to posts in community and mental health settings will make it even more difficult for students to access community and mental health placements and gain the experience they need in these areas.”

As Nursing Times has recently reported, specialist nurses are starting to fight back in some places.

A diabetes specialist nurse presented research last week at a conference on the importance of her role (page 6) and a programme led by the MS Trust has demonstrated the value of multiple sclerosis specialist nurses and helped secure jobs.

Last month, Ulster University academics also launched an online tool designed specifically to help specialist nurses prove the benefit of their work. The Apollo Nursing Resource provides nurses with access to essential management tools and advice, as well as offering networking opportunities with colleagues from a range of specialisms.

Readers' comments (37)

  • All nurses are disposable mr Carter. Where have you been these last twenty years? I look forward to your next report telling us the obvious.

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  • Lord, Lady, Sir, Madam, Mister, Master, Mrs, Miss or Ms Above

    I sincerely hope you mean 'dispensable' and not 'disposable'! I cannot begin to imagine how large quantities of senior nurses could be disposed of and by what methods.

    We weren't recognised or wanted so we sought far better opportunities abroad where there are unlimited quantities of rich green grass!

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  • The Trust I work in undertook a review of many of its senior nursing posts and offered many of us redundancy. Then at the last minute - surprise, surprise found us alternative posts at a lower grade. If we didn't take those posts then we lost the right to redundancy. I and many colleagues found it hard to believe that the organisation was prepared to let so much organisational knowledge just 'walk out the door'.

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  • Nice to see the RCN getting worked up about the only part of its membership is actually gives a flying duck about.

    The vast majority of band 8 jobs are desk-bound 'modern Matron' posts which, to be honest, in most Trusts are just another layer of management added in by the wasteful Labour lot.

    I can't say I'm losing any sleep over this and hope to see more go!

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  • Anonymous | 11-Mar-2014 12:25 pm

    Reckon people in most jobs know they are dispensible', but probably agree that nurses are now so 'disposable' with a sweep of the broom, vast numbers of experienced nurses can be downbanded on a whim to save money. There's no incentive to progress or remain in the profession.

    Might be organisations are recycling senior nurses with those from a non-nursing backgrounds - bit like the NMC, etc, and crossing their fingers for good patient outcomes.

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  • Once again what we have been saying for the past twenty years or so, the RCN is now repeating as if they've had a sudden rush of insight as to the damage consecutive government administrations have inflicted on our NHS.

    These people should stop pandering to the chancers who dictate NHS policies and defend the Nurses and their patients who are put at risk by cut backs and profiteering. ...

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  • In our Trust they have just appointed 3 stroke coordinators seconded for a 3 month period at band 6 (not 7 or8, I realise) and the scheme has shown to be working. However, 2 months into the scheme they have been counted back in the stroke unit numbers and can no longer fulfil their stroke coordinator role. Patients brought into hospital with a stroke are no longer getting specialist stroke car as soon as they arrive in A&E. A while ago someone was telling me they were shadowing a very high up member of staff in our trust, who made a comment, 'Patients are the least of our priorities'!

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  • tinkerbell

    Anonymous | 11-Mar-2014 9:52 pm
    'A while ago someone was telling me they were shadowing a very high up member of staff in our trust, who made a comment, 'Patients are the least of our priorities'!

    Without the patients this bod whoever they were wouldn't have a job. Pathetic isn't it?

    We're here for the patients, they are not here for us.

    I've got one nerve left and haven't left home yet to start my day.

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  • 'Patients are the least of our priorities'!

    W H A T ? !!!!!!

    Sounds like we may as well all pack up our tools and just go home!

    or send all of the managers packing. sounds as if there is no longer room for both under the same roof!

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  • tinkerbell

    I vote for send em packing!

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  • Anonymous | 11-Mar-2014 9:52 pm

    Disgraceful and the manager who said that should be sacked. Contact your local newspaper or CQC anonymously. Patients should be at the absolute centre of everything we do, not just an afterthought.

    I'm absolutely speechless. This must be brought to the wider publics attention!

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  • once again the coments are turning into a manager bashing exercise. I agree that it is appauling that the senior bod said what he or she did re: patients. but lets not lose the core message here. Senior nurses being disposed of/ dispensed with means that their knowledge, skill, experience and organisation memory goes with them. this is why nursing is re- inveting the wheel at every opportunity rather than moving forwards with what we have already started, or reintroducing what has already failed
    Just think tinkerbell and annonymous, you may well be a managers yourslef one day..

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  • Anonymous | 12-Mar-2014 12:22 pm


    lol from 'annonymous', Senior Clinical Manager

    sorry you can't write or spell, and allow yourself to make silly assumptions! More work needs to be done and perhaps one day even you might become a manager!

    I stop short of adding any further and more colourful expletives!

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  • Anonymous | 12-Mar-2014 12:22 pm

    Once a nurse spends more time sitting in meetings, taking decisions that negatively impact on patients, they cease to be nurses and become managers in my eyes and I can't say I lose any sleep about that.

    I can't speak for Tinkerbell, but I can certainly rule myself out of ever being a manager as I lack the callous streak that seems so prevalent in the upper echelons in the NHS.

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  • I am so reluctant to go for a specialist job although I possessed all the skills and experience, simply I am concerning all those posts will vanish soon and I can not go back to my current position. Funny or sad?

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  • Anonymous | 12-Mar-2014 12:38 pm

    sorry, to disillusion you and dispel your stereotyping but I don't appear to fit your mold.

    hands on senior clinical nurse manager who advocates and enjoys carrying out excellent basic care (frequently to be found up to the elbows in buckets of shit and doing my fair share of the cleaning up like any other good nurse), as well as using advanced and more specialist skills and working with and motivating others at all levels, excellent professional and personal interpersonal relationships and communication skills and have never been perceived by anybody, including myself, to have a callous streak and that after over 30 years in the profession. Most of my colleagues and others I encounter during the course of my work possess similar positive attributes so hopefully those you describe are in he minority.

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  • tinkerbell

    I was a manager on 2 occasions, the first post I applied for, the 2nd I was asked to stand in for whilst they sought a replacement, they then asked if I wanted the job permanent, I declined. I gave it up on both occasions so I could get back to hands on care. I have no interest in climbing the ladder to endless meetings and listening to endless bullshit and barely anything ever being actioned and then rediscussed at another meeting.

    Don't get me wrong, i'm not saying there aren't any good managers but they are few and far between. A manager is supposed to make a nurses job easier on the frontline. I have seen little evidence of that in 27 years in nursing but I have seen a lot of managers hiding behind closed doors totally disconnected from what the staff are experiencing on the shop floor.

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  • two important lessons i learned on my senior management degree course, among many others

    1. a manager does not delegate work they would not wish to do themselves

    2.management is a supporting role where you use the expertise of each department and each team member. a manager is a generalist and has experience in their own field and in the area of management they are dealing with but cannot know and do everything hence their need to call on others to discuss with and inform them what resources are needed and the most appropriate plans of action. this in my view is where management goes so wrong.

    good management and leadership is a team effort where every single person counts no matter their background, skills and level of experience or their role in the organisation (a chain is as weak as its weakest link and for which everybody is responsible), and the fact that it is not intended to be a competitive power struggle pitting one profession against another and fighting to dominate but an equal partnership with the central focus on each individual patient and their needs whilst entrusted to our care. effective leadership comes from each member of the interdisciplinary team from the very bottom up as well as from the very top down, with obviously all the different layers from different groups of employees in the middle and is also lateral.

    collegiality, open dialogue and transparency with the freedom to discuss any and all issues anybody considers of importance makes every single employer feel valued and builds greater trust which in its turn enhances quality through keen interest and motivation in a climate of learning from one another and from the organisation as well as its patients and everybody else who comes into contact with it and helps to reduce bullying and other negative behaviours.

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  • I've noticed our hospital has advertised for only newly qualify staff nurses and there is an open day for them soon.
    On the ward I work on we have a good mix of newly qualified and senior nurses and all was going well for a time when we senior got to work with the newly qualified even though it was more work for us, they felt supported. Well recently this internal rotation to night duty has put a spanner in the wheel, as all the senior whether they want to or not, had to take their turn doing nights, leaving the newly Q mostly on their own during the day. The newly Q now suffering stress and going off sick.
    Stupid managers putting more stress on them by telling them they are keeping tabs on their sickness level.
    If they can not look after the ones they have, how the hell can they cope with more?

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  • michael stone

    tinkerbell | 12-Mar-2014 5:15 pm

    I see some 'manager' stuck to you, Tink: you used the word 'actioned' which is the start of the slippery slope, I think.

    Most people would, I suspect, probably just say 'nothing was done about it' or 'but things didn't change': it takes some familiarity with management-speak, to prefer to use 'actioned', surely ?

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