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Exclusive: Nursing director recruitment crisis 'hugely worrying'


Trusts across England are taking months to fill permanent board-level nursing posts, sparking concerns about the future leadership of the profession, an investigation by Nursing Times has revealed.

Data provided to Nursing Times from 134 (85%) acute trusts in England has shown one in eight had a chief nurse or nursing director vacancy this summer.

Of these, the average length of time posts were open was 10 weeks, although one trust had no gap between post holders while another saw the role remain vacant for six months.

“There are fewer people thinking they want to become a chief nurse because they think it’s a risky job if an organisation is in difficulty”

Janice Stevens

Two trusts were outliers and had far longer periods of vacancy – one had its chief nurse post open for a year, while another has not had a director of nursing for over three years. In all cases, posts were covered by interims.

Nursing Times collected the data on senior nursing posts from Freedom of Information requests. The results showed a third of the 18 trusts that had vacancies in the three months leading up to August had been placed in special measures by the Care Quality Commission at some point in the past two years.

Four of the trusts were rated as “requires improvement” by the CQC following their most recent inspection.

Meanwhile, the data revealed that, for those trusts that did not have a vacancy, the average length of service with the organisation for the current director was three and a half years. However, 15% of trusts said their director of nursing had been in post for only a year or less.

In addition, one in every seven trusts had a vacancy over the summer for a deputy director of nursing, although this largely did not occur at the same trusts that had no permanent chief nurses.

Barts Health NHS Trust

Professor Janice Stevens

The vast majority of trusts responding (89%) said their chief nurse or director of nursing post had additional responsibilities included in their job title or role, such as lead for quality or deputy chief executive.

Barts Health Trust interim chief nurse Janice Stevens described the number of vacancies across trusts as “hugely worrying” for both the profession and patient care.

Ms Stevens is on secondment from her job as director of Health Education England for Midlands and East. She was appointed on an interim basis following the resignation of the chief nurse and chief executive at the east London organisation, which wasstruggling with its finances and performance.

Ms Stevens said a series of issues has led to current levels of senior nurse vacancies including fewer opportunities for nurses to acquire the broad range of skills now required for the job, and more scrutiny of those in post.

Smaller trusts that, in the past, were used as training grounds for deputies had also reduced in number due to hospital mergers, which had exacerbated the issue.

“The critical issue is – have [chief nurses] got the support and teams around them to help them in that role?”

Howard Catton

“The skills you need as a chief nurse now are very different to 10 years ago. It’s much busier, there’s far greater scrutiny, and there’s no doubt you are a member of a corporate board – not just an adviser,” she added.

“There is a nervousness. So there are fewer people thinking they want to become a chief nurse because they think it’s a risky job if an organisation is in difficulty, and a lot of them are,” Ms Stevens said.

Royal College of Nursing head of policy Howard Catton said the number of vacancies at both chief and deputy level – as well as the relatively short lengths of tenure – should be seen as a “significant warning” about a potential lack of future supply for senior leadership.

He said senior posts were “bigger” and “tougher” that in the past and chief nurses were expected to deliver change quickly, which meant trusts without adequate support for those posts were less attractive.

“These roles find themselves increasingly at the epicentre of decision making around cost, quality and safety as well,” he said.

“The critical issue is – have [chief nurses] got the support and teams around them to help them in that role?”

“[Chief nurses] are not sufficiently valued, and are not always given the comparable respect and facilities as medical directors”

Gail Adams

Mr Catton said he believed these issues were putting off potential candidates and also causing trusts to delay permanent recruitment until suitably experienced nurses become available.

Unison’s head of nursing Gail Adams echoed his comments. She said: “Being a director of nursing in today’s NHS is a really tough job. They are not sufficiently valued, and are not always given the comparable respect and facilities as medical directors.

“Because it’s tough, and we don’t remunerate them well, we’ve made it almost the job no one wants to do,” she said.

Earlier this year, former RCN chief executive Peter Carter also expressed concern about the number of vacant nursing director posts.

Speaking at Nursing Times’ Deputies’ Congress in June he said: “I am worried about nursing leadership and the number of vacancies for director of nursing posts. People don’t want them – there is a fear that when it goes pear-shaped you’re the personin the frame.”


Readers' comments (11)

  • It's a bit daft to isolate Nursing - every senior post has this exact same problem: nobody wants the jobs, huge interim-infestation rate, etc.

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  • Who in their right mind would WANT an executive nurse post? You are damned if you do and equally damned if you don't in terms of decision making. One of the most unenviable jobs on the planet.
    Some non nursing management posts are just as troublesome because we live in a culture of blame, fear and retribution, with very little support from above.

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  • I had dealings with 1 director of nursing regarding abuse of pts BT RN with her attitude we are better off without them
    The RCN regards officer was with me and they were talking over old times not the pts who had been abused RCN never trust them with anything

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  • Having had recent experience of dealing with a director of nursing I have been left with the feeling that some may seek or be promoted above their capability level.

    Some may say a problem throughout nursing.

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  • Anonymous | 17-Sep-2015 9:09 am


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  • well the directors, funders and government need to wake up an realize one thing. people do want to have secure full time work but why would they work in the NHS for £21,000 a year when they can start with a private provider for £24,000 a year or with an agency for £250 a shift as and when they like. If the NHS increased wages to meet that of the private hospitals and put more of a cap on hours and money for agency staff then people would be more encouraged to work for the NHS and this would mean posts are filled easily. furthermore this would in the long run save a mass amount of money because yes you would pay more for regular staff but there would be massively less spent of the extremely over priced agencies. Finally this would also mean Constantine teams on the wards, increased staff moral and more constant better care for the patients. which is a win, win, win but will anyone actually read this and think yeah thats a good idea spend £x amount more on wages, save £x but not employing agencies and improve staff moral and care standards or will we keep on with this we need to save lets cut staff, cut quality, complain in panorama programs and in media to make everyone feel even worse........

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  • But it is often the Directors of Nursing who jump through hoops to comply with the box ticking and actively encourage the above useage of agency staff rather than support their loyal staff.

    The same goes for the ludicrous amounts of paper work that take time away from patient care. Raise it as a concern that it contributes to inadequate care and low moral and the Director of Nursing isn't interested.

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  • The Director of Quality is leaving Worcestershire Health & Care NHS Trust shortly. To those of us in BBTT campaigning against abuse of staff it has looked as if her job was primarily to smooth over complaints without doing anything. Not very satisfying. Her title would more appropriately have been Director of the Appearance of Quality.

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  • All RCN members should read this blog, you don't often hear another view on the RCN

    The Royal College of Nursing (RCN) represents most of the nurses employed within the NHS and has a membership of over 400,000. It started life as a ‘professional’ organisation for nurses, promoting excellence in practice, before registering as a ‘trade union’ in 1976. Scratch the surface of this grubby, conservative, false-flag operation, and you will see it is not a ‘trade union’ by any understanding of the term.

    I have previously written about nurses and industrial action during the pension’s dispute and defeat of 2011. Not a lot has changed in the last three years. Nurses are still being targeted because they are an easy touch and lacking anything resembling meaningful trade union representation.

    The RCN congress is taking place this week, in Liverpool, with ‘pay’ and ‘taking action’ dominating the debate. Against a backdrop of the growing anger of nurses, the RCN General Secretary, Peter Carter, had this to say:


    “The RCN has not called a ballot, and the unique role of nurse’s means that they should think carefully before taking such a decision. Think what going on strike really means. For a strike to work, it has to have a real impact on someone or something. If you work in a car factory, that means stopping the production line. But if you are a nurse, it means abandoning your patients, leaving those babies in the neonatal unit, cancelling that visit to an elderly patient in the community, walking out of the emergency department, or psychiatric ward.”

    He went on to say that it was important to protest by other means, including “writing to your local MP” and asking where they stand on nurses pay. If they agree with the government’s position, then nurses should “unseat the MP by voting for someone else”

    Peter Carters deceitful and cowardly speech was so absurd, that when I first read the transcript I had to double check that I had not accidentally downloaded it from Private Eye, or a spoof website.

    Firstly, Peter Carter says ‘The RCN has not called a ballot’. Of course they haven’t, because the RCN is structured in such a way that any decision to ballot for industrial action can ONLY come from the General Secretary (Peter Carter). I would wager that the vast majority of the nearly half a million nurses in the RCN have no idea that they have zero decision making power in terms of taking industrial action.

    Historically, the RCN had a ‘no strike clause’ up until 1995, when it was dropped. It was only dropped as it was a barrier to recruitment, not because of any ideological changes within the organisation. It is crystal clear that the RCN still operates a ‘no strike policy’, but does this via smoke and mirrors, and deliberately excessive bureaucracy.

    Peter Carters use of a car factory analogy is ridiculous. Why is he suggesting that the only industrial action is that of a full scale strike? There are many ways of taking action short of a strike, which he well knows. Nurses undertake many extra responsibilities that are not part of their job descriptions, work extra unpaid hours to support their colleagues, and undertake many other activities that could be described as ‘goodwill’… Nurses could refuse to engage in those activities, particularly those activities that pertain to the meaningless bureaucracy that swamps the NHS. Furthermore, there are examples throughout the world of nurses taking actual strike action, winning disputes, whilst not impacting on direct patient care.

    Peter Carters deceitful and cynical use of emotive language and examples of who would suffer during a strike is an absolute disgrace. Only a liar would suggest that striking nurses would literally ‘walk off’ a neo-natal unit, leaving babies unattended. His speech was a nefariously planned attempt to deceive nurses, the media, and the general public, into believing a nightmare vision of what ‘nurses on strike’ would look like, and lead to. Furthermore, if you took his examples at face value, you could then argue the point of how valuable the work of nurses is, and why they deserve to be fairly paid.

    Industrial action and patient care is an interesting subject. Patient care is not just instant, here and now, at the bedside. Nurses should be taking action over the wider issues of care provision. What is the RCN doing about thousands of nurses being made redundant, what did the RCN do about the Labour Party saddling NHS with £300,000,000 of PFI debt, what are the RCN doing about mental health beds being stripped away throughout the country, resulting in people being sent hundreds of miles away from their homes, what are they doing about national terms and conditions being attacked, what are they doing about the Conservative Party privatising the NHS? The answer is ‘nothing’, all they do is ‘talk’ and ‘negotiate’. Nurses and their union should be fighting for better patient care, not just accepting what is being handed down to them…. Nurses who want to take industrial action over issues that have a direct impact on patient care, should be applauded and supported, not vilified… How dare you Peter Carter, how dare you……

    Peter Carters solution to the dispute – “Write to your local MP” is so stupendously ridiculous and insulting; I won’t bother dignifying it with a rebuttal.

    Peter Carter and the RCN are obsessed with the public perception of nurses, and how industrial action may impact of that perception. This attitude is steeped in the historical snobbery and classism that runs through the RCN’s upper echelons like a stick of Blackpool rock. The RCN, a so-called trade union would rather have its members viewed as low-paid, over-worked, servile ‘angels’, than fairly paid, nurses, with self-respect and a backbone.

    Every year the RCN has its congress, nurses are said to be angry about pay, pensions, conditions, service provision, and patient care. Yet all Peter Carter and his lackeys can offer their 400,000 members whose work is absolutely key to the NHS, is ‘negotiation’. Anyone with a shred of analysis can see that ‘negotiation’ not underpinned by a meaningful threat of action is little more than a begging exercise, that has NHS bosses and the government laughing into their board meeting buffet.

    The cowardice and inaction of the RCN is not a new phenomenon. Since the day it became a trade union in 1976, it has operated as little more than a ‘corral’ or ‘holding pen’ in order to keep nurses on their knees, away from genuine trade unions. The RCN has proven itself to be perfect bedfellows for successive governments of all stripes.

    The RCN’s primary tool of recruitment is to gather up student members at University when they commence their nurse training. Students are offered a greatly reduced subscription rates, free pens, and diaries, if they sign-up. Once they have completed their training they inevitably maintain their membership for the rest of the career. For many, it is their first and only experience of being a member of a trade union, so expectations of the organisation are low or non-existent. Recruitment of students is not difficult. They either join the RCN or UNISON whilst at University, with many opting for the snobbery and elitism of the RCN, as they wish to distance themselves from ‘Healthcare Assistants’, who generally join UNISON.

    As part of the RCN’s campaign to dampen down any militancy within nursing, they produce the ‘Nursing Standard’, which sells 70,000 copies each week - with a much bigger actual readership. They also produce a series of monthly ‘specialty’ journals, which are aimed at nurses working within a variety of clinical specialities. Via their range of carefully produced publications, the RCN are able to drip their squalid propaganda into the homes and workplaces of hundreds of thousands of nurses each and every month.

    For the size of its membership, the RCN has relatively few stewards. I once worked in an organisation that had 1,000 RCN members, yet had no stewards whatsoever. The RCN are not troubled by this, as those members paid nearly £200,000 a year into the organisations coffers, for zero in return. The RCN are more than happy for the Unison mafia to run the staff side committees, and toady their way through embarrassing partnership arrangements, with their own members as passive passengers.

    Member involvement at branch and regional level is not much different. Some RCN branches are enormous, yet meetings are made up of five reps, who have never consulted their members on any issue. When I challenged an RCN full-timer about lack of internal democracy and general activity, I was told that:


    “The members are to blame if they cannot be arsed to get in touch or turn up to branch meetings”

    That particular individual never made any attempt to advertise branch meetings, encourage people to get involved etc… he, and others like him were more concerned about maintaining their own position of influence within the pecking order, than assisting rank and file members in becoming more involved. They ran the branch as their own personal fiefdom, wielding the influence of such a large branch membership for their own aims. Whilst they wax lyrical about ‘internal democracy’, in reality it is just a meaningless phrase, as the organisation relies on the apathy and historically ingrained passivity of its membership in order to function.

    If there ever was a situation in which the RCN politburo would sanction industrial action, then you have the nursing equivalent to the House of Lords, (NMC) to contend with. The NMC (Nursing & Midwifery Council) is the professional body responsible for the registration of all nurses and midwives in the UK. With its disingenuous strapline ‘Run by nurses for nurses’, the NMC threatened to ‘strike off from the register’ nurses who took part in industrial action (during the pensions dispute of 2011) as they would have been in violation the NMC code of professional conduct…. In response to this outrageous state sponsored threat, Unison made the token threat of legal action, whereas the RCN said and did nothing. A quick look at the crossover of personnel at the top of the RCN and NMC would reveal why.

    The RCN, without a smidgen of sarcasm, calls itself ‘The Voice of Nursing’. It is nothing of the sort. It is the voice of the establishment that thinks slow clapping a health minister at congress is ‘taking action’. The sooner nurses wake up to this state sponsored false-flag, drop the snobbery and elitism, and see the RCN for the scab staff association it is, the better….. Join another union, any union……

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  • Well said Anonymous | 23-Sep-2015 9:52 am

    Maybe Mr Carter doesn't want to jeopardise any potential Honours. Like all at the top in our profession, they let us down. What they don't seem to realise is that ends up with the patients being let down.

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