A multifaceted approach is needed to increase the nursing workforce, says Janice Stevens
I will probably be accused of being biased but the current shortage of nurses cannot be blamed solely on reductions in the nursing commissions that occurred in previous years. Even those regions where reductions were very modest are facing a significant shortage of nurses. The reality is that the goal posts have fundamentally changed.
The Francis report into Mid Staffordshire Foundation Trust, the Keogh reviews and National Institute for Health and Care Excellence guidance have generated, quite rightly, intense focus, debate and attention on “nursing numbers and skill mix.” Directors of nursing have used evidence-based tools to determine the numbers of nurses they need to deliver effective, safe care and to argue the case for additional investment. Boards are scrutinising and discussing workforce plans in a way that just didn’t happen before. The result is that last year’s five-year nursing workforce forecast changed to reflect the increased demand and we found ourselves in a position where there is a considerable shortage of nurses, particularly experienced ones.
“Increasing placement capacity, mentoring and flexible delivery of programmes have to be tackled”
It is really important that workforce planning needs to keep improving so that we make good commissioning decisions. This requires focused attention and consistency. While Health Education England has increased nursing commissions this year, these will not yield an increase until 2017, therefore we have to look at how we can grow the workforce in the short term. While many trusts are recruiting internationally, there is a critical need to look for other ways to grow the workforce in the short and medium term. I am leading some work to determine how HEE can support the NHS to do this and to get a better handle on some of the issues and challenges we face.
Return to practice programmes have historically been one way to increase nursing numbers and while it might seem a simple option to just run more programmes, our review of the current landscape showed there were mixed experiences and significant variation in areas such as paying fees, quality of the programmes, ability to secure placements and the process of employment. We will be working with local education and training boards (LETBs) to help resolve some of these issues and put in place consistent practices to ensure that future programmes do result in more nurses successfully returning.
Some issues are challenging and will require creative thinking and new ideas. Increasing placement capacity, mentoring and flexible delivery of programmes have to be tackled. Critically, solutions for flexible and part-time working need to be put in place. There often seems to be reluctance to try different ways to address flexible working. While there are examples of good practice to be found, this is one of the main reasons why nurses leave.
Stakeholder events held recently, highlighted the importance of organisations needing to have a good understanding of why their nurses leave to tackle the issues. Burn out, lack of support, not feeling valued and lack of career development were key reasons cited. The literature also showed there is a higher rate of attrition in newly qualified nurses and little thought given to how nurses coming up to retirement could be utilised differently and more flexibly, thus making it a more attractive option to stay in the NHS for longer.
Increasing the nursing workforce is multifaceted and we will be working through our LETBs over the coming months to do all we can to support trusts in this important work. We would very much welcome examples of good practice where you feel you have successfully tackled some of the challenges discussed.
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Janice Stevens CBE is managing director for Health Education West Midlands