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'Critical' reasons behind nurses leaving profession laid bare


Nurses have cited “being treated like foot soldiers” as they are moved about on shift to fill staffing gaps, the increasingly burdensome tasks they are expected to do to meet employers’ performance targets, and lack of autonomy as some of the major reasons for wanting to leave their jobs.

The findings come in a new report by Health Education England’s West Midlands branch, which looked at how nurses could be encouraged to stay with employers.

“Supporting patients was expressed as fundamental but this operated within a set of working conditions which did not support the individual practitioners’ wellbeing”

Narrowing the Gap report

According to HEE, the proportion of nurses and midwives leaving the NHS has been rising every year since 2011-12, increasing from 7.7% to 8.6% by 2014-15.

National Audit Office figures show approximately 17,800 nurses left the NHS before retirement in 2014 and another 7,500 retired, said the HEE report, called Narrowing the Gap: considering gen-gagement.

The report said it was “critical” to understand why nurses and midwives were leaving, and to ensure the NHS had strategies in place to stop this from happening, in particular against the backdrop of the national workforce shortage.

Today’s report – which is the second part to the Mind the Gap report by the same group in 2015 about the particular needs of different generations of nurses – found a number of common problems that all age groups experienced.

These were a lack of supportive working conditions, large amounts of paperwork, not enough recognition, too few opportunities to progress their careers, lack of autonomy, and wages not always reflecting their role.

Six NHS provider organisations across Birmingham helped to host workshops that featured staff from across four different generations – “baby boomers”, “generation X” and “generations Y and Z”. In addition, 110 nurses and midwives took part in an online survey.

“Participants from one workshop agreed that complying with governance requests felt like ‘feeding the performance beast”

Narrowing the Gap report

Younger nurses said they “could be moved from area to area, sometimes without any input or explanation, to compensate for low staffing levels”, which some said made them feel they were “being treated like foot soldiers” and that made them feel drained.

More experienced “baby boomer” nurses in the main said they wanted to continue working for longer by supporting younger staff members, but were not given the opportunities.

Those in the “generation X” group felt most strongly about pay being reviewed in relation to reward and recognition, as well as more consideration for childcare.

Across the generations, work-life balance was seen to be inferior to meeting service needs and nurses said they felt there was little acknowledgment of how it affected them.

Participants described not getting their breaks during shifts, working over their hours and attending meetings and mentorship sessions or completing work on their days off.

“Supporting patients was expressed as fundamental, but this operated within a set of working conditions and expectations which did not support the individual practitioners’ wellbeing or job satisfaction,” said the report.

“Despite significant experience [and] added value derived from additional training….. pay was non-negotiable”

Narrowing the Gap report

Meanwhile, policies and systems were viewed by all age groups as having increased, with paperwork consuming their time and detracting from patient care.

“Participants from one workshop agreed that complying with governance requests felt like ‘feeding the performance beast,’” stated the report.

Participants said new processes were often developed without considering the practicalities, and that organisational governance activities led them to feel “like a flogged horse”.

While participants said their personal attachment to being a nurse was generally more important than leaving for a higher-paid job, wages became more of an issue for them when other problems came into play.

“Their experiences highlighted other factors such as a ‘glass ceiling effect’. Despite significant experience, added value derived from additional training and development and the fact that their contribution to patient care underpinned the business of the service, pay was non-negotiable,” said the report.

Aside from the improvements required to address these fundamental needs, the report also identified a series of “enhancement conditions” that nurses said were critical to job satisfaction.

“The need to have greater professional autonomy was one of the most stark and significant consensus themes across all generations of nurses and midwives,” the report said.

“The need to have greater professional autonomy was one of the most stark and significant consensus themes across all generations”

Narrowing the Gap report

“Nurses and midwives wanted to fulfil their role as a graduate level practitioner, accountable for assessing, planning, implementing and evaluating care and treatment and, more importantly, having responsibility and authority to provide that care in a flexible way,” said the report, which noted heavily bureaucratic systems were to blame.

Participants said the image of nursing and midwifery – and of individuals – was suffering as a result.

“More junior staff described how clinicians would bypass them in favour of the nurse in charge when seeking information about a patient they were caring for,” said the report.

Meaningful recognition was also required, with nurses reporting they felt “taken for granted” and that the working culture often focussed only on things that had gone wrong.

Lisa Bayliss-Pratt

Lisa Bayliss-Pratt

Lisa Bayliss-Pratt

Finally, all age groups wanted more career development opportunities. Those early on and in the middle of their careers wanted better access to high quality role models, while baby boomers said their learning was “often overlooked or neglected as they approached retirement age”.

Professor Lisa Bayliss-Pratt, HEE’s director of nursing and deputy director of education and quality, said her organisation’s role was to ensure the healthcare system had the “staff it needs to care for patients”.

“It’s, therefore, vital that we provide the whole system with the right advice about recruiting and retaining nurses and midwives,” she said.

“The solutions we’ve identified in the Narrowing the Gap report are informed by feedback from the profession about their concerns,” said Professor Bayliss-Pratt.

“We’re now working with our partners across the healthcare system to translate these recommendations into real improvements for staff and their patients,” she added.


Readers' comments (14)

  • I agree with all the above and to state what other colleagues have stated I will not encourage anyone to consider nursing as a career. Anyone taking up nursing as a career you have been warned!

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  • Registered Nurses are "lions led by donkeys" as they are progressively being patronised by the so called "nursing leaders" who are on the "gravy train" of high salaries who are "out of touch" with the realities of day to day nursing with very sick patients and the inappropriate paper work to protect the "Trust" from litigation rather than focus on the hands on work that nursing will always be. Using the term "shop floor" devalues the role of nursing to one of retail processes with patients as inanimate objects who do not have toilet needs and take ages to eat a meal.

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  • I left a ward manager role in 2011 because so much of my time was spent in non clinical activities. My experience and knowledge were under utilised because I was too busy form filling. Why did I need to verify shifts worked when a clerical junior could have done it easily. Why was I expected to walk away from a patient to answer a manager's queries about supplies or stores? I could go on with an endless list of office jobs which do not positively influence patient outcomes.
    Now, semi retired, I do flexible shifts on a unit where I am respected as a clinical specialist, can walk away when my shift finishes. I'm not giving an employer loyalty but I am giving thoughtful and personalised care, so I believe I serve my patients much better.

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  • I am a semi retired nurse
    I have discovered a valuable role in life
    I put off people who are thinking of entering the nursing profession by simply informing them of truths
    I have a score of about 20(ie talked out of nursing) and will continue to do so, so that the young do not waste their talents in a worthless devalued demoralising profession
    Also needing to be mentioned is the NMC which is a protection racket. 4 years of training to live afterwards under the constant threat of an atrocious Sword of Damocles

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  • Agreed. After 30 years of being a nurse I was referred to the NMC and faced 9 months of duress without work(because you have to tell employers that you have been referred) before getting a conclusion that I had nothing to answer. The nursing profession is cancerous beyond treatment.To anyone reading this, if you know of someone thinking of taking up nursing tell them not to be idiots.

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  • Another reason that nurses quit, is the amount of bullying that goes on unaddressed and unabated within the NHS. This is a problem that has gone on for years, but despite all the 'policies' in place which are meant to address the situation, these are not worth the paper they are written on.

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  • I despise my profession
    I despise the NMC
    I despise the day many years ago I entered a school of nursing.
    This is heresy at its worse. A nurse now has to admit remorse to a panel of witch hunters.
    Old people die ,we all do. have any of them seen the results of a resuscitation on a person who has ceased breathing for more than 5 minutes?
    Every nurse in this country should pack it in.

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  • above
    this was regarding the nurse sanctioned by the NMC for not conducting resusc on a deceased person. I am commenting on wrong story. But please read it.

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  • Agreed with every single comment made above! As for the NMC any nurse that is referred to the NMC be forewarned a person with a highly contagious and infectious disease will have better interaction with people. The minute you are referred you are isolated, ostracized all those colleague that you once had coffee with no longer knows you. Nurses are the worse when it comes to caring for their colleagues. If I had my life back I would never step my foot in this profession. Following castration by the NMC noone wants to hire you because you are treated like a convicted felon when it comes to looking for work! There is nothing in place by the NMC for nurses to reintegrate into the workforce. Every convicted felons get a parole officer this don't exist in nursing. Don't get me wrong I like the process of nursing which is the patients and only the patients. Dear colleagues take note your back is a target for knives.

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  • I wholeheartedly agree with all above comments, if I had my time again, I would chose a different career path, anyone thinking of nurse training don't do it, it's the most demoralising environment to be in

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