Nursing workforce shortages remain the “biggest issue” for the profession right now, with the risk of another situation like that at Mid Staffordshire Foundation Trust having never gone away, the leader of the Royal College of Nursing has warned.
RCN chief executive and general secretary Janet Davies said nurse staffing shortages were as “bad” as she remembered them ever having been before.
“The number of vacancies and the increasing demand is critical”
“The number of vacancies and the increase in demand is critical, and we are in a really, really difficult position,” she told Nursing Times in an interview.
“It is the biggest issue for nurses and our members,” she said, noting that workforce pressures and retaining staff could be a vicious circle.
“Not having enough staff to the job that you should be doing is the one thing that really pushes nurses out of the profession,” she said, speaking ahead of the RCN’s annual conference this month.
Asked if she thought the situation was dire enough that another care scandal like that at the former Mid Staffordshire NHS Foundation Trust could occur again, she said: “There’s always been that risk.
“The issue with Mid Staffs was that it was a purposeful cut in numbers. Now it’s not necessarily purposeful,” she said, highlighting the combination of a lack of staff and also the fall in students.
“We’ve not looked at the population and invested in the sort of numbers that we need, so we shouldn’t be surprised – and we’re not surprised,” she said. “But the solutions are harder to come by. It is a very critical time.”
Ms Davies, herself, has been in post at the college now for nearly three years, which she noted had “been an incredibly busy” period.
“There have been some achievements but it’s been an incredibly challenging time in that three years, because we’ve seen so many those significant changes,” she said.
Ms Davies has been chief executive and general secretary of the RCN since July 2015. Prior to that, she was its executive director for nearly a decade.
She started her nursing career in Manchester, gaining experience in acute, mental health and community settings before moving into director of nursing roles.
Before joining the RCN, she was chief executive of Mersey Regional Ambulance Service NHS Trust, where she was credited with overseeing an extensive programme of change and development.
Asked what the key challenges had been during her tenure, she especially highlighted the loss of the bursary in England and ongoing cuts to budgets for continuing professional development.
“We’ve seen the vacancies increase, we’ve seen the changes to education, we’ve seen the continued pressure on budgets – but significantly the changes in education models,” she said.
Asked whether there was still any realistic hope of overturning the government’s policy of moving from bursaries to loans, she said: “We’re not giving up.
“Things are always reviewed and every time you have a government change, people look at education and models,” she noted.
“We will still continue to push for alternatives, for grants, or whatever,” she added, also highlighting that the college was still actively campaigning to retain bursaries for post-graduates entering nurse training.
Earlier this year, the government revealed plans that, from August, new postgraduate students training as a nurse or midwife would be required to take out loans to pay for their training and day-to-day costs. Undergraduate healthcare students stopped receiving bursaries from August 2017.
Latest figures show the number of people from England applying to train as a nurse has fallen for a second year in a row, meaning applicants are now down by around a third since the government opted to end free education for student nurses and instead switch to a loans system.
- ‘Short-sighted’ removal of bursaries for postgraduate student nurses
- Applicants to nursing courses fall for second year since bursary end
Ms Davies noted that the figures represented a “bit of an I told you so”, regarding the warnings given to ministers by unions about its plans to scrap bursaries for students.
She also highlighted the growing divergence between the UK countries on nursing policy, which was especially apparent on education, where Scotland and Wales had so far retained bursaries.
However, she acknowledged that nurses working in those countries probably still thought there were insufficient newly qualified staff coming through to swell the ranks.
Regarding the new routes into nursing being introduced in England, the RCN leader noted they had positives and negatives.
For example, with nursing associates, she highlighted that the controversial new bridging role offered opportunities to healthcare assistants for “education and development and taking on more responsibilities”.
But she warned that the negative was “any form of substitution”, in which those in the role were used in place of registered nurses.
“It’s not fair to them and it’s not fair to the patients,” she said. “The real danger, because we’ve got so many vacancies, is that they will be pushed into that.”
Similarly, regarding apprentice nurses, Ms Davies said there was “nothing wrong” about the model in theory, as long as they were supernumerary and supervised in view of their position as a learner.
“When you look at a good apprenticeship model – as in any industry – they have that supervisor, they are not just left to do things on their own,” she said.
“The biggest danger is having apprenticeships in areas that haven’t got enough staff in the first place so we know then what happens – they just get dragged into providing work and that is not a learning experience,” she said.
She also warned that it was “very important” that the use of the apprenticeship model did not lead to any form of dumbing down or a reduction in people’s ability to be critical of current practice.
“It’s really important that an apprenticeship still enables people to think critically, because it makes a huge difference so they are not just accepting the way things have been – we have to constantly improve practice,” she noted.
However, she questioned why money was being invested in such initiatives rather than simply being used to fund more student nurses.
“The quickest way to do it is to put money into the system that’s tried and tested,” she said. “We’re in such a difficult situation at the moment that we need the very quickest way of getting people in and an apprenticeship takes longer than a three-year programme.”
“We haven’t got very strong relationships but it isn’t a broken relationship – it’s cordial”
In light of the current consultation on pay proposals negotiated by the college and other unions with the government and employers, Nursing Times asked about her working relationship with ministers in Westminster.
“I think there are a lot of things we don’t agree on,” she said. “We haven’t got very strong relationships but it isn’t a broken relationship – it’s cordial.”
She said one of the “challenges” of working with the government was that policies were often made in isolation without “true consultation” or “really working through what the consequences would be”.
“It’s very challenging when you feel you are not being listened to or that the expertise of our members is not recognised,” she noted, particularly referring again to the education changes.
Ms Davies said one of the problems with policy affecting the profession was that “everyone thinks they understand nursing”.
“There’s always this tendency to look at nursing as this whole series of tasks and, therefore, you think you understand what nursing is,” she said. Actually, it’s looking at the whole person and your knowledge and skills are not necessarily visible.”
Follow Nursing Times during RCN congress
Keep up to date with all the key developments at this year’s RCN congress in Belfast by visiting the Nursing Times website, with in-depth analytical coverage and live rolling news between 12-16 May.