It is hardly surprising to hear from the Royal College of Nursing that nine out of 10 of the 50 largest NHS hospital trusts have a number of nurses that is below what their management planned.
This latest report from the RCN, released over the weekend, backs up what the college, ourselves and many nurses have been saying for a while. There aren’t enough nurses to provide care – and patient safety is at risk as a result.
What the college warns is that, left with no alternative, those in charge of rosters and decisions about staffing are often being forced to use unregistered healthcare support workers to provide care.
I don’t blame directors of nursing and their senior teams for using healthcare assistants in this way. They have nowhere else to turn, having been let down by poor workforce planning. Add to that the erosion of the nursing register as the government refuse to look after the nurses that are currently on it by paying them fairly and treating them respectfully, and you have a challenge to keep your wards or units safely staffed. It is not a time for principles, but pragmatism.
But I worry that we are now beginning to normalise substitution of registered nurses for healthcare assistants. Could we get used to having fewer registered nurses providing care, and suddenly find ourselves in a position where finance directors and other members of the board think it entirely feasible to staff a ward or unit with fewer RNs? Maybe even no RNs?
Of course, substitution is a moot point while there are no nurses to take the jobs. And what’s better – a healthcare assistant who is familiar with the patients, the team and the ward environment, or an agency nurse who, in some cases, might not have set foot in the trust before?
“It could be very difficult to argue for more budget for registered staff”
But, when other members of the senior team see the care that is usually the domain of nursing staff being delivered by less qualified and less expensive staff, it may well drive down the perceived value of registered nurses.
Now more than ever, chief nurses and directors of nursing need to be superb at articulating the value of registrants in their nursing teams to hold onto their establishments. It could be very difficult to argue for more budget for registered staff, especially if the government’s plan to boost numbers with nursing associates and apprentices is successful.
Don’t get me wrong – healthcare support workers play a very valuable part in the care of patients, and we need them. I am supportive of routes into nursing that support those staff who cannot gain a conventional degree.
However, I am also in favour of ensuring nursing is a graduate profession that has the status of other graduate professions, and commands the same respect.
When we reduce nursing to a series of tasks that can be performed by anyone, we fail to demonstrate the skill and expertise of a nurse. And I worry that more than ever, we need to articulate just what nursing is and what it can do. If nursing does not stand up for itself and its worth, who will?