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Linda Aiken: 'A new course of action is required to restore the health of the nurse workforce'

Linda Aiken
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It is beyond understanding that nurses in England, the birth place of modern nursing in the soon to be International Year of the Nurse and the 200th anniversary of Florence Nightingale’s birth, are under siege because of decades of benign neglect and poor choices by policymakers.

There are not enough budgeted positions for nurses to provide safe and effective care. Many thousands of nurse positions are vacant. Nurse burnout rates are among the highest in Europe.

It doesn’t have to be this way in England. Wales and Scotland are following an evidence-based strategy implementing safe nurse staffing standards that hold promise of improving care outcomes, as well as the recruitment and retention of nurses.

In the US, nursing is a top career choice; highly talented applicants are flocking to university nursing programmes, including many applicants with university degrees in other fields.

Research concludes that each patient added to nurses’ workloads is associated with a 7% increase in hospital mortality. Yet, the well-documented variation across NHS trusts in patient to nurse workloads has not been addressed by policies in England as in other parts of the UK and in other Commonwealth countries.

”The evolution of advanced practice roles for nurses not only improves patient outcomes but makes nursing a more attractive career choice”

Each 10% increase in nurses with bachelor’s qualifications is associated with a 7% decline in hospital mortality, but NHS policies are promoting, contrary to the evidence, development of nursing associates and a return to apprentice education for nurses that was long ago abandoned by peer countries in favor of science-based education for nurses, doctors, and other health professionals.

England has an acute shortage of general doctors but is decades behind in adopting an evidence-based solution used effectively to solve this problem in other countries—advanced practice nurses/nurse practitioners. The evolution of advanced practice roles for nurses not only improves patient outcomes but makes nursing a more attractive career choice.

Research and experience in other countries suggest embracing the following strategies would make nursing a more attractive career choice for the best and brightest in England and restore the health and wellbeing of the current nurse workforce:

  • Establish safe nurse staffing standards in the NHS below which hospitals are not permitted to go;
  • Institute shared governance in healthcare settings that engages professional nurses in leadership positions and decision-making, and values nurse expertise;
  • Employ international recruitment strategically to enable permanent domestic nurse workforce improvements, such as instituting safe patient to nurse ratios, rather than as an escape valve to avoid addressing critically needed nurse workforce reforms;
  • Prioritise available public resources for university professional nurse education including expedited programs for second career students who already have bachelor’s degrees, rather than developing new categories of non-nurse workers who will need to be supervised by nurses;
  • Expand advance practice nursing through formal recognition of new roles, specification of requirements for graduate education, and certification of clinical expertise;
  • Make university education for nurses better and more attractive by greater interdisciplinary course integration, science and critical thinking, replacing repetitive clinical practice hours with support for life-long learning, and providing forgivable education loans to nurses accepting jobs in the NHS.

The NHS Long Term Plan offers little to suggest that nurses will receive the help they need to continue to be the spine, heart, and connective tissue of the NHS in its next 70 years. A new course of action is required to restore nursing in England to preeminence and to give the public the care they need and deserve.

Linda H Aiken is professor and director of the Center for Health Outcomes and Policy Research, University of Pennsylvania, USA

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