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Nurse specialists at risk once again, warns RCN survey

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One in 10 specialist nurses believe they are at risk of redundancy and more than a third are being asked to cover non specialist staff shortages, according to a survey by the Royal College of Nursing.

The survey of 800 specialist nurses found that 62% are seeing cutbacks in their specialty and 38% are being asked to cover staff shortages outside their particular specialist area.

Additionally 80% of those questioned said financial pressures in the workplace have a negative impact on patient care and 11% said they were at risk of redundancy.

RCN chief executive and general secretary Peter Carter said: “Innovative nurse-led schemes, which not only improve patient care but also save money, are the future of the NHS.

“They provide high quality care and many of them could easily be rolled out across the health service, saving millions of pounds. In many instances, care can be best managed by community-based services, with as little hospital involvement as possible.”

A parallel consultation of clinical charities – including Macmillan Cancer Support, Epilepsy Action and Parkinson’s UK – found more than 62% had seen cutbacks in specialist nurse services in their field.

Many specialist nurses have been targeted for cutbacks during previous downturns, and the RCN is concerned that their unique skills may be lost from the NHS forever.

Macmillan chief executive Ciarán Devane said: “If the NHS is to meet the quality and productivity challenge, one thing it can’t afford to do is cut specialist support. It is proven that clinical nurse specialists improve patient care and save the NHS money in the long term by keeping patients out of hospitals, where they often don’t need to be if they are given the right care and support.”

The RCN cited evidence from the Office for Public Management, which found one nurse-led scheme in Cheshire generated £23 for every pound spent on specialist nursing, as well as significant improvements in patient care.  

The OPM analysis found the NHS Central and Eastern Cheshire oxygen therapy service saves up to £1.1m per annum and improves quality of life for patients. Over a nine month period, 299 patients were kept at home, who would have been admitted to hospital, thanks to increased community support.

If each of the 152 NHS Trusts in the UK prevented just two emergency chronic obstructive pulmonary disease admissions per month, the overall cost saving would be £8.5m per annum, according to the OPM.

  • 10 Comments

Readers' comments (10)

  • I have mixed feelings about this story, I know a number of specialist nurses who work incredibly hard and do a fantastic job. I’ve also come across many who always seem to be somewhere else when you need them, and at least one large Trust where they couldn’t actually agree how many specialist nurses they had much less what value they were providing.

    Specialist nurses are often much better at providing the care junior or even middle grade doctors did in the past, they enjoy the kudos and invariably a Monday to Friday 9 to 5 existence; unlike junior doctors they’re far too expensive to work unsocial hours! But what use is your ‘ICU specialist outreach nurse’ or ‘oncology nurse specialist’ if they’re only part-time? In my 30 odd years experience it’s the middle of the night or at the weekend when they are really needed. As for the benefits they bring, whilst they almost certainly do improve the lot of the patient they’re focused on, and perhaps save money compared to having doctors do the same job that’s only part of the equation. Providing specialist nurses, even those part funded by charities denude the wider nursing establishment and that has an impact on patients who aren’t lucky enough to be the focus of specialist attention – something that isn’t factored in when calculating any savings specialist nurse might bring. The explosion of specialists has also helped to erode the perception in the minds of fellow professionals, patients and the public of the mere ordinary.

    As for ‘38% are being asked to cover non specialist staff shortages’ – welcome back to the real world; ‘11% said they were at risk of redundancy’ is that having being given formal notice that they are at risk or just the worry of it? If it’s the latter maybe they’re the one’s who are always busy somewhere else?

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  • I disagree wholeheartedly with many of the comments of the anonymous above me. Specialist Nurses are highly trained, educated and skilled professionals, and they are a credit to have in our profession. I would rather have that position to aim for as a staff Nurse than not. The more specialists we have, the more Nursing can do for our patients.

    So, back to the point I wanted to make, if specialist posts are at risk, STRIKE, and add protection for specialist posts included in the list of demands

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  • The point is that if a nurse aspires to a higher salary or wants to become an 'expert' in her field, then s/he is on very shaky ground. Is that what we want from our 'profession'?

    It would appear that the Tories have no interest in nursing other than the traditional handmaiden role. That's why they are only speaking to the GPs, as they know where the power and money lies.

    I am not saying nurses want power, but they should be accorded the dignity of the hard work that has enabled them to become specialists in their field. If we are happy to say goodbye to this then fair enough. However, for those who aspire to greater things...forget it!

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  • Nurse practitioners are a defininite bonus. They are, indeed, doing the work of a junior doctor for a fraction of the pay - will have more hands on clinical experience than many doctors - and may generally work clinic hours but that is where the routine daily need is. If there is a requirement for a proto doctor outside of normal hours, they could be recruited. Upskilling nurses is the future, as the boundaries of medicine push further and constraints on funding bite further into budgets. Value, care and expertise, bargain!

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  • I have a major issue with nurses being called "ordinary" just because they are not "specialists". All nurses are doing a job that is extraordinary. If we do not value ourselves and support each other, how can we expect the government to do so? Think about all the times you have made a difference to someone's life, however big or small. As nurses we all make a positive difference and that makes us ALL Special. I am currently working as a staff nurse but have previous experience of working as a specialist nurse, as a community nurse, for a short while in a hospice, and within a variety of nursing homes.
    Having said all that, I believe (I know) that specialist nurses are invaluable and we ought to fight to keep them.

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  • phillpeall, whilst I agree with what you are saying, I do not see Specialist Nurses as 'mini Doctors'. Nor do I see it as 'upskilling' Nurses to work to that level.

    Nurses and Doctors are different, our roles closely intertwine, fair enough, but we have different roles trying to reach the same aim.

    Specialist Nurses are amongst the higher levels of our profession, and work at the same rank/skill level/whatever you want to call it as any Doctor, just without the pay or status, I agree. But we have a specalist body of knowledge in our own right, and whilst it is very closely linked with medicine (of course), it is also different, that is why we have our own specialists in our own field. 'Upskilling' implies that we are not capable of owning our own professional body of knowledge and that we are being 'allowed' to practice at a higher level.

    Unlike the anon above me, I have no issue with being an 'ordinary' Nurse. I agree that the role of Staff Nurse is extraordinary, but I am happy to work in this 'ordinary' role as I work up to a specialist level.

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  • "phillpeall | 15-Apr-2011 11:53 am

    Nurse practitioners are a defininite bonus. They are, indeed, doing the work of a junior doctor for a fraction of the pay"

    Many specialist nurses actually earn significantly more than junior doctors. Most specialist nurses are on at least Band 6, for which the basic pay is £25,472 - 34,189 per annum. The basic pay for a junior doctor is £22,412 (FY1) or £27,798 (FY2).

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  • "phillpeall | 15-Apr-2011 11:53 am

    Nurse practitioners are a defininite bonus. They are, indeed, doing the work of a junior doctor for a fraction of the pay"

    Many specialist nurses actually earn significantly more than junior doctors. Most specialist nurses are on at least Band 6, for which the basic pay is £25,472 - 34,189 per annum. The basic pay for a junior doctor is £22,412 (FY1) or £27,798 (FY2).

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  • Most specialist nurses are worth their weight in gold but do we really need falls nurses, smoking cessation and breast feeding nurses??

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  • P Rogers

    As the opening commentator on this story, I thought I should respond to some of the subsequent comments even if it’s a little late…

    Mike (14.04.11; 4:56pm – “I disagree wholeheartedly with many of the comments of the anonymous above me…” but alas you don’t say which ones. Presumably not the one where I said I knew specialist nurses who work incredibly hard and do a fantastic job? Nor the one where I said they are often much better at providing the care that junior or even mid-grade doctors did in the past? So exactly what do you disagree with? Whilst your experience might be different to mine, which is that some specialist nurses either aren’t that good (despite the expensive education and training they’ve enjoyed) or just aren’t there when I’ve needed them, because the cost of having them provide a 24/7 service is too great; surely you weren’t disagreeing with what constitutes my experience? Alternatively maybe you disagreed with my point that when a cost-benefit analysis of the contribution of specialist nurses is offered it has to look at a broad picture not a narrow albeit simpler service specific one? Perhaps you just didn’t like the fact that the experience I relayed implied criticism of something you aspire to be?

    Phillpeall (15.04.11; 11:53am) “…generally work clinic hours [i.e. Mon –Fri, 9-5] but that is where the routine daily need is.” Whilst I’m not exactly sure what you mean, if you’re saying the clinical demand for specialist nurses is just ‘clinic hours’ then I disagree. Apart from the example I gave of ICU outreach specialist nurses your own example of nurse practitioners particularly those who run minor injuries units (and are some of the few who work round the clock shifts) actually highlights the point nicely. Specialist nurse working patterns are save for odd exception, simply the result of a financial calculation, a calculation few specialists want to argue with because of the desirability of a Mon-Fri 9 to 5 existence.
    Anonymous (15.04.11; 12:24 pm) “I have a major issue with nurses being called "ordinary" just because they are not "specialists"... your ‘issue’ seems to have obscured the point I was making which was that the explosion of specialist nurse roles diminishes the position of the non-specialist nurse in the eyes of fellow professionals, many patients and the public, and indeed many nurses who now have to refer to specialists about things that previously were well within their own competence the term ‘mere ordinary’ was intended to be ironic, which is always difficult when dealing with the written word. However please give the ‘we’re all special’ bit a rest, we’re clearly not all special, if we were Mid-Staffordshire and the recent health ombudsman report wouldn’t have happened.

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