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The case of the disappearing staff nurses


As plans to develop the ward bonus and a training programme move forward, I am becoming increasingly fascinated by this aspect of my work.

Published research seems to suggest that financial incentives are not enough to motivate health workers: good management, supervision and training is also seen as important. We are trying to use this evidence and link the ward bonus with training so that they are complementary and supportive of appraisal and appropriate training, rather than simply about rewarding performance. Of course we hope this will improve the standard of nursing care, but ideally it might also improve motivation.

It all seems possible, neat and tidy. A good idea.

Until you meet the devil who is sitting there, happily ensconced in the details. Then you realise that your good idea is not, in fact, a solution.

Here is an example.

In the hospital where I work, there are some fundamental difficulties that make nursing - difficult at the best of times - even more challenging. An obvious factor is that nurses of all cadres, and senior nurses in particular, are short on the ground. The few nurses in management positions simply do not have the time to provide full supervision to frontline staff, and this can affect patients.

Every week there is a staff nurses’ meeting in the matron’s office attended by the 8-10 staff nurses or ‘in-charges’. I went to the office last week to find the deputy matron sitting behind her desk alone.

“No meeting today”, she said. “There aren’t enough staff nurses to meet”.

Staff nurses who were in post last week can no longer be found in the hospital and their wards are now left without replacements.

Another challenge is a lack of clarity around roles. The health service here has adapted to enormous changes during years of civil war and also to the multiple and diverse initiatives and influences that exist in post-crisis development. The nurses have also adapted, and been subject to those influences, meaning there is a huge mix of skills and experience. Many work outside of their traditional job description, often through necessity, and often without the support thorough training or ongoing supervision provides. Nursing aides, for example, often work in a role similar to a UK staff nurse, while newly qualified staff nurses act in a capacity that we would recognise as ward sister. So the question is, do you accept that the work of many nurses over-extends their training and try to give them the skills to work safely, or do you try to limit their role?

Pragmatism, I believe, suggests that with human resources already stretched - my hospital is actually relatively well resourced compared with other health facilities -reducing the role of whole cadres of nurses could prove disastrous. So, increased access to training to make sure nurses can safely undertake their work would appear to be a good way to improve patient care.

But this leads me back to the case of the disappearing staff nurses. Where have they gone?

They have left their posts to undertake further training.

You can’t deny that it’s a good idea.

Becky Cridford is one of the eight 2010 Vodafone Foundation World of Difference International winners. To find out more about this opportunity visit the World of Difference website.


Readers' comments (57)

  • I feel It is not just the money that retains the nursing staff but the way we are treated and managed. We are treated like a bunch of naughty school children that have to be kept under a non-clinical control, constantly told we are not doing enough, well enough and could do everything better and much more efficiently. We don`t work on our own and are actually just one small part of a much larger team but this seems to be forgotten in the bigger scheme of things. The attitude seems to be: lets just keep nurse bashing and then wonder why morale is low and nurses don`t want to stay!!!!!!!!!!

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  • Anonymous | 4-Jan-2011 10:27 am, I agree.

    I think that money is an essential component of staff retention however. At the end of the day we are paid far too little for what we do, it is a simple fact. But ward 'bonuses' are the wrong way to go to rectifying this. A rise in the basic wage of a Staff Nurse to reflect the level of skill, education, qualification and responsibility we have would be a much better and more sustainable solution.

    But you are right in the fact that there is much much more to the fact that morale and retention is so low.

    We are a highly skilled, autonomous profession in our own right. It is about time we are recognised as such.

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  • Oh, and as for the case of the disappearing Staff Nurse? I disagree with the article. They havent have left their posts to undertake further training, those who are able have already gone abroad to Australia, Canada and the US for superior pay and working conditions; and I plan to join them as soon as possible too.

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  • If Mikes boss is listening, please give him a pay rise so that he can afford to go to Oz ASAP, I am sick of hearing how amazingly well qualified he is and how badly paid and hard done to he is. Good luck Australia!

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  • Anonymous Mike is 100% correct on everything he says.

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  • "We are a highly skilled, autonomous profession in our own right"

    If that were really true for all nurses then we would be paid more and taken seriously.
    Unfortunately there are still huge numbers of nurses that do not do their jobs properly and we need to recognise this and do something about it. If there are still large numbers of patients that are dying because "nurses" do not take proper care of them then we do not deserve better pay. Stop blaming low staffing levels and poor pay for nurses not doing their jobs. Nurses need to prioritise patient care and make sure the important jobs are done before the jobs they like to do. The recent case in Staffs was not all down to low staff numbers, some of it was down to bad practice and to nurses turning a blind eye to what they knew was wrong, a definite breach of their Code.
    At the moment nurses that do a consistently excellent job are in the minority, they need to become the majority before we can demand more money.

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  • i have bee told that to get a pension work to 74 i am tired worn out and physically and mentally exhusted the low pay poor working conditions just add to stress if i was younger i would be of to another country where they look after there nurses

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  • "Stop blaming low staffing levels and poor pay for nurses not doing their jobs. Nurses need to prioritise patient care and make sure the important jobs are done before the jobs they like to do"

    Nurses are prioritising in the way you describe. That is why people are starving, bed sores are present and hygeine is poor. The Nurses have to prioritise doctors treatment orders and drugs before they can even think about moving on to basic care. Dealing with the drugs alone takes 2/3 of a shift and that doesn't include all the time spent running around looking for things, or preparing multiple multiple IV meds that need to be given.

    You are wrong about staffordshire. It was short staffing, I know two Nurses who worked there. The hospital was putting ITU-vented patients on things like pressors onto a 30 bed medical wards where there were only 2 RN's.

    A situation like that means that the other 28 patients get 100% neglected. No choice for the Nurse but to do that. No choice at all.

    Those Nurses filled in enough paper incident forms to kill off an entire forest. Many many calls were made to the DoH, the NMC, the Unions. Nothing was done.

    A nurse in that situation (2 ITU patients plus 28 others) would be left with absolutely no choice but to push you out of the way and run past you as you were shouting for help or a commode or a pain killer.

    I am a very caring Nurse and every time I go into work I skip my breaks and give 100% to ensure my patients are okay. And I am not even close to being able to do the job properly because of the staffing numbers. I work with Nurses who have been qualified for over 40 years and Nurses who graduated a year ago. And we are all in the same boat.

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  • Anonymous | 5-Jan-2011 8:58 am if you don't like my comments you are more than welcome to go away and not listen to them.

    The fact is Staff Nurses now ARE highly trained, qualified and professional. Are you even a Nurse? Because with attitudes like yours quite frankly the profession would be better off without. It is attitudes like yours which stop us from becoming a cohesive profession, that stop us from demanding the status and pay we deserve. At the end of the day it is not the individual Staff Nurse who is responsible for poor care, but the working conditions that is forced upon them such as low staffing levels.

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  • Mike, People like anonymous cannot tell the difference between a Nurse and a care assistant. He/she will also be unable to comprehend how complicated patients are these days compared to yesteryear and how much education a Nurse needs to have to implement Doctors orders without killing someone.

    This stuff is way over the head of sweet little anonymous.

    In the United States RNs make much more money than teachers and police offiicers. When I lived over there I met many people who went into Nursing after years of working as a cop or teacher.

    They all agreed on one thing: Working as an RN in acute care requires more intelligence, education,and critical thinking skills than their previous careers. This isn't because Nurses today are all trying to be doctors. It is because health care is complicated, patients are sicker and the treatments that the doctors prescribe require the person who is delivering the treatment to be extremely on the ball.

    Nursing is also a damn site harder. Many left Nursing and took a pay cut to go back to the police and school teaching. They simply could not handle the workload and all the life and death responsibility.

    I also knew accountants, journalists, loan officers, etc etc who switched careers into Nursing school, (Nurses can make over £40 an hour in the NY area) Same story. They took a pay cut to get out of Nursing and go back to their old jobs. They just couldn't think fast enough on their feet to handle it. Some of these people had previous degrees yet barely scraped through Nursing school as it is so much math and science over there.

    When I tell them that Nurses make less than teachers and cops in the UK they do not believe that it is possible. I just explain to them that things are a bit backward in the UK and that the public has no real understanding of what Nurse is or why hospitals need them.

    Anonymous thinks that Nurses can just go to work and spend their days making beds, handing out pills, and washing/feeding patients without getting anyone killed through neglect.

    Point is just ignore anonymous as he/she is a loon.

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