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'There can be no excellence in practice without senior nurses'


The importance of the “little” things in nursing, such as kindness and compassion, are often talked about but without the recognition that these are far from “little” things.

Listening to the relatives of a dying patient, alleviating suffering or establishing a meaningful way of communicating with someone who has dementia, takes expertise and experience as well as time, effort and emotional energy. That is why the recent Royal College of Nursing’s Frontline First report on the estimated loss of almost 4,000 senior nurse posts at band 7 and 8 - the most experienced in the profession - should be a concern in terms of quality, patient safety, role modelling and leadership.

Traditionally, approaches to workforce modelling sees nursing as a series of manual tasks instead of a complex set of activities, which means nurses’ expertise is rarely valued. Lack of talent management and succession planning may have contributed to the loss of frontline nurse leaders.

NHS employers assure us nurse numbers are increasing, but as Howard Catton, head of policy at the RCN, pointed out, although the number working in hospital settings has increased by about 4,500 since May 2010, over the same period, the number of nurses working in community services, mental health and learning disabilities has fallen by almost 6,300.

As a researcher working with the band 7 specialist nurse community, my inbox overflows with emails about unpaid overtime, higher caseloads, posts left vacant or frozen, downbanding, few progression opportunities, no funding for continuing professional development, bullying and workforce reviews by management consultancies looking for cost improvement.

Amy Bowen, director of service development at the Multiple Sclerosis Trust, said that threats to MS specialist nursing posts have arisen in a number of trusts with known financial problems, leading to threatened or actual downbanding, redundancy, vacancies left unfilled or replacements offered only on fixed-term contracts.

The cancer charity Macmillan Cancer Support reported that since 2009 it has registered 5-6% of specialist cancer posts at risk and the RCN gastroenterology forum stated that 50% of specialist nurses had been asked to abandon their caseloads to work on wards. Difficult working conditions and workforce devaluation are likely to mean more people leave or are forced into reapplying for jobs at lower bands.

There is also the issue that nursing is an ageing workforce and that retirement gives employers an easy option to save money by not replacing posts. In 2009, the RCN rheumatology forum reported that over 40% of specialist rheumatology nurses were aged over 50 years and the British Association of Urology Nurses stated 30% of its members plan to retire in the next eight years.

Nursing is about more than numbers, but without enough nurses doing the right kind of activity, there can be no excellence in practice. The latest Frontline First report is a red flag to the profession, the government and the public.


Alison Leary is an analyst and registered nurse. She is the co-author of Apollo Nursing Resource



Readers' comments (4)

  • The problems highlighted by Alison are real and experienced in many areas of nursing. What is even more concerning are the discussions to increase the scope of practice for bands 1-4 health care assistants, and this poses a huge threat to registered nurses, who perceive that they are being usurped by a cheaper workforce. Registered nurses currently feel undervalued & over worked; their job role & activity having been increased greatly, but with even less autonomy.

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  • I have decided to retire at almost 63 and after 41 years of service. We have just heard that my replacement post has been frozen and my manager is asking me to stay. I feel some pressure to stay, but we are not talking weeks or just a few months, and I don't want to give up on my retirement plans. When I look at it with my practical head on, they want me to stay to secure finances and not because of me. My emotional head says different though.

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  • Anonymous | 23-Mar-2014 8:56 pm

    do what feels best for you and don't be used by anyone. you only have one precious life and retirement.

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  • Acorn47 | 21-Mar-2014 7:56 pm

    Absolutely right to identify the risk of band 1 - 4 HCA's to the primacy of the registered nurse.

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