To feel sad about the figures on nursing released today

[noodleaddict]

It seems like the crisis in nursing is only going to get worse.

More UK nurses and midwives leaving than joining profession
www.bbc.co.uk/news/health-40476867

Sad probably doesn't really describe it actually. Patient care is going to suffer. There is no doubt about it. I see a downward spiral happening and I don't know what to do about it.

We need reintroduction of bursaries for training, we need a pay rise, we need better staffing, we need to reduce the reliance on agency.

When is the government going to wake up??

I wonder what will happen when the nursing apprenticeships start in Sept? I know a lot of HCAs who are going to go for it. I was myself but had a change of heart.

I have my access course and I was a HCA for two years. I recently started a new job in MH as I wasn't sure what route I wanted to take and now I never want to go back to hospital work.

Nurses are paid too badly for what they do. It's just not a nice environment to work in. The lack of staff was a huge problem for me as a HCA and I never felt I could give patients the quality of care they deserved. It was demoralising. Having the responsibility nurses have in the current conditions? No thank you.

where I work there is a massive dependency on agency staff, there are some that have been full time permenant agency for at least 3 years. This shouldn't be allowed!
We are doing exactly the same job, but they have less responsibility and are earning at least double. Why wouldn't you?!

Personally I think that as the scope of the role is changing and nurses are doing more and more of traditionally junior doctors responsibilities, it is necessary to have a good academic underpinning for what you are doing. But I know I am in the minority thinking this.

I just wanted to come in and say I am so, so grateful to all the hard-working nurses who are trying to keep the NHS on track. When I think about the conditions you work in, and the hours you put in, I am honestly humbled.

Is there an over-reliance on agency working/bank nurses?

Is it really necessary to do 'a degree' (like a PP mentioned) with dissertations etc for all nurses, or would it be better to do an earn as you learn type thing whereby a trainee nurse works up
Yes
Nursing has changed since the old enrolled nurse roll that people harp back to. Nursed do lots of things now that doctors used to do, they're a lot more clinical and even an excellent band 4 HCA doesn't quite have the same approach as a trained nurse. There is more to nursing than just learning a bunch of individual skills, it's the overview, which you get from combining a broad coarse with local placements. You can't get that from working up in one place.

There already are less academic routes in healthcare, Band 4 jobs pay well-ish and come with lots of responsiblity and training. We need them and educated nurses.

See, this is the old "do you want clever or do you want caring?" bollocks! Degree educated nurses can be both, and both is better, and there actually are studies that say that degree educated nurses are better at the caring side too, it's not either/or!

Yes, I do want "caring" but not academic types looking after me, helping me to get comfortable and washed etc, but I don't want them making the decisions about whether to call the doctor urgently or as a regular bleep if I'm deteriorating, I don't want them calculating my compicated medication etc.

Being caring but not clever does exlude anyone from healthcare jobs, but it should rightly steer them into support roles not RN roles.

However, the government doesn't agree and we'll have nursing apprentiships soon. I genuinely hope they work out..

I qualified as a nurse two years ago and a fair few of the nurses who qualified with me are now in band 6 positions. It's ridiculous that you can be classed as a senior nurse 2 years after qualifying but they're that desperate to fill the senior vacancies they're just shoving anyone in them.

I went straight into community nursing from uni and then tried out the wards this year. I lasted a month before my mental health started deteriorating and I went back to community with my tail between my legs. It's horrific.

I'm constantly trying to think of escape routes out of nursing. As soon as I find something that pays the same (not difficult!) I'm off.

Is there an over-reliance on agency working/bank nurses?

Agency and bank are totally different and shouldn't be thought of interchangeably.

Bank is a solution to over-reliance on agency, not the same problem

Obviously it's not good if a ward is running on mostly bank shifts, but generally, bank = good , because;

• there will always be nurses who go through periods in their lives where they don't want to or can't work a permanant contract. Bank means that hospitals can retain these nurses, keep up their skills, and re-recruit them back as permanent easily once their circumstances change
• Bank staff know the hospital and it's paperwork, they often work regular on the same few wards, and are often permanant on the wards that they do bank on (for extra money). So there's continuity and they have passwords and log ins and know how the individual departments work, they know the regular staff, they often know the patients as they can book the same ward regularly, they can do more as they're locally trained/updated
• they're cheap! not quite as cheap as permanent staff, but nowhere near as expensive as agency.

I think the pay scale has a lot to do with things aswell, for example a junior nurse 2 years in would jump from £23k to £26k at the start of the band 6 scale yet an experienced top band 5 would only go from £28k to £29k on the band 6 scale.
In our trust many experienced nurses don't wish to take on a 6 role for less than £75 extra per month (with pension and tax deductions it's just not seen as worth the hassle.
Also why do an overtime shift for your area when you can join an agency do a shift elsewhere for double the money!

Our staff bank pays one increment above bottom of the band so once you're a few increments up it's not worth doing bank except on a weekend or night. I personally stopped doing extra shifts becasue once tax was taken into account it just wasn't worth it.
Also our staff bank coordinates all unfilled shifts and the staff we get are still mostly from outside agencies. They are always doing huge recruitment drives but people aren't idiots, why join the bank when your know you'll get the same shifts for better money by sticking with one of the agencies.

I think the pay scale has a lot to do with things aswell, for example a junior nurse 2 years in would jump from £23k to £26k at the start of the band 6 scale yet an experienced top band 5 would only go from £28k to £29k on the band 6 scale.
In our trust many experienced nurses don't wish to take on a 6 role for less than £75 extra per month (with pension and tax deductions it's just not seen as worth the hassle.

Yes. Except, experienced band 5 to band 6 is actually a pay drop as you get less nights (given to the cheaper band 5s).
Older band 5s with kids can't go for band 6 either because you lose your family friendly contracts & fixed/reduced hours that you might have got after maternity leave.
Climbing the bands is really only an option if you're young without a family.

If you didn't do it before you had kids/when you're young, it doesn't make financial/practical sense to do it after.

I have switched careers from nursing to another health care profession which is less stressful and with better pay / more flexibility re hours so less anti-social hours iyswim.

Most nursing is specialty nowadays and so it is not unusual that some nurses feel unable or are not qualified to suture or take bloods if they do not practice in an area that requires them to do so.
I have taken bloods in the past when I worked in outpatients but then did not when I was in theatres.

Every specialty has it's own CPD requirements which have to be updated yearly and so if you do not perform a skill for over a year you lose your qualification to do it and obviously your skill level declines due to lack of recent experience. So if I was asked to take blood now [after at least 5 years of not doing so] I would understandably be a bit rusty at it which would not be best for the patient in my care!

All nurses are now university trained and are also required to complete clinical practice [hands on] experience whilst training to complete the course and become a registered nurse [new grad].
I personally think that university training is important as it means that nurses learn research skills and how to utilise evidence based practice - so the example given up thread about a dissertation on 'how to stop smoking' is important for being able to use and cite current research and incorporate this into a relevant care plan and reasoned argument for such. It also puts nurses on an equal footing with physios and OTs, etc and is good for professional morale / to be frank also means that their input and expertise is taken more seriously by the multi-disciplinary team.

I have left nursing because I found that it was becoming a daily expectation that you could work on a ward with less and less staff but still have the same workload as before. It was considered a bonus to have time to take a tea or lunch break [unpaid of course].
I didn't feel I had the time or the energy to give the level of care that I wanted. The RCN was/is toothless and did not stand up for the rights of it's members or the patients that they care for.
So I left and now work Mon-Fri, 9-5pm hours for more money and less stress.

What we need is not just a payrise

We also need a return to the old contracts.

the vast majority of nurse vacancies are now advertised as fulltime requiring flexibility. So people go to agency/bank if they can't hack nights, or if they need more nights for more money, or if they can't work childcare around changing shifts week in week out

In the past there were "night nurses". People who liked nights did nights, people who liked days did days. Jobs were advertised as "full or part time". Management didn't breath down ward sisters necks about taking away people's family friendly contracts.

A lot of good/experienced nurses leave because they went back on family friendly contracts after

It's not just about money! I think even with no pay rise, a return to varied contracts would do an enormous amount towards recruitment and retainment

Why does everyone on a ward nowadays have to be "flexible". It worked when people did what suited them because everyone was different, there were enough people who wanted permanant nights, to allow those who wanted fixed days to just do weekdays, and to allow those who just wanted weekends to just do weekends! the shifts were covered! people were happier! experiences staff didn't have to leave because someone decided that their kids were too old now for them to not be on the same shitty "flexible" rota as the newbies

I too am currently completing an access course so that I can go back to university next year to study nursing. I must admit that I very nearly walked away when I found that my wealth of qualifications and degrees and life experience mean nothing because they weren't completed within the last five years. Hopefully by the time I qualify things will have started to change for the better.

"A lot of good/experienced nurses leave because they went back on family friendly contracts afte"

dunno where the rest of that sentence went..was meant to say:
"after having kids, but then after a few years management presses the sister to justify why they have staff on irregular contracts. So you get an experiences staff member feeling like what they have been doing (on their fixed days, or shorter days) isn't appreciated and they leave! Also, they're usually older, and don't feel like they can sustain the same shitty shift patterns as a 23 year old!

so the skill mix is all newbies! not good!

Yy Tinsel, I was happily working on a top of band 6 when restructuring meant to keep my contracted hours I would have to work every Sat and Sun so I had to leave because I couldn't access childcare for that.

Lots of extended skills, experience of leading a specialist acute ward, several years of triage, and now I'm in the private sector. Less money, less rights generally but I'm appreciated and get flexible hours.

The NHS is both eating itself, and being destroyed by the tories for ideological reasons. It's a tragedy.

I graduated in summer 2011. There were 3 NHS preceptorship-level jobs in our huge city for 50 of us - they'd had 3 years' warning we were qualifying ffs! As it was, you weren't allowed to apply for any others than those that specifically stated newly qualified. Most of my cohort took jobs in nursing homes with those who were able to moving around the country to get jobs. Several seriously considered going overseas.

The end to end recruitment of nurses needs to change and zi believe the bursary needs to be reinstated, however perhaps with some conditions like needing to pay a decreasing portion back if you work for less than, say, 4 years.

The job I got in a nursing home was crap with no prospects. The keen, ambitious nurse I was is now long gone - I think I'd have been much more driven on a ward with other new nurses. I have been a SAHM for a while now anyway, but I will not return to practice in a profession that others clamour to leave!

Sad, and scary.

Tinsel you are spot on with that. I know so many people who physically struggle with nights yet we all have to do them regardless. There are more than enough staff who actually like nights to fill them but no everyone must do nights.
My trust advertises itself as a family friendly employer. But it's bullshit. Me and DP work in the same service, our respective managers literally sit next to each other in the office yet when I was planning my return after maternity leave apparently they couldn't work together to make sure we never fall on nights together. Literally everytime a new rota comes out we both have to go to our managers and get changes made because we can't both be on nights at the same time. Both of our requests for a few fixed shifts a week were also denied as it didn't fit the ward needs apparently.

Penelope

exactly!

I think a lot of people will work for slightly less if they are appreciated in other ways.

It really is gutting to see a senior staff nurse who has worked on the same ward for 15 years, has all the mentorship and skills etc qualifications, basically told "you're no more use to us than the newbies, so either work a flexible contract or leave"

There is no loyalty returned! Nobody cares that they "did their time" on flexible fulltime in their 20s already.

It's bad for the patients
it's bad for the newbies to have less experienced staff to learn from
And of course it's bad for all the older nurses who have kids, are caring for aging relatives, are getting/feeling old themselves and can't hack jumping from nights to days to nights anymore!

They're just basically told they're disposable

I stopped working 2 yrs ago having qualified in 1987 , I was 48/49 , I'd had both my shoulders repaired in the previous 18 months and the total lack of support from the unit I was working on meant I couldn't face going back . Sad really as I had prior to being moved to this unit enjoyed working pt ( original ward closedand we were all dispersed) . I told the NMC last year that I was relinquishing my registration and have had two or three letters since about return to nursing schemes . No way , I do not miss it at all and am in the fortunate position that I don't need to work . I think they need to bring back either the bursary or paid training like the old days .

PolarBear

yes, that too, the new "perceptorship" jobs advertised aren't a patch on the old style rotations that used to be on offer for newly qualified nurses

But for the rotations to work, you needed wards with older experienced nurses who were happy to teach rotating newbies who were only with you for a short time

Nowadays experienced nurses who stick around are fed up of always being the only senior one on duty and having to pick up the slack from a constant stream of newly qualified staff who can't do half of the things that need doing, so the good will towards teaching/helping is eroded

We need caring, dedicated compassionate AND academically minded people. Nursing is now such a complex specialised profession and we should be proud to have the title and all that comes in achieving it.

I work in district nursing so can only comment on this area. The main problem is the DN role becomming administrative rather than the senior experienced clinicians they were. This means good, sound clinical nurses dont want to go into the roles and they are getting filled with inexperienced, non rounded nurses who are ambitious and want to climb the ladder. Great - but I think you need to be ready and at the right point to take up these posts for the benefit of the whole workforce. It also demotivates those nurses who would make wonderful role models, senior clinicians and caseload managers but who have no pathway to do that as the only way is to leave all that behind and become administrative.

But if you have posts to fill what are you going to do?! We have been advised its a case of 'bums on seats' in terms of recruitment as the situation is dire. It all then has a knock on impact and everyone wants to leave as they feel unappreciated and demotivated.

Plus pay scales dont reflect knowledge and responsibility.

I have to say, in contrast, I am having a very difficult time and my manager cannot be more helpful. I have had some health difficulties and was referred to Occ Health, but adjustments that were assumed to be likely to be recommend were actioned prior to the appointment coming through. Then I've had some terrible family difficulties that have required time off work and will likely require an extended period off work. My manager has been nothing but supportive, even suggesting a way forward that will minimise the impact on my work record.

So I think that it's variable. The pressures across the NHS in general are high, though, sadly.

But if you have posts to fill what are you going to do?!

Yup. See for example forensic nursing (police cell nursing)

Used to only recruit band 6 MINIMUM experienced nurses for obvious reasons. I know a newly quilified nurse who just got a forensic nursing post straight from uni . Scary! I worry for her PIN!

I actually don't think it varies much from manager to manager any more lougle. They're not that autonomous any more

e.g. the ward where there were 2 senior nurses on fixed days - their fixed days were opposite each other. Which meant that there was a senior staff nurse on duty every day of the week - it worked beautifully! The ward manager loved it! Ward manager was told that she would be "frozen" from offering any more flexible working requests if she didn't take some of the long standing ones away. She said "but it actually suits the ward! They're working opposite each other! I always have an experienced nurse on every day! it's a win-win"

But nope, she was told no new flexible requests to be offered by her until she reduced some of the existing ones, and the long standing ones would be reviewed in 6 months anyway.

Obviously, if you know your flexible contract is going to be reviewed in 6 months, you don't wait 6 months to start looking elsewhere….

My manager , on the face of it , was being helpful , she agreed with what occ health and hr said about adaptations to my duties but the fact was when I got to the actual ward , the various sisters in charge on the shifts just disregarded it and I ended up with 6 patients , including 2 side rooms , a shared ( and extremely workshy) CSW when I couldn't even move my arm enough to tie up a pinny behind my back . It wasn't fair on me , or the patients , so I went off sick again and then they moan because you've gone off sick .

I have been qualified for 27 years and last year decided I needed to get out of Nursing before it did serious damage to my health.
I have witnessed traumatic deaths / events so many times, people dying horrible deaths ( despite Nurses best efforts to avoid it). I've never been offered any help or counselling or supervision. I've worked nightshifts for many years just to be able to make ends meet and cut down on childcare costs but it takes it's toll. In the past year I've seen 3 very experienced collegues hauled over the coals for mistakes they made whilst under intolerable pressure. Something just clicked late last year and I realised no amount of money wa sworth the stress and toll on my health. I started looking for another job and found one which was not nursing but still uses a lot of my Nursing skills, but is hopefully something I can continue doing as I get older ( my back is knackered after 30 years of Nursing). I still do some Nursing as the pay in my new job is significantly less, but it is a lot more bearable doing Nursing one day a week rather than 4 or 5.