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??

There are some agencies about who charge a fortune. I will fess up that I am ex NHS, and I now work in an agency supplying HCAs the the NHS. We are put under huge pressure and unrealistic requirement from the government to ensure our staff meet standards. Standards that I know far exceed the NHS's employment requirements. This is very expensive to maintain. If those standards were dropped to NHS standards....we could reduce the admin fees!

I hope everyone in this thread is reading and replying to the consultation on the new nurse training. More uni time and less placement time. I think we're going to have a lot of nurses who know a lot of theory but cannot complete basic nursing care.

I'll give an example. A band 2 HCA earns £14000 pa approx. They receive unsocial hours payments for weekends, nights and evening work which can easily top up wages to £16000 pa. They have 7 weeks leave a year, 4 weeks training so the 'at work weeks' in a year equals 41 weeks a year. They have a week sick so are at work for 40 hours a week. They require 10 hours payroll and admin time at £10 per hour (£100)The trainers need to be paid which costs an additional £500 per year. This employee therefore costs at £11.06 per hour.

We charge about £11 an hour for a fully trained HCA with no contractual obligation or employment from the trust who can request, cancel, move or change that persons shift with no quibble or query.

I'm not quite finished reading the thread but to the poster who asked if it needs to be a degree....without a doubt yes.

There's a lot of value in learning on the job. And we do that. Half of our degree is going out and doing the work. However, there's a particular skill that I've been taught twice out in practice. I learned a lot from the two nurses who taught me this skill. Without the degree work that I do in uni, I wouldn't know that they'd both taught me methods that were slightly wrong...one was outdated, the other missed a step. The way we do things in Nursing is very specific and has clear rationale. Without the degree, I'd have been able to be a nurse without ever knowing that I'd taken other nurses' bad habits as standard practice.

I'm due in hospital myself soon. I'd be far happier knowing I was being cared for by a nurse trained to degree standard.

Where can we find the consultation Loris?

It's on the nmc website.

www.nmc.org.uk/news/news-and-updates/nmc-announces-radical-overhaul-of-nursing-education/

Agency nurses do have a place but in all honesty in my service they are a hindrance and permanent staff get quite resentful at them. The nature of my ward means that one off agency nurses are literally just a body to show we're meeting minimum safe numbers. They can't have access to the computer system, can't get involved with therapeutic work since we are a more long term service and have to spend time developing the relationship and most importantly they can't have keys so have to have everywhere opened for them. They quite literally get paid, sometimes significantly more than regular staff, for sitting in the lounge and doing the hourly checks.
I know that's not their fault but it is so frustrating.

I'm with Pickleypickles On the job training and pay them for it. I trained in the early 80's so have been at it a long time.
This is a mess of the governments own making.
If people want a degree they could go on after basic RN training and add a short period to make it a degree, make it degree nurses get to advance onto band 6/7, most of us never get out of band 5 as there are a lot less 6/7 positions than there are nurses.
I'm no longer in the NHS I'm in private dementia care, somewhere I can do a good job and feel a sense of accomplishment at the end of the day, knowing I've made a difference in someones life.
No managers throwing paperwork at you while also telling you you have rounds to do, patients to wash and dress and meals to get out medicines to give, Oh and put the phone in your pocket as you need to answer calls and know everything off the top of your head as soon as a call comes in. It's a complete mad house in many hospitals, they need to drastically increase the numbers of HCA's as well as nurses.
I no longer wake in a panic at 2am wondering if I did something, and I don't feel like crying in the shower each morning as I have to return to that NHS job.

This is all so familiar and I see no possibility of improvement. Nursing is very often not family friendly, eats its young and is completely undervalued by many of the public and the government. It seems the only places it is valued are private companies.

Hmm. Yes I do think nurses benefit from degree education.
I wonder why we don't argue for doctors to be just caring people who pick it up on the job?
I do a job as a nurse which in some places is done by a dr. I have to provide the same level of care so why do people think I should not have the same opportunity to learn. Oh and I'm band five.

And night shifts are mostly staffed by band 5s. Maybe one HCA, a junior doctor who is covering hundreds of patients across the hospital and maybe one one or two more senior nurses on call for the whole hospital.

Nowadays nights can be as busy as days: proceedures finish later so you have post op and post proceedure care that in the past would have been done and dusted by the day staff. Treatments that used to just be done during the day going on through the night etc.

You really wanna be a patient at night with caring nurses who weren't quite up to a batchelors degree academically in charge of all that? but it's fine cause they're "nice".. and have learnt all the common things that happen regularly on the ward on the job.

What happens with curveballs and rarer complications?

Band 5 nursing is not just about ticking off individual skills like catheter care, wound care etc. Band 5s nowadays have to make clinical decisions, are dealing with very sick patients and deterioration with very little back-up at night, are handling security incidents, complaints, questions from relatives who want intelligent informed answers, aggression, band 5s are in charge at night so also dealing with staff issues….

There is a place for task-oriented types, who want to learn some useful healthcare skills and care. That place is band 2-4.

I've met brilliant band 4s who were better at individual skills than the trained nurses and were amazing assets to the ward.. but invariably don't prioritise in the same way as a trained nurse would. They tent to be routine led and task led and don't tend to deviate from that or notice things that aren't quite right.

And that's fine. But it shows the difference between people who learn how things are done here locally, and people who learn an overview of how things need to be approached in nursing in general, and then applying that locally.

Equally I've met a few students who think it's below them to make beds. Basic nursing care is still important. It's about having a balance.

That's not a degree thing though, I've met band 4s who think beds are band 2s jobs and only wanna do the skilled work like ECGs and wound care and cannulas. I've met band 2s who avoid elderly wards because they don't like doing pad changes, who only work on wards that they think will be less heavy and then if those wards get a few all care patients in, they get good at being very busy with the tea trolly every time a turn is due!

I think that a lot of what is covered in uni over the years actually helps to emphasise the importance of the less glamourous interactions rather than the other way round.

I don't think it is true that the degree route produces a disproportionate amount of nurses who don't wanna do basic nursing, not compaired to the "learn on the job" staff in the lower bands.

There were plenty of bed-pan avoiders before the degree route became standard! I'm in it long enough to remember that it wasn't all hand holders and bed bathers when less nurses had degrees!

Nursing offers a very broad range of careers though. I'm not Interested in working on a ward - in fact if that was the only thing available you wouldn't see me for dust! So I think it's sometimes unfair to portray those of us who aren't interested in bathing patients somehow "less caring". I don't work in an area where bathing patients is required.

I think the move to non-degree nurses (nursing associates, theoretically degree-level apprenticeships) is frightening as well.

The nursing degree apprenticeship sounds good to me. They will qualify with a degree as good as the ones uni trained nurses will have.

Nursing associates bridges the gap between HCAs and nurses. My understanding of it is that APs didn't have a defined role as such and couldn't put much of their training to use (at least it was that way in my hospital) so training up nursing associates will solve a lot of that problem and they will be able to give very basic drugs to take some of the load off nurses.

I am not sure why people think this will be a bad thing? Nurses will leave with a degree and nursing associates will have more skills and a defined role to help lighten the load. I can see their being a problem with the NHS hiring less trained nurses and more cheaper nursing associates though.

I am not sure why people think this will be a bad thing? Nurses will leave with a degree and nursing associates will have more skills and a defined role to help lighten the load. I can see their being a problem with the NHS hiring less trained nurses and more cheaper nursing associates though.

As a nurse I'm not sure how comfortable I would feel with a nursing associate giving medication whilst I'm on shift. Are they going to be regulated? Is it that I will have to countersign? Who has the ultimate responsibility? It seems at the moment it works be me, the registered professional who's PIN would be on the line.

And yes I can guarantee the NHS will use this as an excuse to reduce nurse numbers and employ cheaper band 4s. The only place in my trust with band 4s at present is 1 ward which cannot recruit or retain band 5 staff.

I tried to go into nursing before it became a degree. I was told that my NVQ , 3 of them, the fact I had 9 years experience counted for nothing. I got a new job and I'm now top band 3. I learnt to do various skills . Bloods, ecg, catheters,setting up equipment and assisting in minor surgery. I go onto wards and teach top band 5 how to use equipment, sign off competencies as I'm a assessor but not good enough to be a nurse? Im doing a degree through the open university to better myself but our trust doesn't do band 4 positions. Feel like I'm stuck in a rut. I'm eager to learn and due to financial reason , being denied the chance.

As long as the academic standards are exactly the same, I also don't have a problem with nursing apprenticeships. I'm concerned that the standards won't be the same.

I can see their being a problem with the NHS hiring less trained nurses and more cheaper nursing associates though.

As far as I'm aware, the scope of a NA is not yet defined. They might very well be giving all drugs. Some band 5 vacancies have already been downgraded to nursing associate posts -- and the first batch of NAs won't even finish training for another year and a half. Hospitals are struggling, and largely failing, to fill registered nurse vacancies. But rather than taking steps to make the profession more attractive, and to retain the nurses/students we already have, they're going to fill in the gaps with NAs. Cheaper. Not as safe as a degree-level nurse, but that's tomorrow's problem, innit?

I've worked alongside a few trainee NAs, and they were very, very good. But it's looking very much as though they're going to be chucked out onto wards and expected to do the work that a band 5 nurse is doing now, with less training and for less pay.

They will have their own PIN, but that doesn't necessarily mean that RNs won't also bear some accountability as a "senior" member on the ward. And at the end of the day, a PIN is only useful because you can take it away once somebody has caused harm. It doesn't prevent the harm occurring.

Nursing offers a very broad range of careers though. I'm not Interested in working on a ward - in fact if that was the only thing available you wouldn't see me for dust! So I think it's sometimes unfair to portray those of us who aren't interested in bathing patients somehow "less caring". I don't work in an area where bathing patients is required.

I think the point is though if I asked you to wash a patient you wouldn't turn your nose up as it's an 'hca's job' as some students seem to think.

Oddly enough, the 20% drop in applications isn't as much of a problem as it sounds: nursing and midwifery degree courses are vastly oversubscribed. I am opposed to the abolition of bursaries in principle and think it will mean the loss of mature students entering the profession, but it isn't necessarily a problem from the point of view of numbers getting in.

The real problem is people leaving the profession because conditions are so awful, as posters on here have so eloquently described. Add that to an ageing workforce approaching retirement, and European nurses leaving the country, and you have a massive staffing problem on your hands. I don't know if the government has the will to do anything about it, unfortunately.

And could I ask nurses whether they feel frustrated at the fact that the old SEN role was abolished and nursing became an all-graduate profession - and now with the nursing associate role we're going back to the way it used to be years ago?

I'm a registered nurse and have been qualified for 21 years.

I'm quite apprehensive about the 'restructuring' of nursing. I think the abolition of the SEN role was a good thing, it put all registered nurses on a level playing field. I wasn't keen on a 2 tier nursing system, I'd like to think you're either qualified or you're not.

I fully appreciate there is a place for differing skills and experience in a clinical environment; nursing has changed beyond all belief in the last 20-25 years and those that hark back to 'the good old days' when wards were awash with nurses and auxiliaries doing back washing, obs and bed trolleys are very out of touch with modern nursing. To me, it makes sense that less qualified staff do the more routine work freeing RNs up to do the things only a registered nurse can do.

I believe nurses being graduates is a good thing - nursing now is so very different to how it used to be; we're doing stuff that 20 years ago junior house officers did.

There does seem to be a public perception that not all nurses are equal - those that work in 'sexy' environments like ITU and ED are held in higher regard. Those that work in Elderly Care and nursing homes are 'lesser' nurses, which is not only daft but offensive. The skills needed are different but extremely valuable. Hell, I work in primary care - we don't even get student nurses on placement with us as what we do is so unimportant. OK so I haven't given IV drugs for donkeys years and I don't need to make beds and wash people but I have a huge skill set and vast experience and work as an autonomous practitioner. I run my own clinics, make clinical decisions and assess, implement, monitor and co-ordinate care and treatments.

I wouldn't go back into a hospital for all the tea in China. Until they realise that they need to offer genuinely flexible working, decent conditions and support they are going to struggle to retain good staff.

Clockwork that makes sense, I can understand why people are worrying about the NA role.

It was put as an option to me but for the low pay and the problem of potentially being treated as a cheap band 5 without the degree education to do it put me off.

I hear from a manager/ nurse in the NHS that the degree apprenticeship standards will be just as high as uni standards. I guess that will remain to be seen.