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Urgent action is needed to address “alarmingly high levels” of nurse stress, turnover and intentions to quit, which have been exacerbated by the coronavirus pandemic, a new report has warned.
A blueprint published today by the King’s Fund health think tank called on organisations to transform workplaces in a bid to eradicate staff burnout and exhaustion.
“We need to create environments and cultures where nurses and midwives can flourish”
Professor Michael West
The report, The courage of compassion – Supporting nurses and midwives to deliver high-quality care, suggested the introduction of “minimum standards” to improve working conditions and ensure nurses can “thrive and flourish”.
It also called for a further review of the impact of 12-hour shifts on nurse mental health and wellbeing.
The report, commissioned by the RCN Foundation and featuring analysis of key data and interviews with staff, flagged that the UK health and care workforce had been “struggling to cope”, even before Covid-19 hit.
“Staff stress, absenteeism, turnover and intentions to quit had reached alarmingly high levels in 2019, with large numbers of nurse and midwife vacancies across the health and care system,” it stated. “And then the Covid-19 pandemic struck.”
The pandemic had laid bare and worsened longstanding issues faced by the workforce such as “inequalities, inadequate working conditions and chronic excessive work pressures”, the report added.
To transform the workplace and instil positive change for the professions, eight key recommendations were made, alongside additional practical suggestions.
As part of this, the report called for a set of minimum standards to be implemented for working facilities and conditions, which should include giving staff “places, time, and a sense of right and necessity” to rest.
Meanwhile, pay was a “dissatisfier” for nurses and midwives, the report said, adding that staff “must be appropriately remunerated for their work”.
Organisations must also “take effective measures to protect nursing and midwifery staff from violence, threats of violence, harassment, bullying and abuse”, the document stated.
“This report provides a blueprint for the actions that are needed to tackle the issues which have long faced the profession”
In terms of shift patterns, the report urged employers to introduce work schedules and rotas “based on realistic forecasting”, which would also support shift swapping when necessary, as well as breaks.
Whilst the report recognised that some professionals preferred 12-hour shifts, the think tank called for a “courageous, comprehensive and transparent” review of these hours for nurses and midwives.
This review should investigate the impact of 12-hour shifts on staff “mental health and wellbeing, capacity for earnings and on care quality and safety”, and explore alternative shift patterns.
Report author and director of leadership and organisational development at the King’s Fund, Suzie Bailey, stressed that the “current system is not sustainable”.
“An urgent review is needed to investigate alternative shift patterns and look at mitigating the impact of 12-hour shifts on staff wellbeing, care quality and safety,” she added.
“This may include providing rest areas for staff to decompress during shifts or to sleep after a night shift before driving home.”
The report also discussed historic and ongoing issues of racial discrimination experienced by staff from an ethnic minority background.
This included the fact that nurses and midwives from these backgrounds were “systematically overrepresented” at lower level jobs in the NHS and “underrepresented” in senior posts.
As part of its recommendations, the report said organisations “must work to ensure that the level of voice and influence experienced by staff from minority ethnic groups is equivalent to that of other staff in their organisations”.
In addition, it stated that “assessments should be regularly undertaken to ensure that staff from minority ethnic groups are not disadvantaged relative to other staff in relation to working conditions”.
The report also pointed to data from NHS Digital which showed that in hospital and community services in England in 2016/17, 28% of staff leaving the nursing or health visiting profession left within the first three years of their service.
To help with this issue, “attention must be paid” to the early years of nurse training and work experience, noted the report.
“We owe a great debt of gratitude to everyone working in health and care over the course of the Covid-19 crisis”
Ms Bailey added: “We hope our recommendations will inspire positive changes to enable nurses and midwives to thrive and provide the compassionate, high-quality care that they joined the profession to deliver.”
Meanwhile, Professor Michael West, senior visiting fellow at the King’s Fund and report author, said: “We need to create environments and cultures where nurses and midwives can flourish.
“Unfortunately, this isn’t where many frontline staff find themselves at the moment, with increasing numbers facing working conditions that are damaging to their health.”
He noted that “major issues” included chronic excessive workload, bullying, inadequate supervision, discrimination and poor teamworking.
“We need to see a concerted effort to tackle these root problems, to transform work life experience for nurses, midwives and thereby the quality of care for the communities they serve,” added Professor West.
Deepa Korea, director of the RCN Foundation, said the report “delivers a powerful message about the urgent transformational change that is required to enable nurses and midwives to thrive in their workplaces”.
“Importantly, this report provides a blueprint for the actions that are needed to tackle the issues which have long faced the profession,” she said.
Susan Masters, director of nursing, policy and public affairs at the Royal College of Nursing, welcomed the report, which she said further highlighted that nurses were “under enormous strain every day of their working lives”.
The RCN also welcomed a full review on 12-hour shifts and their impact on nurses and patient care.
Rebecca Smith, managing director of NHS Employers, which is part of the NHS Confederation, also welcomed the report and the recommendations included.
She recognised that “frontline staff are already exhausted and overstretched at a time when they are facing yet more challenges as we head into the inevitable difficulties that winter presents for the NHS”.
“We owe a great debt of gratitude to everyone working in health and care over the course of the Covid-19 crisis,” she said.
“They have displayed incredible dedication, sacrifice and fortitude, and employers must continue to prioritise the wellbeing of the workforce, to build on some of the great work that is already in place, and continue to develop the support offer in line with the needs of staff as this develops.”
A Department of Health and Social Care spokesperson said the first half of the NHS People Plan published in July “demonstrates our commitment to making the NHS the best possible place to work”.
Meanwhile, an NHS spokesperson said: “There are now more than 300,000 nurses in England with over 13,000 nurses joining the NHS recently; and this year there was a 22% increase in applications for nursing degrees, all backed by a £28 million fund to boost international recruitment.”
“Meanwhile, nearly half a million nurses, midwives and other NHS staff have been given extra support with their health and mental wellbeing needs via our self-help apps, text services, online forums and telephone helplines during the first wave, when the NHS cared for more than 110,000 Covid-19 patients.”
Full list of key recommendations:
Key recommendation 1: Authority, empowerment and influence
Introduce mechanisms for nursing and midwifery staff to shape the cultures and processes of their organisations and influence decisions about how care is structured and delivered.
Key recommendation 2: Justice and fairness
Nurture and sustain just, fair and psychologically safe cultures and ensure equity, proactive and positive approaches to diversity and universal inclusion.
Key recommendation 3: Work conditions and working schedules
Introduce minimum standards for facilities and working conditions for nursing and midwifery staff in all health and care organisations.
Key recommendation 4: Teamworking
Develop and support effective multidisciplinary teamworking for all nursing and midwifery staff across health and care services.
Key recommendation 5: Culture and leadership
Ensure health and care environments have compassionate leadership and nurturing cultures that enable both care and staff support to be high-quality, continually improving and compassionate.
Key recommendation 6: Workload
Tackle chronic excessive work demands in nursing and midwifery, which exceed the capacity of nurses and midwives to sustainably lead and deliver safe, high-quality care and which damage their health and wellbeing.
Key recommendation 7: Management and supervision
Ensure all nursing and midwifery staff have the effective support, professional reflection, mentorship and supervision needed to thrive in their roles.
Key recommendation 8: Learning, education and development
Ensure the right systems, frameworks and processes are in place for nurses’ and midwives’ learning, education and development throughout their careers. These must also promote fair and equitable outcomes.