EDUCATION MATTERS
Education for workforce planning Elizabeth Rosser ies, damn lies and statistics!’ The origins of this quotation remain a mystery, rather like the saying, ‘There are three degrees of falsehood: the first is a fib, the second is a lie, and then comes statistics’. While both may have originated in the 19th century, two centuries later the sentiments remain. April 2015 saw the publication of the final Royal College of Nursing’s (RCN) Frontline First campaign to monitor the impact of the coalition government’s budgetary efficiencies and their effect on the nursing workforce. It is common knowledge that the NHS faced mammoth financial cuts of £20 billion when the coalition government took office in 2010 (RCN, 2015).With about 70% of NHS provider costs attributed to staffing, frontline staff would necessarily take a direct hit. However, with various interpretations on the numbers, the picture is complex, and it is important to interrogate the figures and consider the impact The Government claimed that we have ‘more nurses than ever before’ (RCN, 2015). What has been interesting is that the publication of the second Francis Report (2013) halfway through the coalition’s term of office seems to have had a significant impact on staffing levels. Between 2010 and 2012, staff numbers dropped dramatically and from 2013 they began to rise again, particularly in the acute sector—the so-called ‘Francis effect’ (RCN, 2015). However, there were losses of qualified nurses in the community, in mental health and in learning-disabilities nursing; a rise of 33% in healthcare assistants (HCAs); a significant rise in the number of overseas recruitment; and a 150% increase in the spend of agency nurses, presenting an extremely volatile nursing workforce (RCN, 2015). Education matters. In their observational study of nine European countries, Aitken et al (2014) found a significant impact of qualified nurses’ educational level and workload on the quality of care. An increase in a nurses’ workload by one patient increased the chance of a hospitalised patient dying within 30 days of admission by 7%. They also found that an increase in nurses holding a bachelor’s degree is associated with
548
a reduction in hospital patient mortality. So, not only do staffing levels have an impact on the quality of care, but so does their level of education. There are three areas of concern. The first is qualified nurses. If we are to believe the RCN (2015) statistics (they present a compelling picture), NHS trusts are struggling to recruit qualified nursing staff, and, in spite of the ‘Francis effect’, they remain lower than in 2009. In particular, there has been a loss of 2800 of the most senior, experienced nurses over the past 5 years. How then are nurses to support the myriad staff they work with to achieve the high-quality care they aspire to? If, as the picture suggests, qualified nurses are supervising HCAs, the transient workforce of agency nurses and highest-ever recruitment of overseas nurses, how are they able to offer the focused mentoring of student nurses and still deliver quality care? How are they to pursue their own professional development and find the ‘head space’ to progress their own education and mandatory updating, engage in participatory continuing professional development (Nursing and Midwifery Council (NMC), 2015), supervise the wider workforce, and promote and deliver evidence-based practice at an acceptable standard? All this against a backdrop of an ageing nursing workforce and a mandate to innovate with service redesign. Are we asking the impossible? The second concern is skill mix. In spite of the fluctuating numbers of student commissions, Willis (2015) in his Shape of Caring report recognises the importance of preregistration education to develop the future nursing workforce. He also recognises the need for qualified nurses, nursing students and HCAs to develop a critical questioning approach to their care in a climate of adaptive and innovative practice.With such a rise in the HCA workforce and reduction in qualified staff, and loss of senior nurses across the NHS, the skill mix must be questioned, as well as the level of supervisory capacity to support nurses at all levels. In particular, the availability of strong leadership that Francis (2013) believed to be crucial to the establishment of organisational culture must be challenged by the reduction in numbers,
but also by the considerable workload of any qualified practising nurse doing 12-hour shifts. Last, the increasing trend of the rising transient workforce is also a cause for concern. With the reduction in student commissions between 2010 and 2012, now slowly recovering, there are fewer newly qualified home-grown nurses entering the workforce.With a 3-year lead-in to change, NHS trusts have had to look elsewhere and recruit from overseas to prop up the current workforce. The RCN (2015) confirms that, for the first time since 2006, the UK has moved from being an exporter to being an importer of nurses, with more nurses entering the country than leaving. These nurses enter the UK from different cultures, with different standards and understanding of nurses’ work, and although they do an excellent job, they need a great deal of supervision, support and education to develop their practice. Apart from the cost of this support, they will be counted among qualified nursing numbers, so the cost of support and education is hidden. Workforce planning is not an exact science. But whatever the figures, it seems clear that frontline nurses are being overloaded and that their education and development are being challenged, as is their capacity to educate and support others. Their position is fragile and it will be the role of us all to lobby the new government to invest wisely, avoiding a continuous spiral of workforce boom and bust, and support them in meeting the challenges of BJN the future. Aitken LH, Sloane DM, Bruyneel L, et al (2014) Nursing staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet 383(9931): 1824–30 Francis R (2010) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. http://www. midstaffspublicinquiry.com (accessed 8 May 2015) Nursing and Midwifery Council (2015) How to Re-validate with the NMC. NMC, London Royal College of Nursing (2015) Frontline First: The fragile frontline. RCN, London Willis G (2015) Raising the Bar. Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. Health Education England
Elizabeth Rosser
Deputy Dean, Education and Professional Practice, and Professor of Nursing, Bournemouth University
© 2015 MA Healthcare Ltd
L
‘
British Journal of Nursing, 2015, Vol 24, No 10
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
Education for workforce planning Elizabeth Rosser ies, damn lies and statistics!’ The origins of this quotation remain a mystery, rather like the saying, ‘There are three degrees of falsehood: the first is a fib, the second is a lie, and then comes statistics’. While both may have originated in the 19th century, two centuries later the sentiments remain. April 2015 saw the publication of the final Royal College of Nursing’s (RCN) Frontline First campaign to monitor the impact of the coalition government’s budgetary efficiencies and their effect on the nursing workforce. It is common knowledge that the NHS faced mammoth financial cuts of £20 billion when the coalition government took office in 2010 (RCN, 2015).With about 70% of NHS provider costs attributed to staffing, frontline staff would necessarily take a direct hit. However, with various interpretations on the numbers, the picture is complex, and it is important to interrogate the figures and consider the impact The Government claimed that we have ‘more nurses than ever before’ (RCN, 2015). What has been interesting is that the publication of the second Francis Report (2013) halfway through the coalition’s term of office seems to have had a significant impact on staffing levels. Between 2010 and 2012, staff numbers dropped dramatically and from 2013 they began to rise again, particularly in the acute sector—the so-called ‘Francis effect’ (RCN, 2015). However, there were losses of qualified nurses in the community, in mental health and in learning-disabilities nursing; a rise of 33% in healthcare assistants (HCAs); a significant rise in the number of overseas recruitment; and a 150% increase in the spend of agency nurses, presenting an extremely volatile nursing workforce (RCN, 2015). Education matters. In their observational study of nine European countries, Aitken et al (2014) found a significant impact of qualified nurses’ educational level and workload on the quality of care. An increase in a nurses’ workload by one patient increased the chance of a hospitalised patient dying within 30 days of admission by 7%. They also found that an increase in nurses holding a bachelor’s degree is associated with
548
a reduction in hospital patient mortality. So, not only do staffing levels have an impact on the quality of care, but so does their level of education. There are three areas of concern. The first is qualified nurses. If we are to believe the RCN (2015) statistics (they present a compelling picture), NHS trusts are struggling to recruit qualified nursing staff, and, in spite of the ‘Francis effect’, they remain lower than in 2009. In particular, there has been a loss of 2800 of the most senior, experienced nurses over the past 5 years. How then are nurses to support the myriad staff they work with to achieve the high-quality care they aspire to? If, as the picture suggests, qualified nurses are supervising HCAs, the transient workforce of agency nurses and highest-ever recruitment of overseas nurses, how are they able to offer the focused mentoring of student nurses and still deliver quality care? How are they to pursue their own professional development and find the ‘head space’ to progress their own education and mandatory updating, engage in participatory continuing professional development (Nursing and Midwifery Council (NMC), 2015), supervise the wider workforce, and promote and deliver evidence-based practice at an acceptable standard? All this against a backdrop of an ageing nursing workforce and a mandate to innovate with service redesign. Are we asking the impossible? The second concern is skill mix. In spite of the fluctuating numbers of student commissions, Willis (2015) in his Shape of Caring report recognises the importance of preregistration education to develop the future nursing workforce. He also recognises the need for qualified nurses, nursing students and HCAs to develop a critical questioning approach to their care in a climate of adaptive and innovative practice.With such a rise in the HCA workforce and reduction in qualified staff, and loss of senior nurses across the NHS, the skill mix must be questioned, as well as the level of supervisory capacity to support nurses at all levels. In particular, the availability of strong leadership that Francis (2013) believed to be crucial to the establishment of organisational culture must be challenged by the reduction in numbers,
but also by the considerable workload of any qualified practising nurse doing 12-hour shifts. Last, the increasing trend of the rising transient workforce is also a cause for concern. With the reduction in student commissions between 2010 and 2012, now slowly recovering, there are fewer newly qualified home-grown nurses entering the workforce.With a 3-year lead-in to change, NHS trusts have had to look elsewhere and recruit from overseas to prop up the current workforce. The RCN (2015) confirms that, for the first time since 2006, the UK has moved from being an exporter to being an importer of nurses, with more nurses entering the country than leaving. These nurses enter the UK from different cultures, with different standards and understanding of nurses’ work, and although they do an excellent job, they need a great deal of supervision, support and education to develop their practice. Apart from the cost of this support, they will be counted among qualified nursing numbers, so the cost of support and education is hidden. Workforce planning is not an exact science. But whatever the figures, it seems clear that frontline nurses are being overloaded and that their education and development are being challenged, as is their capacity to educate and support others. Their position is fragile and it will be the role of us all to lobby the new government to invest wisely, avoiding a continuous spiral of workforce boom and bust, and support them in meeting the challenges of BJN the future. Aitken LH, Sloane DM, Bruyneel L, et al (2014) Nursing staffing and education and hospital mortality in nine European countries: a retrospective observational study. Lancet 383(9931): 1824–30 Francis R (2010) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. http://www. midstaffspublicinquiry.com (accessed 8 May 2015) Nursing and Midwifery Council (2015) How to Re-validate with the NMC. NMC, London Royal College of Nursing (2015) Frontline First: The fragile frontline. RCN, London Willis G (2015) Raising the Bar. Shape of Caring: A Review of the Future Education and Training of Registered Nurses and Care Assistants. Health Education England
Elizabeth Rosser
Deputy Dean, Education and Professional Practice, and Professor of Nursing, Bournemouth University
© 2015 MA Healthcare Ltd
L
‘
British Journal of Nursing, 2015, Vol 24, No 10
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 27, 2015. For personal use only. No other uses without permission. . All rights reserved.
