ALAMY

ANALYSIS

The Care Quality Commission is concerned about a shortage of nurses working in care homes. So why is the sector struggling to recruit skilled nurses? Kat Keogh reports

Negative media coverage puts nurses off a good career option

Last week, the Care Quality Commission (CQC) published its annual report on the state of health and social care in England. While newspaper headlines focused on safety concerns in four out of five hospitals it inspected in the past year, the report also warns that there is a shortage of nurses working in the social care sector. Nurses have the highest turnover rate of any role in the social care sector, the report reveals, with one in three vacancies left unfilled in some areas. One in five care homes inspected by the CQC in 2013/14 did not

have enough staff on duty to ensure residents received good, safe care. The CQC says it is particularly concerned by staff shortages in care homes, and recruitment to these roles should be given a ‘higher priority’.

Francis effect

The inspectorate says the so-called Francis effect – where acute trusts have recruited thousands of nurses in the wake of the Mid Staffs scandal – could be partly to blame. ‘The recent increase in nurses in the NHS following the Francis report may have exacerbated this shortage,’ the

report states. ‘This issue is now affecting the quality of care, and is a pressure that is likely to increase as many registered nurses working in social care are approaching retirement age.’ The CQC adds that nurses may also be put off from applying for jobs in care homes because they believe there is a lack of career progression compared to working for larger NHS hospitals, where there are more opportunities to move between specialisms. The issue of career progression has attracted much debate among nurses

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ANALYSIS

and healthcare assistants on Nursing Standard’s Facebook page (see box). Others cited less favourable pay and working conditions in privately-run care homes compared to working in the NHS, as well as being one of a small number of nurses on a shift. One care home nurse told us she was dissuaded from starting out in the sector because it would not be challenging enough. ‘When I graduated three years ago, many nurses I knew, and some tutors, encouraged us not to start our careers in care homes as we would lose our skills,’ she says.

More respect

‘The perception is that care homes and their nurses are somehow inferior to nurses that work in acute areas. My experience has been that many acute skills are used and you can be the only nurse responsible for a whole building. It is just as much about “nursing” as anywhere else.’ Another adds: ‘I work in an amazing home, the work is hard but rewarding. Our manager is one of a kind, but we do need more respect from the wider profession and community.’ RCN professional lead for the care of older people Dawne Garrett says that care homes can often be viewed unfairly by the public – and the profession – because of high profile cases of neglect such as the Winterbourne View scandal. Following the exposure of the abuse of people with learning disabilities at the residential hospital in Bristol, two nurses were given six-month sentences for wilfully neglecting patients. ‘Unlike hospitals or GP surgeries, members of the public and other nurses may not have much contact with care homes,’ she says. ‘They rely on the media to tell them what goes on in care homes. As a lot of the coverage focuses on the negative, there is a perception that care home nurses are not as “good” as other nurses, which is not the case.’ Age is another reason the CQC is concerned about a shortage of nurses in care homes. Twenty nine per cent of

nurses working in the adult social care sector are likely to retire in the next ten years, according to Skills for Care, the sector’s development body. Ms Garrett adds that care homes should put a greater focus on staff training, and even offer preceptorship courses to attract newly qualified nurses to boost numbers. ‘Access to training can vary if you work in a smaller care home compared to the NHS, but it can be better in larger organisations,’ she says. ‘We should be encouraging people to have a career working in care homes. You have a chance to deliver highly personalised care. You get to know your residents and their families and spend a lot of time with them.’ Frank Ursell is chief executive officer of the Registered Nursing Home Association, a membership body which represents care home owners. He says

MEMBERS OF THE PUBLIC AND NURSES MAY NOT HAVE MUCH CONTACT WITH CARE HOMES – Dawne Garrett that the best way to ensure care homes have sufficient nurses in future lies in better workforce planning. ‘It takes three years to train a nurse, so we are now seeing the results of cuts to training places on university courses, as well as more hospitals taking from the available pool of nurses after the Francis Report,’ he says. ‘Health Education England needs to get better at thinking long-term.’ Mr Ursell adds that the care home sector is more flexible than the acute sector, and can be the perfect place for nurses looking for a work-life balance. ‘Some homes have “twilight shifts” between 7-11pm which are good for nurses who may have families at home, but still want to have a career,’ he says. ‘It is as rewarding as working in a hospital. You go in every day and know who your patients are. It is long-term care, not the constant turnover of patients you may have in a hospital’ NS

A TASTE OF THE CARE HOME DEBATE ON OUR FACEBOOK PAGE ‘Poor wages, poor progression, poor staff to client ratio, poor educational development, the list is endless. If conditions were improved I may consider it, as older people are a rewarding client group to nurse.’ ‘I have worked in care homes for the past 20 years, I started as a healthcare assistant and worked my way up to becoming a staff nurse. Residents in care homes are not classed as numbers on the end of a bed of a ward, they are people with familiar faces who we look after every day in their older years.’ ‘Nurses in care homes are even more undervalued by employers than in the NHS. The pay is lower, there are fewer holidays, the pension is hopeless and there is no sick pay. Training too is appalling. On top of that nurses in other areas put them down as being not skilled enough.’ ‘Working in a care home is not seen as “trendy”, but it is back-to-basics nursing which is something that we should never forget. A care home is a very rewarding place to work in the right circumstances.’ ‘I love my care home job.’ ‘Pay is not in line with the NHS. Sometimes there is only one trained nurse and HCA for 26 residents, poor working conditions and equipment.’ ‘I currently work in a nursing home and I get nowhere near the same pay as my friends who work in the NHS. However, I love working with older patients, they bring so many interesting stories and life experiences that I feel every day is a training day.’

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Negative media coverage puts nurses off a good career option.

Last week, the Care Quality Commission (CQC) published its annual report on the state of health and social care in England...
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