WORK FORCE I S SUE S
families. There has been a 38% decrease in the number of nurses working in learning disability in the NHS in England. Additionally, there is a considerable gap between capacity and demand in district nursing services. This amounts to unmanageable caseloads and some leaving the service as a result. There were reports of staff being ‘broken’, ‘exhausted’ and ‘on their knees’.5
Vacancies are also running high in adult social care with a registered nurse vacancy rate of around 6.6%. Many in this sector work on zero hours contracts which are known to be associated with a higher turnover rate.
Staff turnover is high across nursing and midwifery: Previous research has shown clearly how workplace factors such as long working hours, poor quality working environments and lack of supportive leadership influence nurses to leave the profession.6
More than a third of nurses
working in England are considering leaving according to a Royal College of Nursing survey in May 2020.7
Some 44% of
respondents indicated that the way nursing staff had been treated during the pandemic made them consider leaving the profession. This was higher among minority ethnic group staff (54%) than among white staff (42%).
Stress levels: Health and care staff repeatedly report higher rates of work-related stress, depression and anxiety than those in most other sectors. Staff survey results also
indicate that between 35% and 45% report being unwell due to work stress during the previous year. Such stress is likely to be chronic, as measures of work stress repeated over time among health and care staff are highly consistent as identified by West and Coia (2019).
Sickness absence (3.4%) in the NHS in England is reported to be twice the rate in the private sector (1.7%). Staff stress, absenteeism, presenteeism (attending work despite being unwell), turnover and intentions to quit had reached alarmingly high levels in the NHS in late 2019. And then the pandemic struck.
Causes of workplace stress The report explores seven key stressors which are work pressure, moral distress; pay; education and entry into nursing and midwifery; work schedules; discrimination; and bullying, harassment and abuse. The Nursing and Midwifery Council surveyed 1,626 of the 15,600 nurses who left their register across the UK, between November 2018 and June 2019.8
The top three reasons for leaving were retirement (52.7%), too much pressure resulting in stress and poor mental health (26.4%), and a change in personal circumstances (24.5%). Other reasons included disillusionment with the quality of care provided to patients (16%), staffing levels (15%) and concerns about workload (12%).
Moral distress is when staff are in situations where they are unable to provide the quality of care that they feel they should be able to because of excessive workload or a lack of resources. This was reportedly far higher during the pandemic where there have been shortages of beds, the need to discharge patients quickly to create capacity and a shortage of some services for critically ill patients.
Many staff are intensely dissatisfied with
their pay, with 61% of those who responded to an RCN survey (UK wide) considering their pay/ grade to be inappropriate. Nurses across all pay scales report financial challenges, with more than half (56%) of the 7,720 nurses responding to the 2019 RCN survey saying they had to cut back on food and travel costs, 23% had taken an additional job, 21% struggled to pay their gas and electricity bills, and 11% had been late with mortgage and rent payments. Nursing is a gendered profession and yet research published last year showed that men are still advantaged in terms of pay and opportunities for promotion and development across some pay grades in the UK.9 Entry into the profession once qualified is a highly stressful time for new nurses and midwives who report feeling apprehensive and unprepared. They tend to feel they have little autonomy, but face high work demands. The author thinks it is astonishing that the very people who could take away some of the stress of staff shortages are treated poorly when taking their first jobs. Working hours and excessive workloads affect patient safety, productivity, efficiency and the wellbeing of staff. Shifts of more than eight hours carry an increased risk of accidents that accumulates. Many nurses prefer to work twelve hour shifts so that they can work extra on their days off to top up their wages. Nurses from ethnic minority backgrounds are much more likely to work seven or more additional hours per week and to take on extra paid work as they are less likely to be able to increase their salaries via promotion.
Discrimination evidence from the NHS
staff survey (2019) is stark – from patients, their relatives or carers (18.3% of BME staff and 4.6 % of white staff) and from managers/ team leaders or colleagues (14.4% among BME staff and 6.4% among white staff). The proportion of cases of discrimination experienced by BME staff that were based on ethnicity has also risen over the last five years from 77.8% to 82%. In addition, bullying, harassment and abuse has risen with more than 20% of staff having experienced it in the last year. The major perpetrators are colleagues and more senior nurses and midwives. New staff are most likely to report bullying. Factors which contribute to bullying include hierarchical management cultures and nurses and
16 l
WWW.CLINICALSERVICESJOURNAL.COM NOVEMBER 2020
©Robert Kneschke
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100
