Workforce Dynamics – future directions and magic wands
An interview with Anne Marie Rafferty, Professor of Nursing Policy, King's College London, about the issues affecting the UK nursing workforce. Many of them are recognisable in other European countries too
Question 1: You spoke at ECCO about a legacy of under investment in nurses in the UK – Can you tell us more about why this has happened, the impact it has had and why this is a false economy?
Answer: The Organisation for Economic Co-operation and Development (OECD) demonstrates that many high income countries with whom we compare our economies – the US, Canada, Australia – have been steadily stimulating and increasing the supply of nurses into the workforce over the past year in anticipation of growing demand. The UK, or more precisely England, has been subjected to what is called ‘boom and bust’ and consequently fallen far behind in terms of its capacity to respond to growing demand. It is now below the OECD average. This is a false economy because it undermines the resilience of the workforce, reflected in us having some of the highest rates of burnout in Europe. This is a false economy because it stores up problems for the future and is not a recipe for sustainability.
Q2: You used the phrase ‘a misshapen workforce’ with not enough specialist and advanced roles – again, what is the effect of this? How can we resolve it?
A: We have a ‘Christmas tree’ structure of the workforce where the vast majority is bunched around the grades at the bottom of the hierarchy, Bands 5 and 6, with relatively little pull through into senior roles. This reflects the massive underinvestment in senior roles required to provide leadership to the mass of the profession to deliver high quality patient care with consistency.
Q3: How can we boost the training, role and status of nurses at a time when costs are being cut, often from the bottom up? Is there scope for more peer-to-peer, and senior to junior training?
A: Undoubtedly there is scope for us all to pull each other up, but we also have to recognise there has been significant strategic failure to plan for the whole of the workforce and build a powerful and predictable pipeline into senior roles as we do, for example with doctors.
Q4: EONS is leading the ‘Recognising the value of cancer nursing’ [RECaN] project which will examine closely the links between nurse investment, training and patient outcomes across Europe. How can we impress upon policy makers the need to act on these findings?
A: Keep at it…! Build coalitions with a range of bodies as you are doing and most of all with patients, who are your greatest allies. It needs an orchestrated campaign, and finding where your allies lie and who your opponents are and what is in their minds – finding ‘workarounds’ in influencing with a clear lobbying strategy is your greatest opportunity.
Q5: Is there one innovative thing you would most like to see happen in workforce dynamics that would help shape a better future landscape?
A: A plan based on the recognition that our greatest asset is our current workforce and that we need to invest in our current qualified workforce, offering a robust career strategy – an integrated approach across the cycle, and a magic wand to make it happen!