‘There is a legal duty to ensure appropriate levels of nursing staff ’
A substantial increase in nursing is needed to ensure the ongoing delivery of high-quality patient care
HELEN WHYLEY
THERE are very real fears that the number of nurses working in the Welsh NHS is not keeping pace with patient demand. Here Helen Whyley, associate director (Employment Relations) at the Royal College of Nursing in Wales, explains how we can boost these figures in the long-term
NURSING is the largest professional group working in health and social care. It comprises numerous distinct specialities such as children’s nurses, district nurses, learning disability nurses, school nurses, oncology specialist nurses, dementia specialist nurses, general practice nurses and mental health nurses, to name just a few.
Nursing is still one of the most popular professions in the country. Yet the demand of nurses outweigh the supply.
So why do we have a shortage? The number of nursing posts in the NHS still does not reflect the needs of people receiving care.
There is an increased nursing workload in caring for an ageing population with increased dependency and co-morbidities.
A substantial increase in nursing is needed to ensure the ongoing delivery of high-quality patient care.
Put very simply it takes a higher number of nursing staff with a greater level of knowledge and skill to care for a person with a broken hip if they are also physically frail, and living with dementia, diabetes, a heart condition and respiratory illness.
This is even more the case if this person is being cared for at home, alone or in poor housing.
There is a clear understanding by the nursing profession of the Welsh Government’s vision for specific health services.
The government has always set out high standards in service delivery plans including ‘Design for Life’, ‘Brief Encounters’ and ‘I Care’.
However there is often apparent disparity between the Welsh Government’s national plan and the health board service plans.
Furthermore these plans can engender frustration in the profession at the apparent lack of workforce planning to meet the demand created.
There have been improvements in NHS workforce planning in Wales in the last two years and the new body Health Education Improvement Wales and the Nurse Staffing Levels (Wales) Act 2016 should continue this process.
Health boards in Wales now, have a legal duty to regard the importance of ensuring appropriate levels of nurse staffing in all settings.
In adult acute care settings, an appropriate nurse staffing level must be calculated and maintained. Health boards will have a duty to report on compliance with staffing requirements and take action if failings occur.
The Nurse Staffing Levels (Wales) Act 2016 will save lives in Wales.
Workforce planning in Wales should be an effective and transparent process that can analyse nursing need across the NHS and independent sector and seek to ensure that nursing as a profession emerges with the right numbers and with the right skills to best deliver patient care.
The demographics of the Welsh population and their needs change over time, alongside an evolving evidence base of research in effective care, skills, knowledge and technology.
In the past nurses and healthcare support workers in Wales have not felt valued by the NHS or Government.
This is partly related to pay (which has not kept pace with inflation in recent years) but also other factors such as being too busy to provide the level of care nurses wish to give.
Other factors include long hours, inflexible working patterns and poor access to continuous professional development (CPD).
Improving access to CPD is also an important way of showing how the nursing profession is valued and improving morale.
Doctors, for example, have access to CPD as part of their contracts. Professional development and learning does not and must not stop at registration. It is a fundamental career-long requirement for every nurse.
It is a requirement for successful revalidation by the Nursing and Midwifery Council.
CPD is essential for patient safety and clinical effectiveness, and is one tool used by the nurses and healthcare support workers to ensure that the highest standards of practice are promoted and maintained.
Investing in nursing, through a fair pay agreement, good terms and conditions and access to continuous professional development will benefit people receiving care.
The Welsh Government should examine ways to widen access to the nursing profession. In order to provide the future workforce needed for the NHS in Wales, it is crucial that there are sufficient numbers of nursing students entering the profession.
Student nurses spend three years (years which are 42 working weeks and not merely the traditional academic calendar) undertaking the nursing degree spending 50% of their time on practical placements often on an NHS ward.
The student nursing bursary must be retained.
The workforce is an essential field of health and social care policy.
No policy of improvement to public health or of service can be implemented or designed without an adequate consideration of the professional skills and roles that are needed to work in new models of service delivery which will be required to meet changes in future demand.