The Nuffield Trust informs us what nurses, nurse managers, directors of nursing and chief nursing officers have known for some time: nurses are leaving the profession in droves (Palmer and Rolewicz, 2022). The Department of Health and Social Care (DHSC), however, does not seem to have received the memo that in June 2022 there were over 46 800 nursing vacancies. It does not seem to be up to speed with the workforce crisis impacting on individual nurses, their families and patients. The perennial question surfaces again: where is the workforce strategy? It would appear, despite the numerous warnings from august organisations such as the Royal College of Nursing (RCN), The King's Fund and the Institute for Fiscal Studies, that the workforce crisis has been pushed aside with a ‘make do and mend’ attitude.
In the past year more than 40 000 nurses have left our NHS: one in nine of the workforce (Palmer and Rolewicz, 2022; NHS Digital, 2022). Why are they leaving? There is an urgent need to understand and take action regarding the reasons why nurses have left and plan to leave, and also why they stay. Many of those leaving were highly skilled and knowledgeable nurses who had many more years of work left to offer. The number of leavers is almost offsetting new registrations.
In Scotland, it is revealed that (for the most recent year available) some 7470 nurses left. Nor is the data consistent within countries; in England, rates of nurses leaving active service range from one in eight in the South West (12.3%) to one in nine in the North West and in the North East and Yorkshire (both 10.9%) in the year to June 2022 (Palmer and Rolewicz, 2022). Anomalies in the data continue with differences in the type of NHS provider. The highest average nurse leaver rates appear to be in community provider trusts (16.8%). The lowest average reported rates were in non-specialist acute trusts, at one in eight nurses – from 11.8% for small acute to 12.4% for multi-service acute. The Institute for Fiscal Studies (Kelly et al, 2022) has noted that compared with British nurses, EU nationals were more likely to leave the NHS, whereas those nurses stating a nationality other than British or EU are less likely to leave.
At the time of writing, the RCN is balloting its members on industrial action – outrage alone will not address the untenable situation. At an emergency meeting, the RCN council immediately and unanimously decided to ballot members. It is urging members to take strike action and with over 465 000 this is a considerable chunk of the workforce.
The Nursing and Midwifery Council (2022) has updated its position in relation to industrial action. It has situated the statement according to the Code, as well as acknowledging the right of nurses to take part in lawful industrial action, which might include strike action. The standards and behaviours that the public expect from nurses will continue to apply. The employer should provide guidance for staff who are working during any period of industrial action as this may be more challenging than usual.
Nurses form the single largest profession group in the health service, we are key to how our NHS functions (or not). The government's commitment for 50 000 more nurses by March 2024 remains to be achieved. A workforce strategy (that includes a robust and realistic retention plan) is urgently needed, but this is akin to closing the door after the horse has bolted, too little too late. The government continues to show disdain and contempt for the nursing profession as well as other public sector workers with its derisory pay offers. There is a hole in the bucket, and it needs to be fixed. We are at a significant juncture: the shortage of staff is threatening to hinder the ability of the NHS to address backlogs in treatment. The DHSC is said to be re-prioritising its plans for our NHS, in which case making sure that we keep the amazing nurses we already have must be a priority.