Executive Director of Professional Practice, Nursing and Midwifery Council, considers what the latest report on the NMC register tells us about nurse recruitment and retention
Sam Foster, Chief Nurse, Oxford University Hospitals, considers the range of issues that needs to be considered to enable retired nurses and those redeployed from other areas to care for patients with COVID-19
Safe staffing as part of the COVID-19 response has required significant focus from senior nurses. The patient case mix has changed significantly and, typically, 10-15% of the clinical workforce have been self-isolating or been off sick themselves.
NHS Employers (2020) details that emergency legislation and support from the professional regulators has provided guidance for existing staff, student nurses, recently retired professional staff and those who had left in the past 3 years, to enable them rejoin the workforce, through nationally and locally coordinated processes.
The bringing staff back regional team contact me a number of times a week with details of staff who have indicated that they have either previously worked in my Trust and/or that they wish to work for us to support the COVID-19 response. Although initially there was quite an interest, over time, these numbers have significantly reduced. Despite proactive contact with this potential pipeline of nurses, and offers of refresher training, the campaign for my organisation and colleagues has not translated into many additional nurses.
This is by no means a criticism of the campaign. Our key pipeline of additional staff has been through the redeployment of nursing staff whose usual role was not ward based, nursing patients with respiratory failure, or those with critical care needs.
NHS England/NHS Improvement (NHSE/I) has been issuing rapid guidance on clinical and operational issues almost daily to support us in the context of the pandemic. The NHSE/I (2020a) guidance on rapid deployment of staff into new environments summarises key areas. It advises us to consider:
Action all areas: recognising that the totality of the care pathway will need staff to be available to meet care demand
Early deployment: an approach that many of us have taken and that has paid dividends. Feedback to me has been that early training has enabled staff to feel psychologically safer and prepared to work in unfamiliar areas
Building competence and confidence: while recognising that all staff have a responsibility to work within their competence, the guidance notes that team-based capability will be more important than individual capability. Leaders of teams and services are encouraged to think in terms of competencies rather than roles. This has been extremely well delivered by the critical care teams who have had to completely redesign their way of working in line with the NHSE/I critical care nursing guidance, moving towards a task approach with an overseeing senior nurse
Supervision: all staff working in a new clinical setting or organisation should be appropriately supervised when delivering clinical care, with easy identification of who is on duty to guide them in practice
Labelling: staff should wear identification badges clearly stating their name, professional background, the role they are now performing and grade. Many will be moving into unfamiliar teams and settings with the risk that colleagues make assumptions about levels of experience and expertise
Health and wellbeing including rostering: it is essential that staff receive support and have access to tools to ensure they are able to maintain good health and wellbeing. The guidance signposts to the range of resources available and local initiatives are being well publicised
Prioritisation: it is important that all staff feel that their knowledge and skills are being used to maximum patient benefit. The guidance advocates a move towards task allocation and its use at the beginning of a shift to support clarity of roles.
There is a large number of education and training resources available via professional bodies, Health Education England and NHSE/I. The NHSE/I education and training framework (2020b) supports organisations to assess the skill set of their clinicians, identify additional skills required to perform new roles, depending on the care setting, and then deliver relevant training or refresher training where required.
The framework suggests three steps:
Planning: service plans; for example, critical care surge plans or use of the private sector can drive the training requirements of existing staff
Map skills and training requirements: the service plan can drive the staffing, skills and competencies required
Competencies and self-assessment tools: following the training needs analysis, self-assessments will guide the consideration of refresher training or new skills training.
In the midst of the pandemic, I am very proud of how the nursing workforce has responded. It is a time when we all must come together to show leadership and agility to respond to the changing needs of our staff and patients.