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Why an NHS nurse is hard to find
Nurses are a scarce resource in the NHS
Nurses say that poor pay and conditions have led to the recruitment and retention crisis in nursing, while some argue that modern training is too academic.

Either way, most are agreed that there is a nursing shortage and it is getting worse.

The government t is taking action to remedy the crisis, both by improving pay and conditions for nurses, and creating the new upper rank of consultant nurse.

One of the largest surveys of NHS workers says almost one in five health workers are doing a second job to make ends meet and one in three health work the equivalent in unpaid overtime of two weeks a year without pay.

This has led to a stressed workforce that suffers poor morale and appears unattractive to potential new recruits.

The Royal College of Nursing (RCN) says there are currently more than 12,000 nursing vacancies in the UK.

It said that the NHS is suffering, and has been suffering for some time, "the worst recruitment crisis in 25 years".

The NHS is particularly short in some specialisms, such as midwifery. The shortage led to one hospital recently deciding to limit the amount of time women could spend in maternity units.

In a bid to keep staffing levels up, hospitals have recruited nurses from as far afield as Australia and the Philippines.

The NHS has even been accused of poaching skilled nurses from developing countries which can ill-afford to lose them.

But not even this is enough, and the shortfall has to be made up from somewhere. It is left up to nursing agencies to shoulder the burden.

However, paying for an agency nurse is more expensive than employing a staff nurse, as agencies are only supposed to provide emergency cover when there is a temporary shortage of staff.

Quality of care 'suffering'

There are also fears that the crisis is threatening the quality of patient care.

Alan Milburn has clashed with nurse leaders
Liz Jenkins, assistant general secretary of the RCN, said: "When you get too many agency nurses, you get no continuity of care.

"The patient in their bed sees a different person every day who doesn't understand their condition, who may not even know much about the hospital they work in."

An RCN survey carried out in September 1998 looked at about 50 different trusts to see how the shortage was affecting patient care.

It found that a high percentage of nurses were "very-concerned" that the shortages were having an impact on patient care.

More alarmingly, a report in the Guardian newspaper said that one agency was providing nurses who were "incompetent or mentally unstable".

Pay concerns

The main reason for the recruitment and retention crisis - attracting nurses into the NHS and then keeping them there - is usually singled out as pay.

Agency nurses get paid more
Nurses are expected to work long hours under heavy pressure, yet the starting salary of is just over 14,000.

The RCN estimates it would take a 20% pay rise to bring an NHS nurse's salary in line with that of a police constable and a 17% boost to match a teacher's.

Before starting work at that level of pay, a nurse has to spend three to four years training.

Other reasons

However, pay is not the only reason nurses choose to leave the NHS.

"Another important reason is to do with conditions, so we want to see more family-friendly policies and more flexibility," said an RCN spokeswoman.

"Some nurses choose to work for an agency because it gives them more flexibility whereas in the NHS in a lot of areas that sort of flexibility doesn't exist."

Recent changes in training have also been attacked for putting too much emphasis on academic qualifications and too little on practical skills.

This has been said to be intimidating to would-be nurses with less academic interest in the profession.

It has also led to fewer trainee nurses being available on the wards.

A study from the Social Affairs Unit, a British think tank, said that bedside training had been replaced by university lessons.

This puts too much emphasis on status, managerial skills and technical competence with hospital machinery and ignores the basic skills of caring for patients, it said.

The report also said that nurses' traditional role of comforting, feeding and bathing the sick had been replaced by the hospital manager focusing on "cost centres" rather than patient care.

This makes nursing a less attractive profession to new recruits, it said.

Nurses attacked the report, saying that low pay and poor working conditions were to blame for recruitment problems.

Government action

The government says it is taking action. As part of the comprehensive spending review last summer the government announced that it would recruit another 15,000 nurses to the profession.

In September, then health minister Alan Milburn announced a 50m package to tackle the crisis.

It included:

  • Extra training places for nurses, including funding to make it easier to enter nursing through measures such as an increase in the number of part-time courses in nursing and midwifery;
  • Extra money to retrain nurses who have left the NHS and enable them to return;
  • Making money available so that assistants can progress to become fully-qualified nurses;
  • An increase in the amount paid to student nurses.

Alan Milburn, in a previous incarnation as health minister, detailed proposals for reform of NHS pay in letters to the two chairman of the independent pay review bodies which recommend annual increases for doctors, nurses and other NHS staff.

However, he enraged NHS workers by insisting the government would only be able to undertake reform of their pay if the review bodies recommend rises that are "affordable as well as fair" for 1999-2000.

Christine Hancock, general secretary of the RCN, said at the time: "Nurses need a proper pay boost now. The promise of jam tomorrow simply isn't enough."

See also:

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