To what extent is a lack of nurses affecting the NHS?

Abstract

After completing this research, I was able to gather and recognise that a shortage of nurses and health care assistants in hospitals has had a major impact on the NHS' results. I was able to draw this based on both secondary and primary data that I gathered and analysed. According to my study, the goals that I have set for myself in this project include recognising the rise and decrease in numbers in relation to a nursing degree. By doing so, I was able to recognise the massive drop in the number of nurses applying for the course. I concluded that the number of people leaving the NHS and applying to research on an NHS-funded course like nursing or midwifery has decreased significantly over the last five years.

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My second objective was to assess public opinion on why nurses are leaving their jobs. I was able to elicit a wide range of responses from a diverse audience and many explanations emerged. Given that most of the public agreed on improving the working environment, it can be inferred that one of the key factors that causes nurses to leave the profession and thereby jeopardise the NHS is because of this. As a result of my primary research, I found that the public believes that the NHS' failure is due to mistreatment of nurses. Finally, the aim was to investigate the various policies put in place by the government to assist nurses working in the NHS.

Abstract

Introduction

Aims and objectives

Research rationale

Analysis of data and information

Conclusion

Bibliography

Introduction

For this project, I've chosen to look at how the NHS is affected by a nurse shortage in hospitals. The reasons for the nursing shortage are various and are causing concern. One possible explanation for this is that there aren't enough students interested in pursuing a nursing degree at university, owing to the long hours and heavy workload and lack of funding. Consequently, many students agree that obtaining a nursing degree would only cause them stress because it is such a challenging career. In addition. The NHS is short on nurses because some nurses graduate and begin working only to find that the job is not what they expected. The rise and decrease in statistics in relation to a nursing course are the subjects I will be discussing during this project. This means I'll be looking at why graduate nurses are leaving their positions, as well as analysing the data and comparing it to the previous five years. This will assist me in getting a better understanding of the subject, which will aid in the completion of the project. I'll also be gauging public opinion about the reasons why nurses are leaving their careers, which will include nurses, teachers, students and the general public. Finally, I'll look at the various government policies for supporting nurses and undergraduate nurses. This will ideally provide me with insight into whether both graduate and undergraduate nurses are receiving the proper treatment both at work and at home.

Aims and objectives

Aim 1: To comprehend the rise and fall in statistics in nursing courses.

Objective 1: Investigate the reasons why nurses are quitting their jobs.

Objective 2: Analyse the data and equate it to the previous five years.

Aim 2: To assess the public's perceptions of the reasons why nurses leave their employment.

Objective 1: Create a Google Forms survey and send it out to the public via email.

Objective 2: To investigate the consequences of the nursing shortage (You could look at the impact on patients, hospital etc.)

Aim 3: Examine the various methods used by the government to help nurses and nursing students.

Objective 1: To investigate what the government is doing to support or finance nurses.

Objective 2: To analyse the efficiency of these methods in mitigating a nursing shortage.

Research Rationale

Primary research

For me to complete this study, I'll need to gather information that will help me expand on and clarify the objectives I've set. I'll have to do some research on each target which will be achieved by identifying the relevant sources that will provide me with the required details to complete each aim’s objective. I'll be relying on primary sources as I would need to gather my own knowledge first-hand to complete the task to the highest standards. This will also assist with the accuracy and consistency of the data collected. I will conduct primary research to assess the public's opinions of the reasons why nurses are all leaving their employment. I'll use Google Forms to complete this task. This will be comprised of five separate questions with options: yes or no, or a box for responses that need further explanation. I'll then send it out to the public via email such as teachers, parents, and students. To get a more diverse set of data, I'll ensure the survey is distributed to both males and females and wait for responses before using a spreadsheet to analyse the data.

I believe that a survey is the most successful method as it’ll allow me to obtain information that’ll help me draw a conclusion and formulate a general response. The questions include what the public thinks about the reasons for the shortage of nurses in the NHS, as well as personal experiences with NHS-funded health care and reports or news they've heard about. This will help me formulate a clearer understanding of the subject and arrive at a credible conclusion. I'm aiming to gather qualitative data rather than quantitative data because I'd like to receive findings that are based on words rather than numbers. I'll be evaluating my data with descriptive statistics; this will help me to look at averages and separate my data into useful parts, enabling me to view it considering my priorities and objectives.

Secondary research

To complete this project and conclude for my first aim, which is to understand the statistics in the NHS about nurses, I will conduct secondary research by collecting various sources from the internet. I'm going to use the article ^[1]‘Nursing in practice’. The shortage of nurses is the key source of concern for the NHS, according to this report. It addresses the consequences of a staffing shortage and how a shortage of staff can impact patient care, as well as the protection of patients and their encounters with the NHS. Statistics on how many nurses leave the NHS each year are included in the report. This will help me complete my objective for aim one because I’ll be able to compare the data to the previous five years. This source is credible since it was released by the NHS, making it trustworthy. The information is also pertinent to the matter I'm discussing because it covers a lot of ground in terms of why the NHS has a staffing shortage. The source was published on the 8th of October 2019, rendering it current and trustworthy. The website is correct since it was written by a specialist by the name of MIMI launder. The aim of this article was to educate the public about the consequences of a staffing shortage on residents. For my second source, I chose an article on how the 'Shortage of nurses in the UK is affecting patient care and threatening lives’^[2]. Similarly, this article discusses how nurses are forced to abandon their work due to a shortage of vacancies and high turnover rates. Since it was published on a government website, this article can be trusted. The source is also reliable since it was published in 2018, making it both current and factual. The aim of this article is to raise awareness about the difficult working conditions that nurses face.

For my second aim, to assess the reasons why nurses leave their employment and the impact it has on patients; I used the website 'Guardian.com'^[3]. The study explores why nurses are leaving their jobs, with the key explanation being the horrendous long hours they are expected to work. This then interferes with their personal life and time with family. This article is trustworthy as it was published by a professional nurse that is familiar with the topic. The material is also relevant as it was published in 2019, making it resent and reliable. The article includes statistics from between June 2010 and June 2011, where 3,689 employees said that they decided to stop working for the NHS in England due to long hours, little to no holiday breaks, low wages etc. For my final aim, which was to investigate the government's stance on nurses in the United Kingdom. I used an article^[4] on how the British government is failing the NHS and nurses in the UK; it addresses the overwhelming workload that nurses face, which has resulted in between 33,00 and 35,00 nurses leaving the NHS. Since it was released by the NHS in 2018, the article is accurate and trustworthy as the statistic is backed by evidence.

Aim 1

Objective 1

Due to the extreme changes in the healthcare sector over the last decade, it’s all contributed to the massive impact on patient care outcomes. As a result, it has affected the efficiency of all nurses in the UK. Over the past ten years, nurses have experienced increased workloads, leading them to become more stressed. Consequently, a small number of nurses have left in the hopes of seeking a better career. According to my research, the reasons why include, nurses working overtime, nurses dealing with bullying or toxic attitudes, nurses dealing with bad bosses, low pay, heavy workload, and simply a lack of work/life balance.

An average nurse is supposed to work a 12-hour shift daily and many nurses are required to work overtime to fill between gaps in shifts and cover for sick or absent nurses. Some nurses can opt to work overtime or night shifts to supplement their income. However, not all nurses are in favour of working longer shifts than they are expected to; in fact, most nurses are forced to accept another shift with just an hour's notice. This can be exhausting for a person, especially if they want to live a healthy lifestyle outside of work. Many nurses are unable to spend quality time with their families or have any alone time due to their overtime commitments. They’re prone to being tired, burnt out, and therefore demotivated, this can affect a nurse's decision to leave their job to pursue a career that values their personal lives. This affects the NHS because fewer nurses in the hospital would jeopardise patient care as well as the hospital's credibility. Another reason already stated is nurses are forced to leave because of bullying or toxic attitudes at work; however, this subject does not receive the attention it deserves because many people are afraid to speak up about it. Working in toxic conditions is exhausting for everyone, but it's even more so in hospitals, where patients' lives are on the line.

Moving on, low pay ^[5] is another explanation why the NHS is declining because of nurses quitting their jobs. A registered nurse's average income in the UK is £23,000. A registered nurse with less than 20 years of experience may make up to £34,105 per year. Nurses with more than 20 years of experience should expect to earn 15% more than these average salaries, according to ‘nursing salary’ ^[6].This, however, is insufficient. Low pay is a big reason why nurses are leaving the profession.It has been stated by^[7]Ophthalmic nurse practitioner Helen that: "'We are real people with mortgages, cars to run and families to look after. “I’ve reduced my own hours to care for my children but pay remains so low that it’s not worth returning full time - it won’t cover childcare costs." This demonstrates that nursing salaries are not as high as they should be, resulting in many nurses leaving the NHS to work in the private sector or choosing a new career entirely, further destroying the NHS.

In relation to the title, I believe that a shortage of nurses has a huge impact on the performance of the NHS because nurses are the backbone and base of all hospitals in the UK.

Objective 2

According to my research, I have gathered that in Data published by^[8]NHS Digital shows that just under 33,500 nurses left the service in 2016 – 3,000 more than joined. This means that more nurses are leaving than entering the profession. That is about 20% more than the number of people who gave up in 2015. This also indicates that the figures are rising year after year. The numbers have only gotten worse in 2017/18. The discovery that nearly one-third of nurses left due to intolerable strain has worried politicians this year.

^[9]In 2019, More nurses have opted to leave the profession due to a lack of work-life balance; figures show that the number of nurses leaving the profession has increased from 1,069 to 2,910 in just 5 years.^[10]According to the Guardian, Nurses are breaking under the strain of heavy workloads, increasing demand for treatment, and severe understaffing, according to health unions. Many staff in the NHS have been working beyond their normal hours to complete tasks.

In 2010, in the Northern Ireland and Scotland region, the leaver’s rates were also on the rise. In Northern Ireland, almost 7.5% of nurses left the NHS, while 7.2% left in Scotland. Furthermore, many younger nurses are leaving the profession for a variety of reasons. Younger nurses and student nurses, more than any other age group, face the most animosity and hurtful remarks. Because of their lack of training, they are more likely to make mistakes and lack the skills necessary to be a professional nurse.

Secondary graph

It is clear from this graph that the number of joiners and leavers on a nursing course in the NHS is increasing. Because of the complications and mistreatment nurses face daily, more nurses have made this decision.

From looking at the range, which is the maximum subtracted from the minimum, I can conclude that the number is 34.

Aim 2

Objective 1

Average age of participants in the survey

Looking at this graph, the majority of respondents were between the ages of 20 and 30. Because my target audience was over the age of 18, this was beneficial to me. The reason for this being, it will ensure that I gain more intellectual and reliable data.

As shown in the graph, 40% have voted for it, concluding that Bullying and toxic behaviours at work is the primary reasons for nurses leaving the NHS. Nurses with low pay came in second, followed by a lack of holidays and, finally, a heavy workload and stress. This has aided me in gaining a deeper understanding of the public's perspectives on the topic. To back up the public’s opinion, I collected information from undergraduate nurses and junior nurses who were willing to speak about the realities of working in a hospital and tending to reliant people, as well as being handled differently by other seasoned nurses and doctors in the hospital. According to Bethany, an undergraduate nurse at Swansea University, it is very common for nurses in a unit to bully new hires or new graduates. This was due to nurses in some areas or specialties perceiving or believing that they are superior or “better than” another unit, resulting in them degrading them and other undergraduate nurses regarding their care, education, or specialty.

Bullying, Bethany said, not only affects the person who is being abused, such as herself and her co-workers, but also patient care. She claims that being handled unfairly in the hospital has a negative impact on her performance and, therefore, on the quality of treatment she gives to her patients. Adding to Bethany's viewpoint, according to the^[11]‘Nursebuff’ online, it states that bullying in hospitals is one of the leading causes of nurses leaving their jobs and seeking other careers. This is because it creates excessive stress, which causes a nurse's spirit to be dragged and desire to leave a toxic environment.

The public believes that low pay is the second reason why nurses leave the profession; approximately 36.5% of the public voted that low pay is one of the reasons why nurses are now quitting. The average pay of a registered nurse in the UK, according to PayScale.com, is £23,000. Many nurses with less than 20 years of experience who do not earn bonuses or promotions find it incredibly difficult to live comfortably and fulfil all their needs and wants with their salaries.According to an anonymous ex nurse on the^[12]metro, she quit nursing to work at Lidl because it was closer and paid better; she added that as a nurse, ‘the price of everything is going up and it’s harder and harder to make ends meet.’ We’re never able to treat ourselves or go on holiday. Everything I buy for my daughter is second hand including her school uniform.’ This demonstrates that most nurses are uneasy in their jobs and would prefer to work in a less stressful/demanding career, regardless of its status.

The next factor for nurses leaving was lack of holidays. The only guaranteed holiday a nurse receives is their annual leave, which is a legal necessity for all employees. However, a nurse cannot choose when they take their annual leave, which may be inconvenient. Aside from that, nurses rarely, if ever, get paid time off for holidays such as bank holidays, Christmas holidays, Easter holidays, etc. This is because nursing is a very demanding occupation, requiring a large amount of work to be done to the highest expectations to meet the needs of the patients. Nurses who regularly take holidays risk the patient's treatment failing and not being met to a higher standard. This is because when there are just a few nurses on a shift, they cannot function as well, causing delays in treatments and care.

Finally, with a 10% vote, the public decided high workload and stress causes nurses to quit. Nursing is a high-workload profession, and a heavy workload limits the amount of time a nurse can devote to various tasks. A heavy workload may influence the decision to perform different procedures, which may affect patients. It also causes nurses to become extremely depressed and exhausted, causing them to reconsider their career choices and even leave the profession.

Based on the public feedback I received; It’s clear that the main reason nurses leave their jobs is because of toxic attitudes and bullying at work. Nurses are leaving the profession because they are unhappy with their work environment, and many of them feel disrespected.

Objective 2

A shortage of nurses has a detrimental effect on patient care.According to ITV news,^[13] patient safety is at risk in England due to a shortage of 40,000 nurses. The Royal College of Nursing states that, about 71% of nurses in the UK believe there are not enough nurses to provide safe treatment to patients. According to ^[14] a royal college nurse, three out of four people in the UK think there aren’t enough nurses to care safely for patients in the NHS. A new public survey has revealed people are concerned that they will not be able to get the treatment they or their family members need as a result. The effect of nurses leaving the NHS is huge, as the NHS heavily relies on nurses to provide the best possible treatment to patients.

Nursing shortages often raise the risk of errors when it has been clinically demonstrated that when there is a high patient-to-nurse ratio, nurses experience burnout and frustration, and patients experience higher mortality and failure-to-rescue rates than when there is a lower patient-to-nurse ratio. When a nurse is exhausted or dissatisfied, they are more likely to make mistakes, such as not taking adequate attention when recording information, accidentally ignoring requests and concerns that a patient may have, and so on. This may lead to serious errors, which may result in complications or even death.

Adding to the shortage issue, since nurses are primarily female, there will be a shortage of nurses, especially during childbearing years. Nurses will cut back or leave the profession entirely if conditions become too difficult; some will eventually return, while others will pursue new jobs. Furthermore, since a nursing course is highly demanding, it can be overwhelming for pregnant women, forcing them to take a break or even leave.

Aim 3

Objective 1

There is no doubt that the government is doing everything possible to assist and ensure that all nurses and midwives are comfortable in their jobs, but not nearly enough is being done.^[15]The UK government have recently granted all student nurses from September 2020 to receive a payment of at least £5,000 per year that they do not have to repay, mentioning the lack of financial stability that student and undergraduate nurses faced while on a nursing course as the reason for this.

From September 2020, all new degree-level nursing, midwifery, and many allied health students will be eligible for funding. The goal is to assist as many students as possible and ensure that they can support themselves. This decision was influenced by student protests across the country, as well as constant requests and demands from the British public to focus on the NHS and ensure that it has everything it requires to provide the best possible care. The current prime minister has stated that ⁶‘Nurses epitomise everything that makes the NHS so revered across the world – skill, compassion, energy and dedication’. This demonstrates that all nurses' hard work is not going unnoticed, and that they will be supported by the government to live comfortable lives while providing the best possible patient care.

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Moving on, ^[16]In 2015, England decided to eliminate bursaries for all nursing and midwifery undergraduates in the UK, which was widely condemned by the British public, resulting in some change. Bursaries were recently reintroduced to universities across England after the UK government re-evaluated its decision to ban them. The government has reinstated payments of up to £8,000 per year to all healthcare assistants employed by the NHS. The goal is for nurses to be able to support themselves financially and not have to worry about finding work, housing, or living expenses. This decision has aided the profession's growth, as the NHS are now enrolling 50,000 more in the course. This will benefit students who want to pursue a nursing degree because they will be given financial assistance to continue their studies.

If students want loans erased, they will have to spend time in the NHS and work as a nurse for up to three years. Up to 80% of their loans will be repaid and thereby cancelled because of the loan forgiveness fortunes which have been developed into several hospitals throughout the Uk. All existing student loans are forgiven and written off after an undergraduate health care assistant begins working in a hospital. ^[17]

It is important for the government to implement new laws and legislation to sustain the existing rate of students applying to nursing programmes and, as a result, seeking a career in the area.

Objective 2

The government's grant of up to 5,000 a year to all student nurses is incredibly effective; this is because not all students have the financial resources to cover their tuition fees and must either work extremely hard or depend on family and friends for assistance. The government's introduction of this rule has certainly raised the number of students applying to become nurses and midwives. The explanation for this is that students can now afford their housing, luxuries, transportation, and living expenses without worrying about student loans or their financial security. This has since raised the number of nurses who remain in the profession and do not leave. The figures resulted from over 1,000 students dropping out of a nursing programme in the past year to just 50 in the previous year. These figures suggest that sponsoring students is a very effective way to keep them in the industry and not pursue another area.^[18]

Furthermore, it has also aided the NHS's condition and there are more staff inside the hospital carrying out the workload and ensuring that everybody has a role to play. When bursaries were eliminated from all healthcare students in 2015, over 1000 participants dropped out of the curriculum. Since the responsibilities were so wide and far-reaching, it had a significant impact on the competence of nurses within hospitals. As a result of the situation, nurses were forced to continue to share the workload among the few nurses that remained, as well as work overtime and night shifts to ensure the job was completed.

In recent years, the British government issued an ultimatum to all universities in the UK to enact bursaries, which meant that nurses would not have to pay to attend universities and hence would not have to worry about student loans or student debts. All undergraduate nurses and newly qualified nurses’ benefit from this. The main reason for this was that they could now go to university and work in the NHS without worrying about money. This has undoubtedly improved their work ethic and assisted all nurses in providing world-class patient care. Students should also concentrate on themselves while still being able to support themselves financially. Furthermore, it has been declared that all students working in the health care sector have the right to have their student loans forgiven under certain conditions. These terms and conditions include having to work for the NHS for a certain number of years as well as working in a hospital that follows the built-in loan forgiveness fortunes. This has a positive impact on undergraduate nurses as well as newly qualified nurses because it relieves them of all the stress that they will be facing, it will also strengthen their resolve to remain in the profession.

Conclusion

Aim 1

I investigated a range of different sources to find the most relevant information and discovered that there are countless reasons why nurses and undergraduates feel compelled to leave the profession when they are subjected to harsh working conditions such as mandatory overtime, low pay, hazardous environments, and bullying. They will not stay any longer, and it is understandable that they will escape the stress and leave the NHS. To retain competent nurses, an effort must be made to build a positive working environment free of these stressors. I have come to believe that the rise and decrease in the number of nurses joining and leaving the profession is entirely due to the way nurses are treated in hospitals, and that something must be done to reduce these statistics. I think that a lack of nurses has a significant impact on the performance of the NHS because nurses are the backbone and foundation of all hospitals in the UK.

According to the information I have collected, the number of nurses leaving the NHS fell dramatically in 2016 following the cancellation of bursaries in England, but shortly after it was reintroduced in parts of Wales, there was an increase in nursing applicants and the number of nurses staying in the NHS. This demonstrates that restoring bursaries had a positive impact on the NHS, as many nurses were able to continue working for the organisation. This has had a positive impact on the NHS to some extent, as patient care has been strengthened, as has general performance and roles of health care aid in NHS funded hospitals across the UK.

Aim 2

As a result of my primary study, I discovered that the public is all in agreement that mistreatment of nurses is causing the NHS's downfall and a lack of patient care in the NHS. I was able to effectively reach out to the public and establish a conclusion based on their reactions, so I was able to receive all the information needed to accomplish this aim. Overall, I discovered that dissatisfaction with the work environment is on the rise, and many nurses feel disrespected daily, leading to nurses leaving the profession.

Due to the sheer workload that must be done in hospitals due to absent nurses, the shortage of nurses has had a significant effect on hospitals funded by the NHS across Wales. This has impacted all hospital health assistants, including doctors, surgeons, occupational therapists, radiographers, and others.

Aim 3

The government has put in place various regulations and funds to improve the working conditions of nurses in the UK and the performance of the NHS. All these constraints have been placed purely to aid in the retention of nurses in the NHS. Many nurses have left the profession because of a lack of funds and attention from the NHS. To retain the number of students applying to nursing programmes and thereby pursuing a career in the profession, the government must enact new rules and regulations. I think that the government is well aware of the hardships and problems that nurses face on a daily basis; as a result, it was made a priority to help alleviate their struggles and ensure that they are comfortable in their position as nurses. However, I think that more must be done to ensure the statistics are maintained and preserved as they are now; otherwise, more nurses may leave the profession.

Overall, I think the government is taking the right steps to help maintain nurses in the profession; statistics show that over 1000 more students are applying to nursing programmes. This demonstrates that the newly introduced regulations, have had a positive impact on the NHS, making it stronger. They have resulted in more nurses applying for the course, giving them the confidence to complete their degree and become professional nurses. Now that that issues have been resolved, nurses have the freedom and support to pursue their dreams without fear of financial repercussions.