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  • 01 November 2018
  • 9 min read

Battling paperwork, governance and staff shortages to get the job done

  • Abby Holland
    PICU Mental Health Nurse

Nursing has become a heavily paperwork and deadline orientated job, with a lack of contact with patients. Nursing has become, in short, much more of a desk job.

Hands tied by too much paperwork and admin

Student nurses, at the beginning of their training, are rightly excited and passionate about delivering excellent care. I’ve been that student nurse, looking forward to having engaging and meaningful conversations with patients.

Unfortunately, at times, I feel my initial optimism was misguided.

Policies: good and bad

Various policies affect the way that we nurse; they give us guidance and support, something to adhere to.

Policies are largely there to protect nurses, when followed correctly.

However, I feel that sometimes policies can be restrictive as no patient follows the same treatment pathway.

Policy can sometimes leave nurses feeling anxious about deviating in order to provide unique care.

Policy can also create an atmosphere that stifles learning, questioning or critique, because a nurse may feel they can’t stray outside “what the policy tells us”, when adapting policy to fit a patient’s treatment plan might be the better alternative.

The musician Frank Zappa famously quoted ‘that without deviation from the norm, progress is not possible.’

I believe this to be true.

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Staffing numbers are in decline

Staffing levels within general nursing and mental health has been an on-going issue for years.

It is no secret that it is now considered, according to the BBC, a “national emergency”.

The Nursing and Midwifery Council (2017) state that new figures have shown an increase in nurses leaving the NHS, and a slowed down intake of new nurses.

There could be many reasons for nurses leaving the NHS. One of them was explored by Cavell Nurses’ Trust, who carried out a survey in 2018 of 2,200 nurses.

They found that a worryingly high number of UK nurses are living on the breadline and are twice as likely to suffer financial hardships than those working in other industries.

Although a relatively small number of nurses were questioned, if these figures can be found amongst a small group, putting this on a larger scale would possibly give us an insight into why nurses are leaving.

What a staff shortage actually means on the ward

I can recall working numerous shifts on dangerously unsafe numbers, as well as being the only qualified nurse on shift whilst being expected to support and run the place safely.

The NHS and its management are expecting nurses to do the job of three for the price of one.

It has long been identified that we are losing more nurses than we are recruiting. But solutions are slow to arrive.It has taken almost a year before some sort of statement or plan has been put together and published acknowledging this.

In September 2018 Matthew McClelland, Director of Fitness to Practice, stated that for a long time in healthcare, there’s been a tendency to focus on blame and punishment when things go wrong.

A new approach is needed

Best practice management and pastoral care – changes are needed

A new approach should be adopted that puts people first and to encourage a culture of openness and honesty.

McClelland believes that this is the best way for nurses, midwives and the wider health and care professionals to learn from mistakes and prevent mistakes from happening again.

He further states that members of the public, and healthcare professionals agree that striking nurses from their registration isn’t always necessary.

However, with all the above information, we know that this is not always the case.

Managers across the NHS need to provide a nurturing environment where nurses can be open and honest about their mistakes, as well as able to learn and move forward.

From personal experience I can account for when this has not happened and actions detrimental to the nurse have occurred.

Nursing qualifications – a narrower window

When I first applied to do my nurse training, bursaries were in place, as well as two different ways of accomplishing your nursing qualification (including the option to do the Advanced Diploma instead).

This allowed students who didn’t meet academic / degree requirement grades to still do their training.

These two courses were practically the same, bar the dissertation required for the degree.

The Advanced Diploma has now been scratched. This effectively cuts out a big demographic of people (would-be nurses) who may not have the grades on paper, but who could have made excellent nurses.

False economy

Scrapping of the student nurse bursary

As well as high staff turnover numbers in the NHS, the intake of new mental health nurses for vacancies has dropped dramatically.

A likely cause of this is the scrapping of the bursary for student nurses. Without a bursary training can become an unaffordable cost for many would-be nurses.

Given the already relatively low pay of the nurse, students are concerned about the large amount of debt they will be left with, together with worries about never being able to pay it off.

They must also face their ability to cope financially throughout their training.

Data released in August 2018 shows 21,030 applicants had secured a place on university nursing programmes across the UK so far this year – a 2% reduction from 2017 and an 8% fall from 2016.

This is even more present within mental health services, which is increasingly under pressure due to the combined difficulties of mental health nursing recruitment and retention.

This lack of staffing leads to beds shutting and a physical inability to provide the care nurses strive to give and the public expects to receive.

Though the entire nursing profession is burdened by these issues with staffing numbers, it does seems a sharper challenge within mental health.

Evidence suggests that it has been hit more seriously by these shortages.

Proportion of nurses by nationality before the EU referendum

Brexit and the haemorrhaging of nursing staff

When discussing nursing shortages, you cannot ignore the impact Brexit has already had.

The UK is heavily reliant on international nurses, and in the light of Brexit, there is no certainty for them, or any hoping to travel to the UK for work.

In 2015 it was estimated that approx. 20,000 EU nurses were working in the NHS.

Brexit discussions have already made many feel nervous and have decided to leave the NHS.

The NHS is haemorrhaging staff at a rapid rate.

Fixing the nursing crisis

So what can be done to fix this nursing crisis?

Part of the responsibilities lie with the managerial team on the wards.

Striking that balance between providing exciting opportunities for new nurses and retaining the already-committed nursing team it holds.

A large responsibility lies with the government to provide further funding and support - and they seem aware of this, given the budget this week. But is this enough?

It is clear that Government needs to makes changes on financial support for training new nurses as well as policy regarding existing nurses.

Nurses are the backbone of our health care system, and Mental Health Nurses are a fundamental part of that backbone.

What would the NHS be if there were too few of us?

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About the author

  • Abby Holland
    PICU Mental Health Nurse

I qualified in 2015 from Southampton University with a degree in Mental Health Nursing. I have worked in Psychiatric Intensive Care for the 3 years where I currently reside as a Charge Nurse. During these 3 years I also spent 3 - 4 months working on acute female ward. I am also a Makaton signer, and Learning Disabilities lead on my ward.

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  • Abby Holland
    PICU Mental Health Nurse

About the author

  • Abby Holland
    PICU Mental Health Nurse

I qualified in 2015 from Southampton University with a degree in Mental Health Nursing. I have worked in Psychiatric Intensive Care for the 3 years where I currently reside as a Charge Nurse. During these 3 years I also spent 3 - 4 months working on acute female ward. I am also a Makaton signer, and Learning Disabilities lead on my ward.