A new report published by the Royal College of Nursing Scotland has warned that NHS Scotland is still short of nearly 4,000 nurses as “demand continues to outstrip supply”.
The report, released on Wednesday, has urged for a plan to keep nurses in the health service, along with nine other recommendations around work culture, staffing and employment.
“The Scottish Government must develop and implement a fully funded nursing retention strategy that addresses wellbeing, workplace culture, development opportunities, flexible working and career progression by April 2025,” one of the report’s ten recommendations said.
NHS Scotland figures showed the number of nurses rose from 61,567 whole-time equivalent (WTE) staff to 63,605 in the year up to December 2023, but vacancies in the field have remained high, with 3,961.8 WTE posts still unfilled as of the end of last year.
Meanwhile, fewer people are opting to study nursing, as for the second year in a row not all undergraduate student places for nursing were filled, and more students are not completing their courses. It is feared that this create further issues as the number of registered nurses needed and those entering the workforce is set to widen.
The report states that staff shortages are having a significant impact on the quality and safety of care across Scotland’s health and social care services, and patient waiting lists continue to grow.
In February, it was revealed that the number of people in Scotland waiting for cardiology appointments was the highest level on record, despite heart-related illnesses being ‘Scotland’s biggest killer.’
Meanwhile, NHS nurses are becoming stressed, burnt out and looking for new jobs altogether.
One Specialist Nurse said:
“We have staff shortages that are affecting the level of service we provide, also affecting staff’s health and wellbeing, some are off with work-related stress.”
Another Advanced Nurse Practitioner said:
“Over the last week I have felt more and more that I want to leave the nursing profession. I feel we are not heard, no one cares. We are no longer nurses we are firefighters trying to put out the fire whilst getting burned.”
The report says the issues stem from years of underinvestment, a lack of workforce planning and poor population health.
RCN Scotland board chair Julie Lamberth said the situation was “not sustainable”:
“At no point has NHS Scotland employed the number of nursing staff, it says it needs to deliver safe care and the registered nurse to resident ratio in many care homes makes safe care impossible,” she said.
“At the same time, with the squeeze on budgets, we are hearing reports of nursing roles being axed. The Scottish Government must get serious about the workforce crisis and the long-term implications for the public’s health.
“Nursing vacancies are having a damaging impact on our members’ ability to provide safe and effective care. And on their own wellbeing, when shift after shift they work extra unpaid hours to cover gaps and go home feeling that they are unable to provide the quality of care they want.”
Scotland, the RCN’s report found, also lagged behind the Organisation for Economic Co-operation and Development (OECD) average of 9.2 nurses per 1,000 of the population, with 7.9. The country was also well behind the figures for Finland, Norway and Ireland, which boasted 18.9, 18.3 and 15.2 respectively.
Colin Poolman, the director of RCN Scotland, said:
“Nurses and nursing support workers across Scotland are underpaid, under-staffed and many are at breaking point. The current service pressures, and staff shortages, have resulted in unsafe conditions being normalised.”
Among the other recommendations were calls for nurses to have “fair pay, good employment terms and safe working conditions”, as well as for the Government to implement a recent review to provide time for training and a shorter working week.
Royal College of Nurse Scotland recommendations
- During 2024 the Scottish government must have published an agreed set of recommendations and actions from the Ministerial Nursing and Midwifery Taskforce and have established an implementation board to oversee the delivery
- The Scottish government must develop and implement a fullyfunded nursing retention strategy that addresses wellbeing, workplace culture, development opportunities, flexible working and career progression by April 2025.
- Scottish government and employers must ensure that registered nurses and nursing support workers, wherever they work, have fair pay, good employment terms and safe working conditions that reflect their safety-critical role. Future pay awards should be restorative and be commensurate with the demands of the role and the level of education required.
- The Scottish government and NHS employers must implement the three elements of the Agenda for Change review – protected time for learning, shorter working week and review of band 5 nursing roles – in full and nursing staff supported to challenge where employers are not delivering on these commitments.
- The Scottish government must evaluate the implementation of the Health and Care (Staffing) (Scotland) Act 2019, including a review of the funding and resources for health and care employers to meet their duties under the Act. An annual parliamentary debate on safe staffing should ensure ongoing scrutiny.
- Issues with the effectiveness of the current nursing and midwifery workload and workforce planning tools must be addressed and adjustments to the amount of time allocated for breaks and predicted absence must be made to ensure the tools provide an accurate assessment of the number of nursing staff required to deliver safe patient care. An evidence-based methodology for determining safe and effective staffing in the care home sector must be developed.
- The Scottish government must expand the routes nursing to grow the domestic workforce including an increase in the number of student places and a national pathway for nursing support workers who wish to become registered nurses to gain their nursing degrees. As part of the package of support for students a cost-of-living increase to the nursing bursary and associated allowances are required to ensure students can complete their studies without financial hardship.
- Employers must ensure a level of staffing and resources that allows senior charge nurses (SCNs) and their community nursing equivalents to be non-caseload holding, which protects the supernumerary status of nursing students, and provides the capacity to support new registrants, nurses new to a role or those recruited from overseas.
- Development of the National Care Service must recognise the essential role of the registered nurse in community services and care homes and ensure that clear clinical and professional governance processes are embedded within reformed structures.
- The data being used to inform workforce planning must be improved. This includes addressing the gaps in the workforce data for the NHS, social care and general practice, and publishing data by professional groups on staff absence and banks and agencies use every quarter for additional transparency.
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