Tories’ election pledge to boost NHS nurse workforce puts emphasis on retention

Tories’ election pledge to boost NHS nurse workforce puts emphasis on retention

Conservatives have resisted calls to reinstate the nursing student bursary in England

The Conservative Party general election manifesto promises £5,000 maintenance grants for nursing students and a 50,000 increase in the number of NHS nurses in England by 2025.

A large portion of those 50,000 nurses would be new recruits, but would be the result, the Tories say, of improved nurse retention, as well as some people returning to the profession.

The Conservatives claim their figure would break down as:

• 12,500 nurses (25%) recruited from abroad, through a new ‘NHS visa’.
• 18,500 nurses (37%) remaining in the profession or returning to work 'through improved career development opportunities and enhanced retention'.
• 14,000 graduates and undergraduates (28%) taking extra university training places.
• 5,000 (10%) joined an 'expanded' nurse apprenticeship scheme.

Maintenance grant for nursing students

The last Conservative government abolished the nursing bursary for students in 2017. Now the party is saying it would pay all students £5,000 in maintenance grant, if elected; those in regions or disciplines struggling to recruit, such as mental health, would attract enhanced funding, up to £8,000. 

The party will not reinstate the nursing bursary, meaning students would still have to pay their tuition fees, which are currently capped at £9,250 a year.

Tuition fees, on top of living costs are ‘too big barrier to many’ would be nurses 

RCN general secretary Dame Donna Kinnair said the combination of tuition fees and living costs was too big a barrier to many and both funding areas needed to be addressed.  

'Forcing would-be nurses to pay tuition fees has demonstrably failed,’ she said.

'With this announcement, Boris Johnson has not brought back the bursary – he is pledging to return one element of the package and keep the costly tuition fees in place.'

The Liberal Democrats, Green Party and Labour Party have all said their governments would reinstate the nursing student bursary, with Labour saying it would add 24,000 to the workforce in England in the next five years.

Number of mental health and learning disability nurses falls ‘significantly’ in a decade

Number of mental health and learning disability nurses falls ‘significantly’ in a decade

NHS Employers says figures show growing gap between workforce and demand for services

New data has revealed a large decline in numbers of nurses specialising in mental health and learning disabilities care in England.

The NHS Digital statistics show there were 36,196 mental health nurses in May this year, compared with 40,602 in September 2009.

Learning disability nurse numbers also declined, falling from 5,553 to 3,201 over the same period.

NHS Employers director of development and employment Sue Covill said: ‘These figures reveal some sobering realities. 

‘In mental health and learning disability nursing, staff numbers have significantly fallen over the past decade, while demand for care and services continues to grow.

‘There is a great deal of work to do to fill those gaps.’

NHS Employers has suggested ways that the government could increase specialist nurse numbers. These include: improving staff retention; developing a supportive policy for migrant nurses; reforming the apprenticeship levy; and reinstating funding for continuing professional development. 

Government cites work to boost nurse numbers

A Department of Health and Social Care spokesperson said the interim NHS People Plan will help to raise the profile of mental health and learning disability nursing. 

They added that the nursing degree apprenticeship programme will also boost staff numbers in these specialties.

‘We are already working to ensure that nurses in other sectors can easily move into mental health or learning disability nursing,’ they said. ‘And postgraduate students who started studying last year will receive a £10,000 incentive payment once they take up employment in these specialties.’

Responding to the data, RCN professional lead for mental health Catherine Gamble said the government must be held accountable for nurse numbers.

‘The upcoming spending review is a chance for the government to put their money where their mouth is and invest at least £1 billion a year in nursing higher education,’ she said.

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Mandatory training in learning disabilities and autism for all NHS nurses

Mandatory training in learning disabilities and autism for all NHS nurses

All nurses working in the NHS and social care in England will receive mandatory training in caring for people with learning disabilities and autism from next year.

The training programme, backed by £1.4 million of government funding, will be named in memory of Bristol teenager Oliver McGowan, who had autism and died after being given an antipsychotic drug that caused him to suffer a rare side effect. His parents have campaigned for better staff training since his death in 2016.

Inequalities in care and premature deaths in people with autism and learning disabilities

His mother, Paula McGowan, said: ‘I believe my son Oliver died an avoidable death, and if the medics looking after him had had a better understanding of his needs, it may never have happened.

‘We have never had mandatory training like this before and I believe this is a very important first step in addressing the inequalities of healthcare and premature deaths in people who have autism and learning disabilities.’

A trial of the new training package for all health and social care staff will begin in 2020 and run until March 2021.

Data on inpatients who have learning disabilities or autism will also be published by the government as part of its commitment to ‘greater transparency’, the Department of Health and Social Care said.

But the chief executive of disability charity Sense, Richard Kramer, said: ‘For many young people with learning disabilities and autism, this is too little, too late.’

Case reviews for mental health hospital inpatients

The mandatory training announcement follows the government’s commitment to review the care of every mental healthcare inpatient with a learning disability or autism over the next 12 months.

Health and social care secretary Matt Hancock said the case reviews for all 2,250 inpatients will mean every individual is given a hospital discharge date or a plan to move them closer towards one.

The decision comes after a report by parliament’s joint committee on human rights, which said mental health legislation must be overhauled to stop the ‘horrific’ and inappropriate detention of young people with autism or learning disabilities.

The report said the human rights of many young people were being breached in mental health hospitals and called for the criteria for detention under the Mental Health Act to be narrowed.

Nurse safety: boosting numbers 'helps protect against aggression or harassment'

Staff safety found to increase when registered nurse numbers are higher than the clinical requirement

The risk of staff experiencing aggression from patients in mental health settings is influenced by how many registered nurses are on shift, a new study has revealed.  

Researchers from Birmingham City University (BCU) reviewed incidents of patient aggression in inpatient settings, recorded between September 2014 and March 2017, by an NHS mental healthcare provider in England that offers acute and community services. The data were culled from 10 locations (totalling 51 wards) and across the early, late and night shifts. 

They found that fewer incidents were reported by all staff groups when nurse numbers were higher than the clinical requirement, which is calculated according to the condition and number of patients admitted to wards.

Over the time period, 6,520 incidents of aggression by patients towards staff members were reported, affecting 12,138 members of staff.   

A total of 1,762 events characterised as ‘inappropriate behaviour’ were logged, affecting 4,058 members of staff.

There were 298 events classed as ‘sexual incidents’ reported, affecting 493 members of staff.

The study authors analysed the data and found that, on aggregate, each additional registered nurse on the early and late shifts led to a 9% decrease in adverse events reported.

More staff reduces rate of adverse events

BCU’s senior research fellow in health and social care, and one of the study’s authors, Sarahjane Jones, said: ‘There is strong evidence that having more registered nurses to, or above, the clinically required levels does reduce the rate of adverse events.

‘However, this is not consistent across all locations and all shifts, so the message would be that we need to understand what goes on in the wards and shifts. It isn’t a one-size-fits-all approach.

‘These findings offer an opportunity for a tightening-up of policy on workforce safety and retention.’

Responding to the findings, a Department of Health and Social Care (DHSC) spokesperson said: ‘No one should have to face the threat of violence or aggression at work.’

They added that the interim NHS People Plan outlines steps to reduce vacancies, and that the department was committed to increasing the nursing workforce.

There are now 36,101 mental health nurses in the NHS, said the DHSC spokesperson, adding that this was more than 750 than in June 2017. 

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Nurses cannot routinely use mental health support service – despite claim they could

Government backtracks on health secretary Matt Hancock’s Twitter statement

The government has confirmed that a mental health support service for NHS doctors and dentists in England will not be routinely available to nurses – despite the health secretary tweeting that it would. 

The NHS Practitioner Health service was set up last year to provide confidential support for NHS doctors in London if they felt they were struggling with their mental health. This service has now been expanded and is available across England for NHS dentists as well as doctors. 

Conflicting information from the government

Health secretary Matt Hancock claimed on social media that the expanded service would also support nurses and other NHS staff.

However, the Department of Health and Social Care (DHSC) subsequently clarified that this was not the case.

Encouraging nurses to seek help

An DHSC spokesperson said: ‘Nurses and all other NHS staff are encouraged to access mental health services local to them, but can contact NHS Practitioner Health if they feel they have nowhere to turn and the service will aim to signpost them to the most appropriate help.

'We want all staff to feel supported at work, and the upcoming NHS People Plan will put the well-being of all employees across the health service at the heart of ensuring the NHS is a great place to work.’

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School Nurses - Does Their Compensation Match Their True Worth?

The National Association of School Nurses defines school nursing as "a specialized practice of nursing, that protects and promotes student health, facilitates optimal development, and advances the academic success" of its population. There are many areas in which in the community in which the school nurses serve, but none more important than the vital role they play in the lives of our youth. Are school nurses compensated appropiately for their responsibilities? Read this article and then decide.

School nurses have always been one of the most diverse and unique subspecialties in nursing throughout the decades. While the specific job responsibilities and pay may have changed some, the mission and purpose of the job remain constant. The National Association of School Nurses defines school nursing as " a specialized practice of nursing, that protects and promotes student health, facilitates optimal development, and advances the academic success" of its population. First and foremost I want to stress the many areas in which school nurses serve the community, the vital roles they play with our youth today, and the challenges that come with those roles. As we dive into the 2018 allnurses.com salary survey results we can see trends in the field of school nursing such as salary comparisons, full or part-time hours, years of experience etc. Are school nurses compensated for their responsibilities appropriately? I will let you decide.

Let me start by saying that I am not a school nurse. I am a nurse that has worn many hats in my 20+ year career, but school nursing is not one of them. I will say, however, that I have ALWAYS wanted to be a school nurse. As a child, they were the nurses that I had the most exposure to on a daily basis. They seemed to always play a huge role in the school's day-to-day function. I was awed by what school nurses knew, the fact that they teach AND practice medicine to hundreds of students, staff, and visitors. They were so organized, knew who to call and when and what was a true emergency. At the end of the day, they knew that sometimes we just needed a hug, a listening ear, and some TLC.

I decided to be a nurse because of my school nurses. After nursing school, it was apparent that I needed to get experience before applying to work as a school nurse. So I did. When the "right time" in my career came to jump in, I realized that school nurses love what they do! They don't leave their jobs until they retire and I can't say I blame them. So my career and calling as a nurse went in different directions. Then, my admiration for school nurses was taken to a new level when I became a mother to three little hooligans, who, despite my best efforts grew up and started school.

I was about as much of a wreck as any other mom on our first child's first day of school. He is still to this day, at 12 years old, our clumsiest child, peanut allergy laden, and asthmatic. This added to my anxiety by sending him to school, epipen and all. No joke, on the FIRST day of school, I got a call from his teacher to tell me that my son had walked into a wall and had a large goose egg on his head. I was then asked by the teacher what did I want her to do with him. What? I said...well, if you think he needs attention, send him to the school nurse. That's when I found out that, in our school district, a school nurse visits each school only one day a week and serves up to 4 or 5 schools! During that day, the nurse's job consists of managing paperwork and teaching teachers how to give kids their medicine's, perform CPR, manage seizures, anaphylaxis etc., until emergency personnel arrives. SAY WHAT??!!

Since that day, I have become a school nurse advocate extraordinaire. I believe in my heart of hearts that school nurses serve as one of the most important members of our community. Their job is so broad, ever-changing, and wide-reaching, that it cannot be compared fairly to any other in the field of nursing. They work as health educators and medical and mental healthcare professionals. One would think that school nurses would be one of the most valued members of a school system and the community as a whole, which would then lead to appropriate compensation, respect, and funding. Boy, was I wrong.....

I was shocked with several statistics that I discovered in writing this article, but this is one of the most profound to me. According to the Centers for Disease Control 2017, 18% of schools have NO school nurse at all or serve in a part-time capacity, and over 55% of schools have nurses responsible for 2 or more schools at a time! As parents, we send our kids to school entrusting that they will be in a safe, cared for environment. If, in the worst case scenario, they need medical attention for a chronic illness or an emergency such as injury or life-threatening condition that the school would be staffed to handle the situation. Obviously, this is not true for many of us. How are teachers and school administrators expected to care for these needs? Teachers are educated in teaching. Administrators are educated in administration and education. Nurses are educated in healthcare, health education, and medicine. Simply put, teachers and administrators are not nurses and should not be responsible or accountable for that role.

According to the U.S Health Resources and Services Administration (2016), over 20% of students that are enrolled in school, enter with a chronic health condition. Such chronic diseases as diabetes (with complicated glucose management systems), seizures, asthma, and of course allergies, (the dreaded food allergies included) are just a few examples off hand. School nurses are able to trend patterns seen with these conditions and can play a major role in student's disease management through collaboration with pediatricians, specialists, parents, pharmacies, and community health staff. They can safely administer prescribed medication and assess and intervene if necessary. When/ if an emergency arises, they can communicate effectively with other medical personnel and start care immediately which can be crucial in many situations.

Let's talk about mental health in children. Many mental health disorders are not "officially" diagnosed until children are school-aged or older based on patterns in behavior, grades, and social situational responses. Collaboration with teachers, school nurses, pediatricians and mental professionals is pivotal in providing quality outcomes for these kids. School nurses participate, initiate and intervene in the treatment and management of ADD, depression, bullying, suicidal behaviors and autism, just to name a few, common mental health issues seen in schools today. Roughly â…“ of visits to the school nurses are mental health related. School nurses get to know the children and family situations they serve. From a community health perspective, think of the impact they have on children who may be abused, neglected, malnourished or lack adequate healthcare. Early intervention can prevent further mental health crisis down the road. Nurses are trained in the management of factors that come with mainstreaming children with mental health disorders. This is one area of education that is ever changing and can be very challenging for teachers and staff.

Education is a key job responsibility for school nurses. They educate staff regarding health care issues of students and other staff. They participate in producing policies and procedures for environmental safety emergencies both outside and inside the school building. They educate students about maintaining their own health and wellness, diseases, social pressures, mental health, and community health concerns. They educate parents and caregivers on issues affecting their children such as diseases, immunizations, and concerns noted by school staff.

This of course, is just a broad overview of some of the vital roles school nurses play in schools and the community at large. With the amount of responsibility placed on these nurses and the number of "patients" they serve each day, lets venture into some of the statistics from 2018 allnurses.com survey such as salary versus hourly pay rates per state/ regions, number of years as a nurse and years of experience in current job title (school nursing).

OK...shocking statistic #2 for me....according to results from the 2018 allnurses Salary Survey, the average pay for a full-time school nurse is only $37,164 for hourly employees and $51,043 for salaried employees. The hourly pay per year feels very low to me given the responsibilities of a school nurse at large. Keep in mind with the next set of values, that for some states only a handful (sometimes only 1), school nurse answered the survey representing their respective state. Some of the highest paid school nurses reside in the states along the west coast and northeast coast. For example, New Jersey hourly paid school nurses make an average salary of $50K per year and salaried nurses make an annual salary of $67K per year. The Texas nurses that responded to the survey were all annual salary based and average $50K per year. This is a sharp comparison to Montana (who only had 1 nurse take the salary survey) making $20K as an annual hourly salary and Georgia with a few more responders making an average hourly salary of $25K per year and an annual salary of $15K per year! This made my brain spin and my stomach upset!

I began to think about how much experience school nurses have and whether this plays into the average pay rates. As I suspected most of the respondents have 5 to 35+ years of career-long nursing experience. As far as the number of years in their current job, those numbers were pretty evenly spread over the span of less than one year to more than 10 years. I wonder whether this number spoke more to years as a career school nurse or years in their present job as a school nurse. Of the school nurses that responded, 99% were women. I further polled the allnurses' school nurses and asked about whether they work year-round or have the summers off. The majority of school nurses do keep their summers off to vacation or spend time with families etc. Some work part-time at their schools and other work in the hospital or as camp nurses during the summer.

In wrapping this up, I have come full circle to where I began with how much I love school nurses. I admire them now more than ever, knowing how much they balance and the grand scope of their practice. I am grateful beyond words for the people who watch over our children as though they are their own. Those who put bandages on our children's wounds both internal and external. Those who watch, listen and truly hear our children and their needs. Those who advocate for our kids individually, school-wide, statewide, and nationally. School nurses are vital to our children and the community's health and welfare. So do we compensate them fairly based on those roles and responsibilities? For those states and counties where schools either don't have nurses or have them part-time or less, we need to look for creative ways to fund full-time nurses in our schools. We need to advocate and speak up for our children. As our nation's healthcare needs evolve and change over time, we have a responsibility to provide a voice for those without one......just as school nurses have done for our children for decades!

As a side note, there are so many more aspects to the discussion of school nursing as a career in terms of roles, challenges, more pertain thought-provoking questions regarding the number of hours worked per day, degrees most commonly held, whether CNAs or LPNs can fill some of the gaps, continuing education requirements etc. Please add more to the conversation!

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