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Nearly a third of nurses are quitting due to stress or declining mental health

Poor staffing levels and Brexit were also cited amongst the top reasons for quitting.

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Nursing and midwifery numbers are at an all-time high.

A report, published today by the Nursing and Midwifery Council, reveals that nearly a third of nurses are leaving the profession due to stress or declining mental health.

‘The NMC Register’ data report explores the numbers total number of nurses, midwives and nursing associates joining and leaving the register between 1 April 2018 and 31 March 2019.

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While the report reveals an overall increase in the total number of registered nurses, midwives and nursing associates, healthcare leaders warn it also highlights a number of major concerns.

Stress, declining mental health and poor staffing levels were cited amongst the top reasons for quitting the profession. News that comes only a week after official figures revealed hundreds of nurses have taken their own lives in just seven years.

The report also shows a continued decline in the number of EU nurses coming to the UK, with over half of those leaving saying Brexit is a contributing factor.

‘The dam is starting to burst’.

Dame Donna Kinnair, Chief Executive and General Secretary of the RCN, said: “Any boost to the register is good news but looking behind the headlines raises further concerns.

“Politicians should be alarmed by the finding that almost one in three quit nursing because of intolerable pressure. They have abused the goodwill of nurses for too long and that dam is starting to burst.

“The modest increases are not of the scale or kind needed to meet demand and the workforce crisis isn’t abating. It is inappropriate to rely on a steady stream of nurses from beyond the EU, which seems to be the plan in England in particular.

“The official figures reveal a big net loss in European nurses, with fears over Brexit cited as the main reason for leaving and partly driving efforts to recruit from even further afield.

“Every country of the UK needs a serious strategy for the domestic workforce to recruit, train and retain a new generation of nurses and have accountability set in law.”

‘EU nurses feel they’ll be better off elsewhere’.

Sara Gorton, UNISON’s Head of Health, said:  “The referendum result has made many EU nationals feel unwelcome. It’s no surprise nurses and midwives think they’ll be better off elsewhere. Not enough has been done to reassure European workers that they’ll have rights, jobs and a future after Brexit.

“The small rise in the number of home-grown nurses is heading in the right direction, but it’s a drop in the ocean compared to what’s needed.

“Without proper funding and bold new ideas, experienced professionals from within the UK and across Europe will continue to leave, putting further pressure on the struggling health service.

“The government should be investing in large-scale apprenticeship programmes to train up existing NHS staff who can’t afford hefty study fees. People who know the NHS already would make great nurses and are more likely to stick around.”

‘Another warning shot’.

Commenting on the report, Andrea Sutcliffe, Chief Executive and Registrar at the NMC, said: “Nurses, midwives and nursing associates make an enormous contribution to the health and wellbeing of millions of people each year so I’m delighted to see such an increase in those joining our register.

“It’s encouraging to know this is being driven by both UK trained and overseas professionals. It’s clear the changes we’ve introduced – to make it more straightforward for those people with the right skills and knowledge to come and work here from abroad – are making a real difference.

“However, we only have to look at the well documented concerns around high vacancy and turnover rates that exist right across health and social care to know there’s a long way to go before we have all the people we need to ensure the best and safest care for everyone.

“And while there has been a drop in the number of people leaving the register, our survey fires yet another warning shot – that the pressures nurses and midwives face are real and must be taken seriously if we are to properly attract, support and retain the workforce that we need now, and for the future.”

Clinical Care

Hourly rounding ‘may not be the best way for nurses to deliver care’, finds study

Hourly rounding places an emphasis on ‘tick box’ care.

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Hourly rounding made a minor contribution, if at all, to the way nurses engage with patients.

A new report by researchers at King’s College London has found that the widespread practice of hourly or intentional rounding, may not be the best way for nurses to deliver care to patients.

The report also found that rounding makes a minor contribution, if at all, to the way nurses engage with patients.

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Hourly or intentional rounding involves standardised regular checks with individual patients at set intervals and was introduced in hospitals in England in 2013, with 97% of NHS acute Trusts in England implementing it in some way.

The majority of NHS trusts adopted the ‘4Ps’ (Position, Pain, Personal needs, Placement of items) model of rounding.

The research was commissioned and funded by the National Institute for Health Research (NIHR) and was led by Professor Ruth Harris in the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care.

Hourly rounding places an emphasis on ‘tick box’ care.

The NIHR report – Intentional rounding in hospital wards to improve regular interaction and engagement between nurses and patients: a realist evaluation – is the first study of its kind in the world.

The study found that rounding placed an emphasis on transactional ‘tick box’ care delivery, rather than individualised care. However, patients were found to value their interactions with nursing staff, which the study argues could be delivered during other care activities and rather than through intentional rounding.

The report also found that rounding was implemented without consultation, careful planning and piloting in the interests of political expediency following the Francis Inquiry Report into care failures in the NHS.

Ruth Harris, Professor of Health Care for Older Adults at King’s College London, said; “Checking patients regularly to make sure that they are OK is really important but intentional rounding tends to prompt nurses to focus on completion of the rounding documentation rather than on the relational aspects of care delivery.

“Few frontline nursing staff or senior nursing staff felt intentional rounding improved either the quality or the frequency of their interactions with patients and their family.”

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Clinical Updates

Nurses’ ‘worry’ better than most early warning scores, finds study

Nurses were asked to grade patients between ‘no concern’ and ‘extreme concern’. 

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Observations

A sense of worry can provide important information for the detection of acute physiological deterioration.

Nurses’ worry has a “higher accuracy” than most published early warning scores (EWS) at predicting if a patient is becoming more unwell, according to a recent study.

The study looked at 31,159 patient-shifts for 3185 patients during 3551 hospitalisations across two surgical and two medical wards. Researchers compared if the nurses were worried about a patients potential for deterioration using ‘the Worry Factor’ with early warning score indicators.

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Nurses were asked to grade each patient between “no concern” and “extreme concern”.

The Worry Score

Out of 492 potential deterioration events identified, researchers found that when nurses had an increasing worry factor the patient was more likely to require emergency medical treatment – 7 cardiac arrest calls, 86 medical emergency calls and 76 transfers to the intensive care unit.

The study also revealed that accuracy rates were significantly higher in nurses with over a year of experience.

The researchers concluded that “nurses’ pattern recognition and sense of worry can provide important information for the detection of acute physiological deterioration” and was often more reliable than traditional early warning systems.

They also noted that the worry score could be used alone or easily incorporated into existing EWS to potentially improve their performance.

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