State of the World’s Nursing Report-2020

In a week and a day on the 12th of May 2020 it will be the bicentennial of Florence Nightingale’s birth. This year as always the International Council of Nurses (ICN) leads global celebrations on International Nurses Day, the anniversary of the birth of nursings most famous pioneer. This year the celebrations should have been “extra special” because 2020 has been designated the Year of the Nurse and Midwife by WHO but it really is the year of the nurse for much more sombre reasons. In the UK has now become more dangerous than being in the army.  https://www.nursingtimes.net/news/workforce/in-memory-a-list-of-nursing-staff-who-have-sadly-died-from-covid-19-20-04-2020/ 

If you are a nurse though what has probably passed you by completely is a landmark publication by the WHO’s State of the World’s Nursing Report 2020, which should have been one of the highlights of the year. So it has now been published and its interesting although somewhat depressing to look at. This is some of what it says.

  • The global shortage of nurses, which was estimated to be 6.6 million in 2016, had decreased slightly to 5.9 million nurses in 2018. An estimated 5.3 million (89%)
    of that shortage is concentrated in low- and lower middle-income countries, where the growth in the number of nurses is barely keeping pace with population growth, improving only marginally the nurse-to-population density levels.
  • Countries with lower numbers of younger nurses (ie under 35), like the UK and many other westernised economies  will have to increase graduate numbers and strengthen retention packages to maintain current access levels to health services.
  • To address the shortage by 2030 in all countries, the total number of nurse
    graduates would need to increase by 8% per year on average, alongside an improved capacity to employ and retain these graduates.
  • 78 countries reported having advanced practice roles for nurses. There is strong evidence that advanced practice nurses can increase access to primary health care
    in rural communities and address disparities in access to care for vulnerable populations in urban settings.
  • One nurse out of every eight practises in a country other than the one where they were born or trained.
  • Nursing remains a highly gendered profession with associated biases in the workplace. Approximately 90% of the nursing workforce is female, but few leadership positions in health are held by nurses or women. There is some evidence of a gender-based pay gap, as well as other forms of gender-based discrimination in the work environment.

The report suggests 10 key actions to address these international nursing problems.

  1. Increase funding to educate and employ at least 5.9 million additional nurses worldwide
  2. Strengthen capacity for healthcare workforce data collection, analysis and use.
  3. Nurse mobility and migration must be effectively monitored and responsibly
    and ethically managed.
  4. Nurse education and training programmes must produce nurses
    who drive progress in primary health care and universal health coverage.
  5. Nursing leadership and governance is critical to strengthening the workforce.
  6. Planners and regulators should optimize the contributions made by nurses to make use of their full scope of practice.
  7. Countries must provide an enabling environment for nursing
    practice to improve attraction, deployment, retention and motivation of the nursing
    workforce.
  8. Countries should deliberately plan for gender-sensitive nursing workforce
    policies.
  9. Professional nursing regulation must be modernized.
  10. A huge amount of collaboration, more than we have ever witnessed before is required to achieve key actions 1-9.

The report concludes that if the investment in nursing is made then the returns for societies and economies can be measured in terms of improved health outcomes for billions of people, creation of millions of qualified employment opportunities, particularly for women and young people, and enhanced global health security.

The full report can be accessed at: https://www.who.int/publications-detail/nursing-report-2020

A summary in English of the report, which this Blog has been based on is available at: https://apps.who.int/iris/bitstream/handle/10665/331673/9789240003293-eng.pdf

The case for investing in nursing education, jobs and leadership is very clear when you read this. Relevant Governments, professional organisation and all  stakeholders must commit to taking action.  SOON… the clock is already ticking.

April @BloggersNurse Challenge: the Retention of Healthcare Staff

Last week I said I’d look at the topic of retention and said that would be interesting once this lockdown phase of the COVID-19 story passes. However, before we get to my thoughts on this you need to understand the context.

So rather than give a history lesson this article by Poly Toynbee in the Guardian on the 25th April does a much better job than I would ever do. See https://www.theguardian.com/commentisfree/2020/apr/24/year-nurse-tories-10-years-bad-care-nhs-crisis

As Poly says

…retention isn’t difficult, there is nothing insoluble about it. Pay them decently, give them as clear a career path ahead as doctors enjoy, and see what happens.

So getting beyond the politics of a pay rise, cancelling healthcare workers student debt, improving healthcare workers working conditions and terms of employment and providing a career path that includes recognition of health care workers in the care home and social care sectors… what does the professional literature suggest.

In a systematic literature review published last year Brook et al (2019) looked at the issue of retaining early career nurses. Early career nurses are important because it is in the transition from student to registered nurse that that the losses to the profession are at their highest.

So what did they say about retaining staff in the first year of practice. Firstly, employers have to offer a transition to practice programme. The form that the programme takes, be it preceptorship, mentoring programmes, residency programmes, internships, externships,orientation to practice programmes or clinical ladder programmes is not as important as having one in place. That is because of the message that it sends out; that the organisation by doing this is indicating the importance attached to their newly-qualified staff and this alone is enough to positively influence recruitment
and retention; especially if the organisation is perceived to be investing in the workforce to a greater extent than competitors.

Interventions with the highest benefit appear to be an internship/residency programme
or an orientation/transition to practice programme that incorporates formal teaching, a preceptorship element and possibly the addition of a mentorship element. They suggest that programmes need to last 27–52 weeks in duration. These findings align with
support that is already offered in USA, Canada and Australia. In the UK preceptorship and mentorship are embedded in our culture so we may be starting from a good position.

Unfortunately most of the studies done looking at this topic have been done in high income economies. The quality of their findings have also been affected by inconsistent and incomplete description of the interventions, missing detail of some components of the intervention and variations in methods of evaluation across the studies Brook et al (2019) reviewed indicating that many of the studies on this topic so far were not conducted using rigorous research methods of evaluation. The quality of this review, like many others has been  limited by the quality of the study reports that are available.

What is of interest is not the interventions but a need to refine and review already established transition programmes. If the programmes focussed more on the elements of teaching, preceptorship and mentorship and considered how these added to the new staff nurses experiences then more successful programmes might result. However, variation in the quality of mentors, preceptors and teaching are bound to affect the outcome of support programmes; so Brook et al (2019) suggest reviewing these before you start out.

The full review is available and published as follows

Brook, J., Aitken, L., Webb R., MacLaren, J., Salmon, D. (2019) Characteristics of successful interventions to reduce turnover and increase retention of early career nurses: A systematic review, International Journal of Nursing Studies, Volume 91, Pages 47-59,
ISSN 0020-7489.
https://doi.org/10.1016/j.ijnurstu.2018.11.003

Unfortunately it does not appear to be open access.

So to the UK response to Coronavirus. Effectively all 4 nations in the UK have just sent all their students out into practice prior to completing their education at a time of crisis. It is not likely that the usual transition programmes that most hospitals and employer they are being sent to are running, or will be in place for them, or even considered, until this lockdown ends and something like ‘normal’ service is resumed.

What happens this month and over the next few months may well shape the outcome of hundreds of new students attitudes towards their profession. Are they going to transition well into their new roles with more limited support? Will the NHS and other employers consider offering better support to those who have commenced ‘early’ to help them out in the current situation? Will the Government follow through on the plans it says it has to better support and reward front-line health and social care staff? Will the COVID-19 situation encourage people to join health and social care professions or will it put them off?

I really don’t have the answers to the above questions. We will just have to wait and see… but I am worried already and angry at how depleted the nursing workforce has become and how badly the successive Conservative governments have treated Nursing and  other AHP professionals.

If nothing else, its time to change or my profession will become less attractive and the recruitment and retention problems existing at the moment will only worsen.

(You can follow me on Twitter @uwsraymondduffy)

 

Who Said That an Ageing Population is a Bad Thing?

I’ve missed another week, but here I am back again. This week I am bringing a new report by The International Longevity Centre (ILC-UK) called “Maximising the Longevity Dividend”.  While older people and an ageing population are often painted as a risk to our economy, this new research shows that the UK’s ageing population brings economic opportunities through older people’s growing spending, working and earning power.

Their research has found that households headed by someone aged 50+ have dominated total expenditure (excluding housing costs) since 2013. And spending by older consumers will continue to rise significantly over the coming decades, from 54% (£319 billion) of total consumer spending in 2018 to 63% by 2040 (£550 billion).

Those 50+ also shift their spending towards non-essential purchases such as leisure, transport, household goods and services.

People aged 50+ are also making an increasingly significant contribution to the economy by continuing to work.. The share of the workforce aged 50 and over rose from 26% in 2004 to 32% in 2018, and it could account for 37% by 2040. People aged 50 and over earned 30% of total earnings (£237 bn) in 2018 and this is expected to rise to 40% by 2040 (£311 bn). The ILC have said that supporting people aged 50 and over to remain in the workforce could add an additional 1.3% to the UK GDP a year by 2040.

To read and download the report CLICK HERE.

AS David Sinclair, Director of the ILC, says

As the population ages there are enormous economic opportunities, but these are currently being neglected. We’ve become accustomed to hearing our ageing population talked about as a bad thing – but the reality is it could be an opportunity. However, we won’t realise this ‘longevity dividend’ through blind optimism about ageing. Instead, we need concerted action to tackle the barriers to spending and working in later life.”

New Website for @RealisticMed Launched

A new website dedicated to practising Realistic Medicine has been launched this week. Realistic medicine refers to putting the person receiving health and social care at the centre of decisions about their care and creates a personalised approach. It encourages health and care workers to find out what matters most to their patients and clients so that the care of their condition fits their needs and situation. Realistic medicine recognises that a ‘one size fits all’ approach to health and social care is not the most effective approach for the patient or for the NHS.

Its important to older people because it encourages services to adapt to the way in which people with multiple, complex and frequently changing conditions require to access care and support. Those people are primarily over 65. Current models of healthcare services are stretched and there is need to re-examine how we can deliver person-centred and integrated healthcare that embraces both statutory and non-statutory agencies. Cath Calderwood, the Chief Medical Officer for Scotland has said, realistic medicine involves

  • Listening to understand patients problems and preferences;
  • Shared decision making between healthcare professionals and their patients;
  • Ensuring that patients have all the understandable information they need to make an informed choice;
  • Moving away from the ‘doctor knows best’ culture to ensure a more equal partnership with people;
  • Supporting healthcare professionals to be innovative, to pursue continuous quality improvement and to manage risk better;
  • Reducing the harm and waste caused by both over-provision and under-provision of care;
  • Identifying and reducing unwarranted variation in clinical practices

The new website which you can access HERE, features resources, good practice case studies and the contact details of Realistic Medicine Leads within the NHS Scotland Boards.

Are You Ready for 64? What about 86 and Maybe More?

I quite liked this as an introduction to this weeks topic. Today’s fifty-year-olds are likely to have an astounding 36 or more years to live. So if you’re approaching later life, you need to think very differently about what those extra years will hold.

So two things that you will have to consider in this weeks. A plan for your future at work and help in achieving the goal of a fabulous later life. Interesting you can find guides to both on the Centre for Ageing Better’s website this week.

Firstly they have published a new report on Employers, suggesting that they should do more for workers in their 40s and 50s to help them plan for the future.To read more about their findings and to download the full report follow THIS LINK 

The Centre for Ageing Better says

…providing mid-life support is an essential part of how employers can respond to the changing nature of the workforce. Workers over the age of 50 now make up a third of all UK workers, but there are more older people leaving work than younger people coming in to replace them. Supporting staff to plan ahead could help employers avoid potential staff and skill shortages, as well as ‘cliff edge retirements’ where people are working one day and stop work entirely the next.

The second item is a new book that the Centre helped to produce called When We’re 64 by Louise Ansari

The book is a friendly, practical guide to preparing for what could be the best years of your life – from the essentials on work and how to fund retirement, to volunteering, where to live and what kind of housing you’ll need The book aims to provide knowledge, tips and pointers to help you think very differently about opportunities that a long life can bring. You can find out more about the book and how to purchase it by CLICKING HERE. 

More Than 10% of the #UK Population Live in Persistent Poverty

Today the Social Metrics Commission,  founded in 2016 to develop a new approach to poverty measurement because the UK no longer had an official measure of poverty for children, adults or pensioners has published its latest report on UK poverty today

In developing a new set of metrics, the commission wanted metrics that better reflected the nature and experiences of poverty and one which could be used to build a consensus around poverty measurement and action in the UK. So what are they saying this year?

Let’s start by considering the UK total population which was 66.04 million people in 2017 (The most recent accurate estimate).

The key messages in this report indicate that ƒthere are 14.3 million people in poverty in the UK. This includes 8.3 million working-age adults; 4.6 million children; and 1.3 million pension-age adults.ƒIndicating that despite  minor fluctuations, overall rates of poverty have changed relatively little since 2000.

The current rate of poverty is close to 22%, which is the same as last year and only slightly lower than the 24% seen in 2000/01.

However, this trend hides significant changes in rates of poverty among different groups. Poverty rates in pension-age adults fell steadily from 19% in 2000/01 to 9% in 2014/15 but have since risen slightly to 11%.

Similarly, poverty rates among children dropped from 36% in 2000/01 to 31% in 2014/15, but have now risen slightly to 34%.ƒ

On average, those in poverty have moved closer to the poverty line now than would have been the case in 2000/01. However, a third (31%) of people in poverty – 4.5 million people – are more than 50% below the poverty line, and this proportion has not changed since the millennium.

7 million people are living in persistent poverty meaning they have been in poverty for at least two of the previous three years and are still in poverty now with not much chance of an escape given the current economic situation. 

Remember this is the UK has the 5th largest economy in the world by GDP

Two questions pensioner poverty is going up, why? Child poverty is not coming down despite several government attempts to tackle it over the years.

Some thing new the report shows; nearly half of people in poverty live in a family where someone is disabled. This is shocking, and has clearly been overlooked by government for many years. Surely this need to be addressed

To access the full report CLICK HERE

One in Five UK Hospital Patients are Harmful Drinkers

A team mainly from Kings College in London conducted as part of the first author’s MRC Addiction Research Clinical (MARC) Fellowship, has found that 1 in 5 in-patients in the UK hospital system uses alcohol harmfully, and that 1 in 10 is alcohol dependent.

They conducted a systematic review and meta-analysis that looked at studies of any design that reported the prevalence of one of 26 wholly attributable alcohol conditions defined by the WHO’s International Classification of Diseases, Version 10 (ICD‐10).

They looked at 124 studies which were all conducted in one or more of the constituent nations of the United Kingdom and in an in‐patient setting (general wards, intensive care units, accident and emergency departments or mental health in‐patient units). The 124 studies meant that they were reporting on a total of 1 657 614 patients.

Having arrived at what is a shocking statistic they have rightly suggested that hospital staff need to be skilled in the diagnosis and management of alcohol‐related conditions given the number of people that they will see as inpatients. They have also pointed out that formal screening for alcohol‐related conditions in hospital remain low and that needs to change

Given the fact that other less prevalent diseases such as diabetes, are routinely screened for and often have dedicated in‐hospital specialist care teams their study provides weight  for increased routine universal screening and support to improving everyone’s training concerning alcohol‐related conditions given this high frequency of encounters.

This study is very pertinent given the UK government’s development of a new alcohol strategy and the NHS 10‐Year Plan which included funding allocations to combat alcohol‐related conditions.

Last year figures suggested that at least 41 English hospitals do not currently have an alcohol care team (ACT’s) in place. This is despite the 10 year plan including a commitment to place ACT’s in hospitals with the highest rate of alcohol dependence-related admissions (according to this study that will be all of them!) although the plan for increasing ACT’s, does not seem to have to any material funding.

To view the whole report see

Roberts E, Morse R, Epstein S, Hotopf M, Leon D, Drummond C. The prevalence of wholly attributable alcohol conditions in the United Kingdom hospital system: a systematic review, meta-analysis and meta-regression. Addiction. 2019 Jul 3 [Epub ahead of print]. doi: 10.1111/add.14642. PMID: 31269539