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)

 

#britgerontology Statement on COVID-19

Well, I said I thought I would post something about Coronovirus in my next Blog, so I’ll keep my promise.

This however does not come from me this is the statement released on the 20th. of March 2020 from the President and Members of the National Executive Committee of the British Society of Gerontology which I am a member of. This statement was made in relation to the unfolding political, policy and media rhetoric concerning age divisions that have emerged during the response to the COVID-19 pandemic which I have at times found quite concerning. My apologies about the length of the statement but it makes some excellent points that we should all consider during this worrying time.

The statement urges Government to reject the formulation and implementation of any policy based on the simple application of chronological age. The BSG call on government and media organisations to be cautious in their use of language so that we continue to foster generational and societal cohesion during the course of the pandemic. Only by bringing the generations together in this time of crisis can we ensure that the least damage is done to people living in the UK and other countries. The statement goes on as follows:

“We affirm the prime goal to control and limit as far as possible the spread of COVID-19. To achieve this goal requires a clear focus on evidence-based practice, using high quality research. We fully support action taken to limit physical interactions, maintain hygiene standards and restrict non-essential travel, and we understand that actions to contain and delay infection will require disruption to our everyday lives.
We urge the Government to ensure rapid COVID-19 testing for our front-line health and social care workforce and the wide range of individuals and organisations who are leading the response to the pandemic. We are also in favour of providing tests for the wider population. This allows people to respond appropriately to the pandemic, ensuring that the right people isolate themselves at the right time. Wider testing is also essential to provide access to robust data that can be used for research and modelling to assist us now in responding to and containing the virus, and in preparing better for future pandemics.
However, for the reasons set out below, we object to any policy which differentiates the population by application of an arbitrary chronological age in restricting people’s rights and freedoms. While people at all ages can be vulnerable to COVID-19, and all can spread the disease, not all people over the age of 70 are vulnerable, nor all those under 70 resilient. Older adults are actively involved in multiple roles, including in paid and unpaid work, civic and voluntary activity in local communities, and providing vital care for parents, partners, adult children and grandchildren. Quarantining the more than 8.5 million people over 70 years of age will deprive society of many people who are productive and active and who can be a key part of the solution by supporting the economy, families and communities. If blanket measures are taken to quarantine older people when others in the population are not quarantined, this places additional burdens on families, communities and businesses, and causes harm to those individuals.

  1. As a population group, it is wrong and overly simplistic to regard people who are aged 70 and above as being vulnerable, a burden, or presenting risks to other people. Many people in this age group are fit, well, and playing an active role in society. Older people participate in paid work, run businesses, volunteer, are active in civil society and the cultural life of communities, and take care of family members including parents, spouses/partners, adult children (especially those living with disabilities), and grandchildren. There are currently more than 360,000 people over 70 in paid work, including one in seven men between 70 and 75 and one in sixteen women. Almost one million people over the age of 70 provide unpaid care, including one in seven women in their 70s. One in five people aged between 70 and 85, over 1.5 million people, volunteer in their communities. People in good health are especially likely to volunteer at older ages with almost a third of those in their early 70s doing so. Older adults should not be excluded but should be seen as a vital and necessary part of economic and community life.
  2. Serious health risks particularly identified for coronavirus are prevalent across the population. Not only do high risks exist across age groups, but also many people in older age groups have no underlying health conditions. Almost half of people in their early 60s have one of a range of health conditions (hypertension, heart disease, diabetes, lung disease, asthma or cancer). Almost one in five people in their 60s have two or more of these conditions. More than 30% of people in their 70s have none.
  3. It may be correct that age itself on average is presenting a risk for coronavirus even without other health conditions. However, this will not be the case for all individuals, amongst whom biological age and immune responses vary greatly. More importantly, this will on average be a gradually increasing risk with any specific age being an arbitrary point on this line. Choosing an arbitrary age, such as 70, presents the age risk as binary. This poses dangers for people below as well as above the age threshold. People below the age threshold will not be charged with the same level of responsibility for preventing the spread of COVID-19 and may falsely believe that they are not at high risk of serious illness or death. Government messaging that people aged 70 and over are vulnerable due to their age runs the risk that other groups may not take seriously messages about the need to maintain physical distance from others and to self-isolate. Messaging about how to avoid catching and spreading coronavirus should apply to everyone irrespective of age.
  4. If people are to be motivated to change their behaviour, they need to accept that they are personally at risk (perhaps due to an underlying health condition or family circumstances). Sweeping age-related discrimination is unlikely to achieve the desired behaviour change. People who feel fit, strong and healthy will feel that the message does not apply to them and will characterise themselves as belonging to a group apart. The age-based messaging also risks pitting young against old. It may make older people feel resistant to what they are being told, which they do not see as applying to their situation. Media, government and public health professionals should strive to use language that resonates, rather than obfuscates, how people identify in their everyday lives.
  5. People of all ages, when staying at home or trying to distance themselves physically from others, remain members of families, friendship networks and communities. All measures should be implemented with an awareness of people’s need for social support and solidarity. It is clear that physical distancing needs to happen across the whole population at once, and sensible rules for maintaining mental and physical health during this period need to be employed. We cannot implement a policy that will severely weaken the physical and mental health of some age groups through isolation while others are more protected. Given the centrality of both mental and physical well-being, there is a need for clear guidance on what people can do to maintain and improve their physical and mental health while keeping physically apart from others. This will only be effective if the message from Government is not divisive around age.
  6. Research points to the fundamental importance of social connections for personal well-being and physical and mental health. The COVID-19 crisis has prompted considerable discussion of loneliness and social isolation amongst older people suggesting, quite wrongly, that these are vulnerable states that apply to older people alone. Increasingly, media discourse is also promoting the view that all older people are lonely and socially isolated. Contrary to this discourse, the evidence shows that loneliness and social isolation affect people of all ages. Recent studies suggest that young adults may be at greater risk of loneliness than older adults, with one in ten people aged 16-24 years being often lonely, compared to three per cent of people aged 65 and over. We also know that people can be lonely or socially isolated even when living with others. Loneliness and social isolation are already intractable social issues that warrant thought and action about connectedness and support across all age groups and communities. Evidence shows that being seen to be part of community life can act as a buffer against feelings of isolation, give people a sense of meaning in life, and protect against depression. Voluntary and community organisations, charities and statutory organisations should receive financial and structural support during this time to continue their longstanding work on tackling isolation and loneliness regardless of age. They should also be supported and encouraged to develop new strategies to improve the number and quality of people’s social connections during the current time. This should include using both old and new communication technologies, ranging from radio and TV to the internet and digital devices, to facilitate social connections between people of all ages. We should be thinking of this period as an opportunity to bring people and generations together, especially by helping to bridge digital divides across society where these exist.
  7. Living alone is a separate issue that has not been adequately considered or addressed. While this is an issue that disproportionately affects people aged 75 and over, especially older women, it affects all age groups and generations. About a third of men aged 80 and over are single, divorced or widowed, but this is the case for 70 per cent of women in this age group (see Table 4). There is an implicit assumption in much discussion about COVID-19 that people will have co-resident family members to look after them, to recognise that they are ill, to keep them hydrated, to help them if they are unable to get back to bed after going to the toilet, to try to encourage some nutrition or to call an ambulance. Co-resident family members can also advocate for hospitalisation or hospital care if needed. If people live alone and no-one is permitted to see them, who will do this? With a simple message to older people who live alone that they must cut themselves off from others, we are also conveying the message that we expect them to become ill without care and even die. Some countries have constructed and converted isolation centres to enable people with coronavirus to move to a place where they can be cared for appropriately, thus isolating them from families and friends but also offering access to care. There is an urgent need for clear policies aimed at supporting people who live alone of all ages. Equally, we need policies that can provide testing, intermediate care facilities (potentially requisitioning hotels, student accommodation, or office buildings), and tangible support for people who live alone.
  8. As well as health and social care workers, family and friends who will need to provide care to people who become unwell from the front line of society’s response to the pandemic and will need to be acknowledged and treated as such. For many people with families who they love and with whom they live or who live within close proximity, it is anathema to leave them to be severely ill, self-care in that state, and potentially die alone. Overwhelmingly, family members will provide hands-on care for one another. They will ignore entreaties to physically distance as they tend to their children, their spouses/partners and their parents and grandparents, knowingly taking risks as they do so. Families will do this for the loved ones they live with, and those they do not live with. To expect otherwise is to ignore the interconnectedness of families and the behaviour of people. Here, rather than tell families to ignore each other, we need to offer rapid testing, advice and supplies (masks where useful for intimate care, eye protection, gowns, gloves, sanitisers, soap). We should also beproviding financial support for people faced with additional costs associated with managing daily life when family members have coronavirus, such as keeping the washing machine running and purchasing cleaning and hygiene products. We need to ask people to isolate as connected clusters rather than keeping loved ones apart. We need to work with human behaviour and not against it.
  9. Special thought should be given to how people might connect with loved ones who live in care settings. Denying people the chance to see their friends and relatives where the physical and mental wellbeing of both depends on that contact, and where other forms of contact may well not be facilitated, is a most drastic curtailment of human rights and needs. Testing becomes crucial, to know who has had the virus, who may be immune, and who may be able to visit in a safe way without danger. Policy and practice should seek innovative ways for people to visit their loved ones virtually, or across physical or spatial barriers. We need to have a much more nuanced and evolving discussion of this particular challenge.
  10. Some common sense is also needed about so-called “self-isolation”. Socially isolating in a large house with a garden, good internet connection and a steady income is a completely different experience to socially isolating in a tiny flat, with no internet and under financial stress. Online food and other deliveries, which feature as a key policy response to coronavirus, are not an option for a large number of people, do not apply at all in many rural areas, and are already difficult to obtain as companies struggle to meet surging demand. We need to find a way to allow people to walk or cycle to local shops, to take exercise (for themselves and their pets), and to wave at one another and make social connections while maintaining a safe distance and observing hygiene requirements, without being singled out or intimidated. We need to think about sustainable policies, perhaps staggering who can go out for what purpose and when, how many people can be at particular places at a particular point in time, and national and reliable delivery of hand sanitisers to food shops and pharmacies on entry and exit. Maintaining physical and, especially, mental health whilst keeping people safe and well is a priority. Exercise, personal mobility and human contact are key to healthy ageing and need to be promoted long beyond the current pandemic.
  11. A key message from research on social aspects of ageing is that policy and practice should be attuned to the diversity of older people in countries like the UK. The older population is far from homogenous and differs substantially according to such characteristics as age, gender, ethnicity/race, sexual orientation, disability, socioeconomic status, marital status, household composition, place of residence and care roles. Given the diversity of older people, and the considerable social and spatial inequalities that characterise later life, broad-brush policy approaches based solely on chronological age are likely to disproportionately disadvantage some groups. They may also ignore the specific needs of marginalised groups of older people, including those who have particular health conditions, live in long-term care settings, are homeless, or are imprisoned. Research on ageing has made considerable progress in recent years in drawing attention to the heterogeneity of older people. It would be a highly retrograde step if this progress was undone by policy measures that reinforce the view that all people over a certain age share a particular set of characteristics.
  12. As well as preparing policies for living through this pandemic, we need to think about death, and the potential for death rates not witnessed for generations in the UK. We need sensible, realistic and emotionally supportive frameworks for attending funerals, and for coping with individual and collective grief. Such frameworks are needed regardless of the age of people coming to terms with loss.

In this unprecedented period, we call for urgent and ongoing data collection and rigorous analysis of social and economic inequalities, and of the impact of inequalities through this crisis on the living conditions of people, their mental and physical health, and mortality. We call for urgent policy action to redress these inequalities. COVID-19 is bringing into stark vision the impact of many years of politically motivated austerity policies that have substantially eroded health and social care services and community and voluntary sector support. The crisis demands an urgent reversal of these policies and calls for future investment in social as well as health care. In particular, we call for the social and domiciliary care workforce to be fairly treated. We call for them to be protected as front-line workers against this epidemic. We call for their high levels of skill to be recognised not only in the form of words, but also in terms of their pay, job security and working conditions.
If physical distancing policies are to succeed, they need to take account of who people are, how they perceive themselves, how they behave, and their emotional needs. Such policies will be difficult to police, and enforceable sanctions are hard to imagine. We need to carry the hearts and minds of the nation with us in the months ahead if we are to ensure the least physical interaction and least spread of the disease. The COVID-19 response emphasises more strongly than ever before the need for co-ordinated ageing policy that cuts across government departments.We note that policies identifying an arbitrary chronological age for restrictions of human liberties are out of line with approaches in other jurisdictions, including Scotland and Ireland. People of all ages are privileged with the same rights and policies need to be applied at population level.

Ageism – the stereotyping, prejudice, and discrimination against people on the basis of their age – has detrimental consequences for societies and individuals. We reject firmly the ageist and stereotypical assumptions that underly public and policy pronouncements that rely solely on the application of chronological age.

We close by declaring our strong support and admiration for clinicians making hard decisions, including, in due course, potentially about rationing life-saving resources. In anticipation of these, we stress that it is not possible for clinicians to make moral judgements about the value of human life based on age. Faced by the pressures of a pandemic, clinicians will in all likelihood know next to nothing about the lives of the people they are being asked to treat and cannot weigh one life against another. All clinical decisions for access to testing and treatment as they unfold should be made on clinical need; using age alone as a criterion for decision making is fundamentally wrong.”

“Five Wishes” and #YearoftheNurseandMidwife Gets Nearer

It is very rare for me to make a TV recommendation particularly since this one is only available via the BBC iPlayer   and therefore not internationally available yet. So for those of you that can, then you should take some time over the holidays to watch Five Wishes a programme marking the 50th anniversary of Scottish Ballet. This year they ran a very special project in Scotland, asking the public to make wishes that could only they could grant.

After hundreds of wishes, and thousands of votes, the final five were chosen and this is the documentary is the story of what happened next.

It follows the ballet troupe every step of the way as they make five unique wishes come true. From 11-year-old Lily battling with cancer to the Every Voice Choir in Dumbarton, these are stories of love, hope and courage – all told with a balletic twist. To view the programme click the link below.

https://www.bbc.co.uk/programmes/m000cwlb

As we approach the new year there are perhaps two more things I should mention. On the 23rd. of December 1919, the Nurses Registration Act was passed and so we have now had UK registration for 100 years!

The NMC have posted an interactive timeline that is a great reminder of some key moments in nursing history in the UK. To view this click HERE

For those of you who don’t know the World Health Organisation announced early in 2019 that 2020 is to be the International Year of the Nurse and the Midwife If you want to get involved go to WHO Get Involved and/or follow the hashtag  #YearoftheNurseandMidwife

Also, look out for the WHO’s State of the World’s Nursing in 2020 report to be launched in April which will provide a global picture of the nursing workforce and support evidence-based planning to optimise the contributions of nurses in improving health and wellbeing for all.

 

Looking Forward to 2020 and Looking Back

In 2015, the world united around the World Health Organisation (WHO) Agenda for Sustainable Development, pledging that no one will be left behind and that every human being will have the opportunity to fulfil their potential in dignity and equality. The following year they released their Global strategy and action plan
on ageing and health committing the member states to ensure the goals are applied as a response to population ageing and urging them to make efforts to further support Healthy Ageing.  Now as a response the WHO has set out 10 Priorities that are needed to achieve the objectives of their strategy and action plan and now we are about to embark on a decade of concerted action on the Decade for Healthy Ageing from 2020-2030. 

The 10 priorities make for interesting reading so a link to the WHO publication 10 Priorities: Towards a Decade of Health Ageing is HERE 

The link between the Sustainable goals for healthy ageing and the sustainable development goals is best explained HERE

More about the WHO’s work in Ageing and the Lifecourse can be found by watching the video and on this webpage which includes what they say about Age-Friendly Environments.

In a bit of a contrast to looking forward, there is a new exhibition at the RCN Library and Heritage Centre in London exploring the place of nursing within the care of older people in the UK, which has changed dramatically in the past two centuries. Created with the help of the RCN Older People’s Forum, Aspects of Age charts the shift from the days of Victorian workhouses to at-home care and future technologies. It also looks at how specialist nurses can help destigmatise old age.  Information related to the exhibition is available at the Aspects of Age exhibition page HERE 

You can also visit the exhibition at RCN headquarters in London from 11 April to 20 September, then at RCN Scotland in Edinburgh from October.

In Advance of Armistice Centenary Day

StJohnsAmbulanceBrigade Nuse
St John’s Ambulance Brigade Nurse 1914

This year Remembrance Day on the 11th of November will mark the 100th anniversary since the end of the First World War. As part of the commemorations, Britain and Germany are joining in a call for bells of all kinds to be rung globally (at 12.30 hrs GMT/13.30hrs CET/12.30 local time) to replicate the outpouring of relief when 100 years ago the guns finally fell silent. The US Centennial Commission has already made a similar appeal to Americans.

For other events and activities taking place to mark the Centenary the following website is useful, click here on  Centenary News.

Of particular interest to me is a  Royal College of Nursing (RCN) online exhibition showcasing the lives of nursing staff during the First World War, which won the Women’s Network History Award for 2018. Called “Service Scrapbooks: Nursing and Storytelling in the First World War” this project digitised and transcribed photographs poems diary entries and illustrations ranging for 1909 to 1919. To go to it click here

this new archive contains a collection of digitised slides from Scottish Women’s Hospitals which is a haunting glimpse into life in a field hospital 100 years ago.

A very moving archive full of personal views of the war by nurses who were there.