Nursing shortages aren’t what
they used to be…….
Professor James Buchan
QMU
jbuchan@qmu.ac.uk
Nursing shortages…
•
•
•
•
•
..what we know
How UK has responded in the past
Current UK situation
International context
What next?
Shortages: what we know
• There is no universal definition of a nursing shortage;
increasing evidence of nurse supply/ demand imbalances in
many countries. Imbalances can be organisational, specialty
based, regional, national ……(cyclical-”boom and bust”)
• Supply of nurses in many countries, low income and high
income, is failing to keep pace with increasing demand [e.g.
Sub-Saharan African countries = shortfall of + 600,000 nurses
in relation to Millennium Development Goals targets]
• Gender-based discrimination continues in many countries =
nursing undervalued as “women’s work”.
• There is a link between adequate nurse staffing levels and
positive care outcomes.
UK and nursing shortages
•
•
•
•
National policy control [£] of “supply”=
=How many “new” nurses to train
=What they are trained in……
=How many nurses to employ in NHS/ how
much to pay them
• =How much £ to invest in their re-skilling
• =How many non EU nurses to allow into UK
• =when NHS nurses can retire…….
UK: history of nursing shortages
• 1932: Lancet Commission on Nursing
• 1939: Inter-Departmental Committee on
Nursing Services
• 1947: Ministry of Health Working Party on the
Recruitment and Training of Nurses
• 1972: (Briggs) Committee
• 1975 (Halsbury) Commission
• 1983 onward: - Nurses pay review body
• 2009: Prime Ministers Commission Nursing
UK: report on nursing shortages
• demand for care outstripping supply
• nurse staffing difficulties in some regions/
specialties
• increasing competition from other
employers
• “unjustified”/biased news coverage of
conditions in hospitals
• need for increased use of support workers
to “free up” nurses
• need for increased emphasis on staff
retention, attracting “married nurses”
back to the health workforce
UK: report on nursing shortages
•
•
•
•
demand for care outstripping supply
nurse staffing difficulties in some regions/ specialties
increasing competition from other employers
“unjustified”/biased news coverage of conditions in
hospitals
• need for increased use of support workers to “free
up” nurses
• need for increased emphasis on staff retention,
attracting “married nurses” back to the health
workforce
• (MINISTRY OF HEALTH, 1947)
Previous UK “solutions” to
shortages: Managing Supply
• Increase numbers in training
• Improve retention (and return)
• International recruitment
• Skill mix change- more support staff
-8
-7
-6
-5
-4
-3
-2
-1
19
98
19
-9
99
-2
00
0
20
00
-1
20
01
-2
20
02
-3
20
03
-4
20
04
-5
20
05
-6
20
06
-7
20
07
-8
20
08
-9
20
09
-1
0
19
97
19
96
19
95
19
94
19
93
19
92
19
91
19
90
UK- “new “ nurses from UK based
training
25000
20000
15000
10000
5000
0
UK Trends: Number of new nurses registering
from European Economic Area (EEA), and “other”
countries 1993-2010
18,000
16,000
14,000
12,000
Other
EEA
10,000
8,000
6,000
4,000
2,000
19 /9
99
/0
20 0
00
/0
1
20
01
/2
20
02
/3
20
03
/4
20
04
/5
20
05
/6
20
06
/7
20
07
/8
20
08
20 /9
09
/1
0
/8
19
98
/7
19
97
/6
19
96
/5
19
95
19
94
19
93
/4
0
NHS Scotland- total (wte) Nursing and
Midwifery workforce 2001-2010 (ISD)
59,000.0
58,000.0
57,000.0
56,000.0
55,000.0
54,000.0
53,000.0
52,000.0
51,000.0
50,000.0
49,000.0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Staffing numbers, NHS England
1997 and 2009 (wte)
450000
400000
350000
300000
Aux
250000
HCA
200000
EN
150000
RN
100000
50000
0
1997
2009
Trends: % change in staffing
numbers, NHS England 1996-2009
(wte)
300
250
%
200
RN
EN
150
HCA
Aux
100
50
0
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
year
Nurses per 1,000 population,
OECD countries
2008 (or nearest year)
Change 2000-08 (or
Professional nurses
Associate professional nurses
Nurses (no breakdown available)
Ireland 1
Finland
Switzerland
Iceland
Denmark
Norway
Luxembourg
Sweden
United States 1
Germany
Netherlands
Australia
New Zealand
Japan
United Kingdom
Canada
OECD
Czech Republic
France 1
Slovenia
Austria 2
Estonia
Slovak Republic 1
Hungary
Portugal 1
Poland
Israel
Spain
Korea
Greece 1
Mexico
Turkey 1
16.2
15.5
14.9
14.8
14.3
14.0
10.9
10.8
10.8
10.7
10.5
10.1
9.7
9.5
9.5
9.2
8.8
8.1
7.9
7.9
7.5
6.4
6.3
6.2
5.3
5.2
5.0
4.8
4.4
3.4
2.4
1.3
20
15
10
Per 1 000 population
5
0
1.8
1.6
1.9
1.4
2.
2
n.a.
1.5
0.7
1.4
1.3
0.1
n.a.
2
1.2
1.0
1.4
0.8
2
1.8
0.6
0.9
-2.1
1.9
n.a.
-0.6
2
0.8
n.a.
-4
0
Average annual gro
OECD countries: Increase in nurse
headcount 2000-2008
6.00%
(compound annual rate)
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
-1.00%
-2.00%
-3.00%
1.
Data include practising nurses and nurses working in the health sector as managers, educators, researchers, etc.
2.
Data refer to all nurses licensed to practice.
•Source: OECD Health Data 2010.
Hospital nurses wages: PPP
comparison, 2008- $US (OECD data)
Luxembourg
United States
Australia (2007) 1
Ireland
United Kingdom
Norway 1
Belgium (2005)
Iceland
New Zealand
Denmark (2005) 1
Israel
Germany (2006)
Japan
Portugal (2005)
Italy
Finland
Slovenia
Mexico
Turkey
Czech Republic
Hungary
Slovak Republic
74
65
52
49
49
47
44
44
43
43
43
42
39
37
35
35
29
24
22
19
16
15
0
20
40
60
80
USD PPP, thousands
What next?
• 1970’s-2000’s- Focus was on supply of
nurses
• Supply side now not the priority (a risk)
• Focus now is on Managing demand and
on Skill mix change
Applicants for pre-reg nursing
education at HEI, 2000-2009
Projections: % Change in NHS nurses
2006/7 to 2015/16, England (wte)
6
4
2
0
2006/7
2015/16
-2
%
Buchan/Seccombe best case
-4
Buchan/Seccombe worst case
WRT projection (est.)
-6
-8
-10
-12
-14
(sources: Buchan and Seccombe /RCN Policy Unit,2007; WRT 2008)
Skill mix change: UK does not have
the second level nurse option……
Second level nurse?
UK
NO…….so focus will be on the
assistant practitioner
Ireland
NO
Australia
YES
USA
YES
Canada
YES
New Zealand
YES (restarted)
What next?: Managing demand
• Emphasis on labour cost containment with
no reduction in quality of care
• Different working patterns: e-rostering
• Adaptive/ flexible staff: re-skilling (CPD)
• Differentiated pay/reward?
What next? Skill mix change
• (Fewer?) graduate nurses, in
“advanced” roles, managing cases and
teams, diagnosing and prescribing
• Increased use of HCA and AP
• Increased emphasis on self care
• = will challenge what we mean by
“nursing”
In conclusion…..
• In the past, nursing shortages have been
“solved” by having “more nurses”
• Over the next 10 years the emphasis will
shift to having “more effective nursing”