There is said to be universal shortage of nursing but not in the Philipines it seems, where hundreds of Filippino nurses cannot get jobs( McGeown 2012 ). The shortage of nursing is politically determined- in Japan for example, it reflects the harsh exams which are difficult to pass hence they have been relaxed (blindbatnews.com 2013 ). It also reflects the higher rate of pay demanded/ earned by nurses compared to care assistants. In many countries, newly qualified nurses cannot get jobs as nurses; “Yet somehow 43 percent of newly-licensed RNs can’t find jobs within 18 months. Some hospitals and other employers openly discourage new RNs from applying for jobs. That doesn’t sound like a huge shortage, then does it?” (Williams 2013).
The UK has no official figure for the lack of jobs for newly qualified nurses. One unofficial figure , based on blog analysis and analysis of advertised hospital jobs, is 2 \thirds (Nightingale 2013). Williams (ibid) suggests that the shortage of nurses is actually “fabricated”. This view is supported when home trained nurses cannot get jobs and when 20, 000 job vacancies in UK (RCN) are actually frozen vacancies ie not really available since nobody will fund the posts. Is this an excuse to obtain cheaper nurses from overseas who complain less (Duell 2013).
It seems that only the major players ie RCN in UK, get a voice, yet they may well have ulterior motives (Nightingale 2013).
For example one of the Associations that the RCN is linked to is The European Federation of Nurses Associations (www.efnweb.org). ”The European Federation of Nurses Associations (EFN) represents the nursing profession and its interests to the European Union institutions. It focuses mainly on nurse education, the mobility and protection of health care professionals, and EU health policies. EFN is the independent voice of the nursing profession in Europe, representing more than a million nurses from national nurses’ associations in 30 countries. … As European citizens, this means having the right to choose where to receive medical treatment across the EU, and to be reimbursed for it. The EFN believes that this Directive, aiming to clarify citizens’ rights to access healthcare in another EU Member State, and to facilitate their access to healthcare services, guarantees the principles of universality, access to quality care, equity and solidarity. Therefore, if a patient is to receive medical treatment in another EU country, he/she will have the same rights as a citizen of that country, and the treatment will be subject to the same rules and standards. … The EFN believes that a transparent system for automatic recognition is needed to deal with the migration of professionals in a practical and efficient way and to ensure that a certain level of health protection for patients and consumers of health care in the EU is maintained. … ENSA goes for a new governance structure to actively lead the nursing students’ movement … The European Nursing Students Association (ENSA) elected five new board members … The new board, coming from Norway, Greece, Sweden, Turkey and Germany opted to work closely with the EFN to make nurses and nursing stronger in the EU. … The EFN General Secretary therefore believes that more students should join ENSA, so that it covers at least one student from each EU Member State’.
The RCN’s affiliation to an organisation that supports migration of professionals might be a cause of concern to some. There is most definitely a shortage of people engaged in caring in the NHS. There are widespread shortages because NHS trusts freeze vacant posts in a bid to save money. Trusts routinely freeze posts whenever staff retire or move elsewhere, creating widespread shortages. Further there is evidence that private equity trusts also employ less staff (Fernandez 2013)
There should be a statutory minimum staff to patient ratio, and, if there is not, then all calls for good patient care are hollow. These minimum staff ratios should apply to both the NHS and private care homes, with any nurse in charge of the latter having a statutory duty to report ongoing staff shortages to the CQC, who would be given the power to send agency staff to the care home. Such ‘interference’ in the ‘market’ is, however, unlikely, given that the main political parties of the UK are wedded to it. Within USA and Australia, some states do have minimum staffing levels for hospitals.
The debate hinges upon the need for nurses or need for staff. Indeed nurses are rather more expensive than care assistants, hence some countries are considering alternatives. Graduates of the ‘Florida State Nursing Assistant Progam’ would argue that they were well prepared to identify signs and symptoms that may indicate further investigation. Such facilities as the Erwin Technical Centre (erwin.edu) offer 165 hours of instruction: ‘The Nursing Assistant Program combines classroom theory and over 20 hours of clinical experience that prepares students to take the Florida State Certification Exam and to pursue an entry level position in a nursing home. All nursing assistants working in long term care in Florida must be certified by the State of Florida’. They state: ‘Nursing Assistants are an important liaison between the residents and nurses. Nursing Assistants are trained to notice changes in residents and report pertinent information to the nurses in charge so adjustments in care can be made. In addition, nursing assistants help residents perform activities of daily living such as bathing, grooming, eating, and toileting. Nursing Assistants are the eyes, ears, and hands of medical professionals keeping residents comfortable, clean, and fed. The courses are held over either two days a week for two months, or two evenings a week for four months. Graduates are informed that: ‘The U.S. Department of Labor lists Nursing Assisting as one of the fastest growing occupations, and the need is expected to grow by 18% over the next six years’. This reflects the current emphasis on budgetary constraint, a ‘tide’ which it will be useless to swim against, and one which will inevitably encroach further on roles traditionally performed by the nurse.
Florida nursing assistant graduates are given a career pathway: ‘Nursing Assistants often advance to become patient care technicians by acquiring additional training in phlebotomy and EKG’s. Also, Nursing Assisting is an excellent launching pad for people pursuing careers in other health care arenas’. Nursing assistant courses stress the importance of a compassionate attitude to would-be entrants. They also stress the importance of education: Vision Statement: “Erwin Technical Center will: Empower students to take ownership of their education; educate students to be highly-trained, productive members of society; and provide an environment for the achievement of higher education, focusing on technology, job preparation and personal growth”.
The average pay in 2010 of Florida nursing assistant graduates was £7.15p per hour as of currency exchange rates applying 0ctober 22, 2013. The annual rate of pay for a patient care technician in the USA as of May 2013 was $15,866 – $42,644 for those with between one and four years experience (www.buzzle.com).The median rate was $26,240 (www.payscale.com/). This equates to £16, 240 per annum. The highest rate ($42,644) equates to £26,380 per annum. Newly qualified nurses in the UK typically start at £21, 000 per anum (nursing.nhscareers.nhs.), which roughly equates with the starting salary for a qualified teacher (point M1): £21,588 (ibid.). Generally, a patient care technician would, on average, expect to earn 80% of the wages of a newly qualified nurse, with nursing assistants expecting 66%. Obviously, as the newly qualified nurse progresses through pay scales, the relative ‘affordability’ on nursing assistants and nursing technicians increases. According to figures from NHS Employers, average pay in the NHS in 2012 – including basic pay plus additions such as overtime – was £30,564 for a nurse, £109,651 for a consultant, £47,702 for a manager and £36,130 for a qualified paramedic.
This is the ‘economic tide’ which the RCN, in its call for high nurse to nurse assistant ratios, is trying to hold back. It is claimed that £500 million of wage costs are equivalent to 15,000 nurses (Donnelly, 2013). It follows that a great deal more staff could be ‘afforded’ if care was given by a different balance of nurses, nursing assistants, and nursing technicians. The danger here is that a more ‘economical balance’ of staff would not necessarily bring about a higher staff to patient ratio, because the logic inherent in running the NHS as a business might result in the same number of staff being employed, with a lesser number of nurses.
As for student nurses, blog after blog reports of the majority of newly qualified nurses not being given jobs, with those that are being offered half time hours on fixed term 6 month contracts, which are unlikely to be renewed. This is cheaper than employing experienced staff, and is a continuous process of repeated 6 month preceptorships; rather like employment schemes that take on a new batch of trainees every time the old batch is about to qualify for a permanent (higher waged) job. There are many student nurses who leave the course before completion within the UK for various reason including assignments, lack of ability to cope on placement (Dimon 2013 ).
There is not a shortage of nurses in the UK, but, rather, a shortage of jobs for them, for both those who are newly qualified and those on part time contracts who would like full time work. It would appear to be the case in other countries including USA and Australia (Viceck 2013). In the UK the course is paid for by the Government; the point is why do we train them?
Dimon C (2013) The Commodity of Care The Cloister House Press .
Free updates http://qualityofnursingcare.webs.com/
Duell M (2013)
‘Full of life’ great-grandmother, 100, ‘died from fractured skull after falling 5ft when foreign carers failed to properly strap her into hoist’
mailonline 8 January
Fernandez E (2013) Low staffing and poor Quality of Care at Nations For Profit Nursing Homes UCSF Nov 29
McGeown K (2012) Nursing Dreams Turn sour in the Philippines bbc.co.uk 5 July
Nightingale L (2013) http://someaspectsofthercn.webs.com/
Viceck G (2013) ‘I am a nurse who is not a nurse’ nurseuncut.com 11 June
Williams D (2013) The nursing shortage myth. The healthcareblog
Carol Dimon and Lenin Nightingale c
Also in nursesfyi January 2014 nursesfyi.com