The higher education sector in Scotland is responsible for delivering newly qualified nursing and midwifery practitioners into the workforce. Currently around 10,000 students on courses across 12 universities are working towards qualifications, leading to registration with the Nursing and Midwifery Council (NMC).
Health and care services across Scotland are experiencing varying degrees of registered nursing and midwifery staff shortages; the Health and Care (Staffing) (Scotland) Bill, and its timing, is critical in ensuring there is an adequate number of highly skilled practitioners in the workforce.
The Scottish Government’s projections for nursing and midwifery staffing for 2018/19 (Scottish Government 2018) shows only a marginal increase in overall staffing despite there being, in some NHS Boards, significant levels of unfilled posts – more than 3,300 across Scotland.
In recent years, we have seen welcome increases in the number of student nurses. This follows a low point in the 2012 intake, the result of a 20 per cent reduction over the preceding years. This relative boom and bust is far from ideal and an approach that must be avoided going forward.
The areas where staffing shortages are at their worst are where the need to increase student numbers is greatest. This makes it increasingly more challenging to maintain the absolute highest standards of clinical care and, at the same time, support the delivery of high-quality student placements that meet learners’ supervision and assessment needs.
The current staffing level and professional judgement tools referred to in the legislation are purported to take into account the learning and teaching needs of students and the registered practitioners’ contribution to their supervision and mentorship. Some within the higher education sector have concerns that the tools used may not adequately reflect the needs of learners. There must, at all times, be an adequate number of registered nurses and midwives to provide safe and effective care and this must include the capacity to develop the future workforce. Under the NMC code registered nurses are expected to share their skills, knowledge and experience and to support students to develop their professional competence. The recognition of learners’ needs is largely absent from the proposed legislation.
As proposed, it falls short of fully recognising the nursing and midwifery ‘supply’ challenges. Over the last three years, there has been a six per cent fall in university applications for nursing and midwifery in the UK. Scotland has seen a one per cent rise in applications, albeit recruitment targets have risen by more than 10 per cent. Despite the welcome commitment to continue the nursing student bursary in Scotland, some universities experience challenges in recruiting adequate numbers of high-quality candidates against the backdrop of increasing targets. So the Government’s commitment to a campaign to position nursing and midwifery as an attractive and rewarding career is welcome.
The Bill as it stands focuses on how to ensure safe and effective staffing based on clinical need, as it should, but the general lack of reference to the importance of ensuring the adequate supply of newly qualified practitioners is a major omission. Supply issues are impacting significantly on current NHS and independent sector staffing and will continue to be a challenge. Getting this legislation right is an opportunity to secure the workforce to deliver safe, high-quality care for generations to come.
Professor Ian Murray is head of school for nursing and midwifery at Robert Gordon University