Time to put nurses in the spotlight

We depend on nurses at the most traumatic times of our lives but we have only a partial understanding of the challenges that they face. Picture: Getty
We depend on nurses at the most traumatic times of our lives but we have only a partial understanding of the challenges that they face. Picture: Getty
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Despite lots of anecdotal evidence of the stresses and strains on the caring profession, there is a lack of hard facts, writes Richard Kyle

Scarcely a day passes when nursing escapes the media spotlight. That nursing captivates public attention is not surprising. We all have something to say about it. Who should be a nurse? How should nurses do their job? How should they be educated? What should happen to those who fall short of the standards of care we expect? Yet, despite all this attention, we know surprisingly little about nurses themselves.

Who are our nurses in Scotland? How many have other caring responsibilities? How many have children? How many nurses enter and leave the profession over time? Where do they come from socially and geographically? Why do they leave? What is the impact of being a nurse on their physical and mental health?

The newly established Nurses’ Lives Research Programme at Edinburgh Napier University puts nurses’ lives in the spotlight to answer these questions.

Doing so is timely. The NHS in Scotland is facing a series of seemingly intractable problems.

Take, for example, the impending “retirement cliff” caused by the ageing nursing workforce. This is a particularly pressing problem for Scotland where almost 50 per cent of community nurses are aged 50 or over. This means that due to retirement nearly half the community nursing workforce will potentially need to be replaced over the next five years. Are we training enough nurses to replace retirees? Do we know how many nurses work beyond retirement age? Do we know how many of those not working might be encouraged to return to practice? Given the Scottish Government’s policy to shift the balance of care towards the community and care closer to home, we urgently need answers to support delivery of these ambitions.

Increasing reliance on nurses from overseas is another challenge facing our NHS. But, again, we have very little evidence to inform policy and planning. The international mobility of the nursing workforce and migration flows of nurses between the four nations of the UK is poorly understood. How many of our nurses in Scotland were trained overseas? How many in England, or Wales, or Northern Ireland? How long do nurses from elsewhere work in the NHS? Do we “export” more nurses than we “import”? Where in Scotland do nurses from overseas tend to work? Answering these questions will aid workforce planning, and could, perhaps, help policymakers find ways to support those nurses from overseas to settle in Scotland and pursue long and successful careers in the NHS. This could reduce nurse turnover and costs.

But, if we know relatively little about nurses’ careers, we know even less about the health of Scottish nurses. In recent weeks the negative health impacts of shift work has resurfaced in the media. How does working 12-hour shifts, now the norm for many nurses, impact their health? Does the physical strain of the job increase incidence of physical health complaints such as back pain? Does the emotional labour of nursing take its toll on nurses’ mental health? What are nurses’ own health behaviours? Finding out could, for example, help the NHS develop strategies to maintain and improve nurses’ health. This could have benefits for their patients and the wider Scottish population through nurses’ increasingly prominent role in health promotion and prevention.

By answering these questions the Nurses’ Lives Research Programme will provide evidence to inform the policy, political and public debate around how solutions to each of these challenges can be found.

Innovatively, the answers come by using data that we already have. Each of us completes a census every ten years, and many of us take part in annual health and social surveys run by the Scottish Government. Nurses do too. But, because there are so many nurses in Scotland large samples of nurses can be created within each of these surveys to research nurses’ careers and health.

This is only possible by harnessing the infrastructure now available in Edinburgh through substantial investment made by the Economic and Social Research Council (ESRC) across the UK in Administrative Data Research Centres. Edinburgh is rapidly becoming a hub for administrative data research and the globally unique Nurses’ Lives Research Programme is at the heart of these developments.

Our initial research has focused on charting changes in the nursing workforce over the past 20 years, prevalence of nurses’ lifestyle behaviours, and geographic differences in nurses’ mortality across Scotland. Over the coming months we’ll be in a position to start sharing what we’ve found once our results are published in peer-reviewed journals. Some of our early findings are surprising, others shocking. But, asking and answering hard questions will shift the focus of the debate around nursing. By turning the spotlight on nurses’ lives ultimately we can better support people that each of us depend on at some point during our own.

Dr Richard Kyle is a Reader in the School of Nursing, Midwifery and Social Care at Edinburgh Napier University