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Friday 15 th 2016

About 12/13 years ago I travelled to Boston with a Health Services Partnership Group where one of our engagements was with a group of Directors of Nursing who were even then trying to manage their health services against a background of horrendous nursing shortages. The problem now seems endemic in the US and becoming so in the UK and Ireland. Those managers had reached a point where they were assisting people with the ambition to become Nurses to achieve Registration over 6 or 7 year periods by facilitating modular, part-time evening and weekend courses which allowed participants to build module upon module until they had acquired the required theoretical underpinning to become registered on completion of a period of internship. I never expected Ireland to be reaching a similar position. In this regard I believe we need to have an open mind on how we attract and facilitate people to become our Nurses of the future.

Nursing Shortages: Recruitment and Retention

Please note below the numbers of vacant nursing posts notified to Head office over the past 10 days:

North Dublin (Psychiatry) 30

North Dublin (Intellectual Disability Services 58

Kildare 10

Laois/Offaly 29

Mayo 28

Vergemount including St. Vincent's Elm Park 19

Wicklow 17

Longford Westmeath Psychiatry 12

Longford Westmeath ID 10

Kerry 30

Wexford 24

Central Mental Hospital 35

Cork South Lee 24

Clare 15

St Brendans 17

Louth MHS 12

I understand that having regard to existing vacancies and forecasted retirements we need 1000 new nurses just to maintain current levels of service without investing in any new developments in accordance with Vision for Change, Primary Care etc. at the same time we are now facing a new moratorium.

Nurse Managers are now being told that

•  Each occasion of overtime and /or agency use has to be separately sanctioned by one of a number of senior managers at the level of Area Manager or General Manager. Managers are cautioned that before submitting applications for approval they should have carefully considered ‘the current financial position', ‘redeployment of existing resources and the ‘mitigation of risk'.

•  Vacancies cannot be filled unless the Nurse Manager agrees to surrender 3 posts in order to have one post filled. This is to be controlled by a new Employment Control Committee.

•  ‘As part of the Funded Workforce Plan Paybill Monitoring Process this effectively means that the financial position does not support the continued use of Agency and Overtime, and in that context, we are now challenged with addressing this area of expenditure as a matter of urgency'.

The shortage of nurses is at crisis proportions. These shortages were easily foreseeable by a Government which was so focussed on cutting numbers of public servants that they acted with complete indifference to the forecasted needs of the sick and disabled. Those who trained as Nurses were herded towards airports and ferry ports to populate the health services of other countries, those who remained were penalised with pay cuts, temporary and unstable employment, and extremely difficult working conditions.

We urgently need a meaningful response to this crisis including:

  1. The restoration of Training numbers to at least the previous minimum of 350 per annum in Psychiatric Nursing and further increases in Intellectual Disability Nursing until we have reached the required numbers. Such is the crisis we would strongly recommend that the numbers in training be increased even further for a 5 year period at which point it might be reviewed in view of numbers then in the system.
  2. The proposed Postgraduate training course to allow RGNs convert to Psychiatric Nursing must be introduced this year.
  3. The Graduate Programme which will enable Graduates in the health sciences qualify in Psychiatric Nursing in an accelerated nurse training programme over 18 months should be introduced immediately.
  1. Many of our current nursing staff began life as Care Assistants. The opportunity for personal development and lifelong learning must be enhanced to allow career progression for those who wish to do so. In this regard it is important that those recruited as HCAs have the potential to convert to nursing as mature students.
  2. The State Enrolled Nurse of the UK and/or the Practical Nurse of the US has never found favour in this country. Now the UK have decided to move towards the Associate Nurse with a commitment to providing a bridging process so that access to Degree Nurse Training can be facilitated. Effectively the UK have agreed that apart from the normal practice of people accessing Degree Courses in Nursing a secondary pathway will also be available :

Health Care Assistant

Senior Health Care Assistant

Associate Nurse

Degree Nurse

  1. While noting this development in the UK I would be much more comfortable with the Sponsorship process implemented some years ago, now contributing very little, which assisted some Health Service employees to convert to nurse training with the support and assistance of the HSE and which now needs boosting.
  2. Psychiatric Nurses who were employed before 2004 can retire @ 55 years of age. Such are the pressures in the system that most of those eligible retire at the first opportunity. However, we need as many as possible to stay in the service for as long as possible. The deferral of the threat to their Pension Package is a help. However we now need a concerted effort from employers to try to retain them full time or on reduced hours.

Items 3 and 4 above are referred to in the HSE Mental Health Division Operation Plan for 2016 as decisions that have been made and are to be operationalised this year. This is very good news and to be welcomed. However, evidence is required as reassurance that these are not just aspirations but that meaningful work is taking place on implementation. The co-operation of bodies such as NMBI are also required in this matter. It is essential that all of the bodies with a responsibility in this area act in a co-ordinated and committed manner to ensure the delivery of these programmes asap.

It is clear from UK publications that they too are reaching for the panic button in response to the crisis that is the shortages of nurses. Nursing Times reports that the Migrant Advisory Council, the MAC, who have a role in identifying professions experiencing shortage for which recruitment of potential qualifies migrants could be targeted, came out publicly in recent days ‘with all guns blazing' stating that the current shortages were due to shambolic workforce planning and a desire to save money. They criticised everyone from the Health Ministry to the NHS and the Trusts ‘for not recognising the obvious warning signs'. They pointed out that the 3000 nurse training places that should have been put in place this year was reduced to 331 because of financial cuts, irrespective of need. They stated that ‘almost all of the reasons why there is a shortage should have been anticipated. They concluded that ‘there were no good reasons why the supply of nurses could not be sourced domestically and opined that the long term solution is to ‘provide sufficient incentives and opportunity', and called on the relevant authorities to explore ‘whether higher pay would improve retention' saying how nurses are paid is not an immutable fact but a choice of Government.

Like our colleagues in the UK we need nurses, we need to train them and to retain them and to attract our Irish Nurse abroad to return. Paying our nurses properly is the one obvious way of demonstrating respect and recognition for the work nurses do. Pay restoration is essential to attraction and retention.

What we don't need is the proliferation of untrained or minimally trained people whose presence will undermine quality of care and impede the achievement of safe, high quality services. How many more Reports do we need from the UK before Managers accept the reality that the higher the level of Nursing numbers in Acute services the better the outcomes for patients.

Colleagues, we need action and we need it now to make a career in Nursing attractive and to entice as many young people as possible to train as RPNs and RNIDs. We also need the Terms and Conditions of Employment, career development opportunities and recruitment and retention campaigns to be strengthened.

Colleagues one of the questions now facing the PNA is: Are we happy to leave this matter to the HSE and the Dept. of Health to sort out or do we need to take action to force a concerted campaign to enhance training, recruitment and retention?