Nursing workforce planning: are we just playing a numbers game?


calculator graphMost people who read the news in the UK are likely to have read recent articles that point to the possibility that there is a shortage of nurses[i][ii][iii]. In a time when we are talking about reconfiguring the way care is offered and moving care into people’s homes it is also well documented that we have an aging nursing workforce with particular concerns in community nursing.  In a report by the RCN in 2012, it was identified that almost 60% of the community nursing workforce could if they chose, retire in the next decade. Of course, it’s not just about the numbers of nurses who leave – it’s also the level of expertise that the system loses when these experienced nurses, who are likely to have up to 3 decades of experience, retire.

There are steps in place to try to attract nurses who were once registered but left the profession back into practice. This work is being led by Health Education England with a concerted public campaign to attract once registered nurses to undertake a period of updating to encourage them to return. You can read more about the campaign here.

Whilst workforce planning as a numbers game is important – we need to make sure we have an adequate flow of newly qualified nurses – what could be just as important is retaining those with the long years of experience to help to pass on their tacit knowledge and skills before they leave the profession through retirement.

Bearing this in mind a paper by Liebermann et al (2015) caught my eye. They discuss that, as well as adequately addressing the recruitment of new nurses, we also need to make sure we retain new entrants and encourage older nurses to postpone their retirement.

anne 1989 on wardI am now 51 and in the last year or so I have thought about the prospect of retirement more than ever in my life. I realise this is a natural progression, that looking forward is a good thing; I also recognise that if every one of my generation does this, there could be an inevitable skill gap. There are ways less experienced nurses can be supported to offer safe care such as decision support technology but even I (as a nurse with a passion for technology) know that this can never replace decades of practice experience. So what do we know about why it is that nurses seek to leave the profession early?

Liebermann et al undertook a longitudinal study via questionnaire that sought to understand what conditions were most likely to encourage nurses to stay, with a focus on the possible differences between younger and older nurses. In other words, do we need to do different things to encourage younger nurses to stick with nursing and for older nurses to encourage them to put off an early retirement?

In some ways the conclusions are not surprising – nurses need good management support to stay and to help them to keep up to the hard demands that nursing places on us. What is perhaps more interesting is that they found differences between the younger and older nurses. The researchers concluded that ‘supervisors [managers] should foster nurses’ expectation of remaining in the same job until retirement age by providing age-specific job resources’ (Liebermann et al 2015).

By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons

By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons

We know that a multi-generational workforce may require different leadership styles, so called ‘baby boomers’ may differ from ‘generation x’ or ‘millennials’, but do we equally need to look at what conditions keep nurses satisfied with their work conditions in this generational way too?

I think this is a fascinating thought that we may need to think about. So, it’s possible that any efforts we make to encourage people to stay in nursing, if we don’t understand the needs of particular generations, may fail. My final point is are we just addressing a numbers game, when we need to start to focus in some detail on how we can retain nurses, recognising that different generations may have different needs?

Liebermann SC., Muller A., Weigal M.,Wegge J (2015) ‘Antecedents of the expectation of remaining in nursing until retirement age’ Journal of Advanced Nursing doi: 10.1111/jan12634

With thanks to Dr Susan Hamer for bringing this journal article to my attention :0)

PS thanks to Ruth Auton for pointing out this paper from HEE http://hee.nhs.uk/wp-content/uploads/sites/321/2014/05/Growing-nursing-numbers-Literature-Review-FINAL.pdf

[i] http://www.theguardian.com/society/2014/dec/17/nhs-nurse-shortage-health-service-overseas

[ii] http://www.rcn.org.uk/newsevents/news/article/london/nursing-shortage-pmqs

[iii] http://www.telegraph.co.uk/news/nhs/11349403/AandE-units-will-be-forced-to-declare-nurse-shortages.html

Golden silence


I learnt a lesson years ago about silence, you know, those empty space between words; I learnt that I didn’t need to fill them, that I could be comfortable in deep wells of silence. This week I reflected that I need to practice more.

cropped-northumberland.jpgWhen I did my leadership programme all those years ago we did a much hated exercise called ‘large group’. There was no structure, no agenda, no objective, just us and time. At first I was so uncomfortable I had to speak. I wasn’t the only one. Some of us shuffled and worried and spoke out filling the minutes and noiseless space. After the first couple of times I reflected on mine and others behaviours and decided I would experiment. I became a silent observer and spent my time listening and watching. I proved to myself that not only could I do it, it actually didn’t feel so bad. I know it improved my listening and observing too.

When I feel anxious or stressed I know I am more likely to dive in with words. I go really fast and have a reputation for being able to talk for England. This week a couple of things happened that made me think I perhaps need to practice silence more.

GoodMorningToAll_1893_songThe first was a great session by @heatherhenry. She talked about how to engage in communities and about giving people space and time, about not barging in with (probably the wrong) answers. She made me smile and gave me a tool for practice – she told us that if you want to be sure you have given someone time to answer, sing a whole chorus of Happy Birthday in your head – that’s just the right amount of time. I’m practicing and although it feels like a long time in my head it doesn’t seem to raise any eyebrows and actually people may well have told me things that they wouldn’t had I not given them time.

time to listenThe second is I spent a great day with a student nurse who is a self-confessed introvert. I reflected that I needed not to talk quite so fast, as, unlike some other colleagues, this conversation couldn’t be like a pacey game of tennis, where I serve the ball and they bounce it back. Perhaps it’s a bit more like golf with quiet walking time between hitting the ball.

Being mindful of silence has always been a positive thing for me but I do need to focus on doing it as my brain darts backwards and forwards and round about and it all tumbles out of my mouth. My son tells me all the time that I ask questions in 3s and it drives him mad – he just says – I can only answer one at a time and which one will it be? :0)

I know that for some people, like me, we are creative when we are bouncing ideas around verbally with others but I respect others right to time and silence. I promise I will continue to try as hard as I can to give people time, careful quiet listening and golden silence.

I had to post this! Silence is golden from the Tremeloes 1967

Thank goodness it was ophthalmology clinic and not sexual health.


I have lost many hours of my life talking about Information Governance (IG) and to make it worse it is not the subject that makes my heart sing.

computerI worked on the National Programme for IT and I have to say, despite what people might say, Information Governance was taken very seriously. So much so that the technical solutions that we worked on to create the best possible situations for holding and sharing the very sensitive information about people became increasingly elaborate and in many cases the solutions themselves were beyond my understanding. I think if we fell into a trap it was that one about increasing complexity making the issue worse, not better, and that we should have gone back to the citizen and kept it very simple.

We had complex use cases that tried to cover every possible sensitive scenario and tried hard to find solutions to them all.

It was hard and not very enjoyable work. But I do think we tried, we tried really hard to make sure it was the best it could be. I’m not sure we succeeded – my test for this is whether the debates have abated, they have not – but I know we put in much determined effort.  I was glad when I moved onto other more interesting and engaging work for me.

caldicottI know IG is a sensitive issue. I get it. I do my training every year and I am clear about my personal responsibilities. I have read Caldicott 2 and I understand not only my responsibility to protect information but also my duty to share when it the best for the patient.

I contrast this effort and experience with my visit to clinic on Friday which I tweeted about at the time. I arrived to the reception desk, in front of a very full, busy waiting area. The seats face the place you stand to book in and are actually quite close. The receptionist is lovely. Both this time and the last time I attended the same clinic I watched her offer very compassionate help to a number of people. But the booking in process stinks! I was asked for my name, address, date of birth and GP in front of the full waiting room; everyone must have been able to hear. I certainly heard every person who followed me recite their information.

waiting chairsI don’t think its OK to blame technology or the people who work in informatics and this feels like where the debates circle. I understand that electronic information can be accessed and shared potentially more widely than that single clinic with the 25 people who were sat observing but I have to say these are people who may well know me, my friends or my family, as they are local. Thank goodness it was ophthalmology clinic and not sexual health.

I accurately gave the feedback about my experience in the exceedingly small feedback box on the friends and family card including the feedback about the lovely receptionist.

Information governance is not just about IT!

‘But she’s my friend!’ – the power of making connections


connections 2A while ago I can remember @PaulJthinks encouraging people to follow me on Twitter as I was a hundred or so followers short of 3000. I now have nearing 8000 and I have been reflecting what that really means to me and how I use my valuable network.

There are a number of people who theorise about networks and connections. Metcalfe’s law is one of these, originating with a theory around Ethernet connections and now sometimes used to describe how number of possible cross-connections in a network grow as the square of the people in the network increases. In other words the community value of a network grows as the square of the number of its users increase.

It all sounds a bit technical to me, and a bit theoretical, but I’ve been reflecting on what my network means to me and how my numbers of followers seems to have grown without any deliberate act on my part to make it happen.

I have always been a connector in groups. In my social life I seem to create social groups and then, as they become impossible to manage socially as separate groups (there are just not enough days in a year), I join groups together. It’s not something I set out to do but I recognise that’s what happens; I am often the unique connection in our social groups – they lived next door, or I worked with them, or their children went to the same child-minder or I used to give them a lift to work.

I don’t set out to behave this way. I don’t set out to collect connections or people or friends it just seems to happen – I love people and I am very extrovert, not in the bouncing loud sort of way, at least all the time, but in the wanting to hear about people and share stories and experiences way. The truth is I am much more reserved than people think but this fascination with people makes me seem very extrovert I suspect (a previous blog covers exactly this here).

people connectingSo why am I thinking about networks and connections now? As I have strengthened my professional network with my social media activity I find I am increasingly focussed on how I can connect people together, that the relationship with me is not the most helpful one but that I can act as a sort of lightening rod to others; connecting wonderful people together. It hasn’t always felt this way but as the strength and depth of my social media network has increased I feel more able to do this – my investment in my relationships seems to have made them deeper and stronger. Again not deliberate act but on reflection that’s is probably what has happened.

When I first noticed this behaviour I did have a moment of anxiety. It’s a bit like when you are at school and your best friend wanders off with another friend that you introduced them to and my instinctive response might have been – ‘but she’s MY friend’.

Interestingly that isn’t what happens now and I’m fascinated by how connecting others to each other seems to step up the power in my network!  I have no idea how I got to 250 followers let alone near 8000 – it just seemed to happen but I do know I definitely feel connected to more great people.

lighteningIn the NHS today it feels more fragmented than ever before. Organisations seem less likely to share than in the past and networks that existed across Strategic Health Authorities for example feel like they have fallen away. I think that if we all behaved as active ‘connectors’ it might just power us up a little bit and we might even find that we become turbo charged if we connect beyond our usual networks; I personally love the fact I have connections in social care, housing, voluntary sector, who work for themselves, who work in the NHS – the list goes on. I don’t know exactly how it happened but I am glad it did and there is nothing more satisfying that making a successful introduction then watching some magic happen! I love my network and seeing it help me to help others through acting as a connector is doubly satisfying – even if there is a little demon on my shoulder saying ‘don’t forget to keep loving me too will you?’

Could you be a better connector? I’m going to keep trying.

The ‘big M’ – more taboo subjects #changethechange


It’s taken me a while to get my blogging mojo back. I’ve not been great you see; back in late November I was struggling with staying well – diabetes related – and had a couple of weeks where I am sure most normal people wouldn’t have worked. But I soldiered on. You see for decades that is what I have done. I have, in the Cooper family way, ‘Just got on with it’. What I find, at 51, is that it’s not quite as easy as it used to be. This has all been coupled with something else that has really been worrying me. I just can’t remember things like I used to. These two things together gave me a real sense of being out of control. Why did I feel so tired? I mean, so tired I felt like I could sleep anywhere. Why couldn’t I seem to remember one day to the next, let alone what I had promised to do, nor people’s names? Why didn’t I feel on-top of my game?? I finally think I know what is going on (and before someone jumps in and gives me wise advice of course I will be seeing my lovely Dr R in due course)  I think it’s one of those taboo subjects that no one talks about – the Menopause. After I started to feel a bit better in December I was lucky to go out with my friends, all a similar age to me, from book club, for our pre-Christmas ‘do’. They are all my age contemporaries – a GP, nurse, laboratory scientist, careers advisor, hairdresser and housewife come chef. I love them all. I decided to confess how I was feeling. I am so glad I did. ???????????????????????????We had a feisty conversation about aging and memory, about being tired, not sleeping, hot flushes and cold night sweats. It seems I am not the only one. One of my friends described her memory symptoms so vividly that I immediately started to feel better. There followed a long debate about the pros and cons of HRT. I definitely came away feeling more normal and much, much more optimistic. Since then, having had the conversation, I feel so much better and am actively doing things that help me to feel good. I know that is obvious but sometimes I just don’t do it! tabooIt led me to think about why on earth no one has ever even broached the subject of the menopause and diabetes. In fact no one ever seems to talk openly about the menopause…. It just seems to be jokey comments and a nod and a wink. Is this another taboo subject? The ‘big M’?? I looked online and of course the ‘big M’ does affect diabetes – it’s obvious. If you search online it says so; the ‘Big M’ can make you hypoglycaemic or maybe hyperglycaemic or maybe just a bit unpredictably dodgy…. And of course if sleep eludes you that has a habit of messing everything up too. If you wake up feeling a bit sweaty then is that hypo sweaty or just a sweaty episode? Well of course you just don’t know without testing and testing and testing. Ah, the ‘big M’! The other thing I found was that although again we don’t talk much about it, the ‘Big M’ can affect memory and it seems to be well reported by women, even if it never seems to be discussed openly. I found various pieces of information but this is the most insightful – a healthtalk resource where women talk about their experience – worth a look. menopauseYou need to understand, I don’t do this sort of messing around in my life! I ‘just get on with it’ and I don’t want to think that the ‘big M’ is getting in my way. Information about what is probably happening to me, along with the shared conversation with my lovely friends, made me feel better. I suppose it’s just another thing like Diabetes, a new visitor in my life, the ‘big M’. My experience over the last month just reinforced for me how important open conversations are and the importance of good quality information. I just wish someone had told me about the ‘big M’ before now. Oh, and I forgot to talk about weight didn’t I?!!? Oh forget that. Lets ignore that! I feel better now and on top of things again. I really wish these were not conversations that make me feel slightly uncomfortable, after all the ‘big M’ happens to many, many people. Why is it that it feels so taboo?

Post script: This blog led me to a group of wonderful women who are determined to change the conversations we have about Menopause and the evidence we have for care about menopause.  To find out more search #changethechange on Twitter

image

Hen Replacement Therapy HRT – thank you June Girvin :)

anne 25

Who knew? Me 25 years ago :) No ‘big M’ here :D

Standing out or fitting in – matters of dress and heels.


I was rushing about this morning getting ready for work and I reflected that it was much easier when I wore uniform; choices were simpler and there was less need to think.

anne 1989 on wardPutting on my blue sister’s uniform was one of the proudest things I can remember; I never tired of it along with my silver buckle that my husband bought me. If I close my eyes I can put myself back there and feel myself sit up straighter, it really was very special. I liked wearing uniform. I enjoyed the feeling of identity it gave me.

All of this led me to think about the symbolism of dress and where I find myself as a middle aged, rounded sort of person. Clothes inevitably have played an important role in my life for lots of reasons.

heelsI recall in the 1990s progressing to a non-uniformed role for the first time. I was in my mid-twenties and it was after all the 90s, where power dressing was still very much de rigueur. I had shoulder pads, tight pencil skirts, frilly blouses and heels – lots of stiletto heels. When I walked through Leeds tonight on my way home the fashions of 2014 have some of those echoes – it made me smile. It’s interesting when life places you on the second time around – I just wish I had saved some of my best clothes from back then.

[An interesting note – when I looked for pictures of me in the 1990s I can find none. My son was born in 1990 and all I can find are dozens of pictures of him. I guess something changed in my priorities then!]

Interviews have always been a time for me where I almost get superstitious about what I wear; always new clothes and silly as it may sound best underwear. I had a friend who always wore red knickers for interviews. I guess in these types of situations we all want to stack as many of the cards in our favour as we can.

New jobs too, demand a close focus on the way I dress. Who do I want them to think I am? Feisty Annie in my slightly hippy tastes or a more serious moderate Annie? What I do know it this situation also demands some new clothes although in some ways this is just like the emperor’s new clothes – I’m just waiting for someone to find me out!

Today I am lucky that I get to visit many different areas of the healthcare system and find myself moving in and out of different organisational cultures but I notice patterns. In big acute trusts it still feels like there is a sort of power dressing going on, albeit the 2014 version. Contrast this with community and mental health services where the styles feel more relaxed and individualistic. I always think, now where am I off to, and which version of Annie do I need to wear today?

Annie at 50th Birthday Bash

Annie at 50th Birthday Bash

Being on platforms and speaking raises interesting issues – mainly those of heels. My lovely ex-boss and now friend tells me that I should always wear heels. I try, I really do, but I can no longer do it. I find myself choosing more moderate heels and go for colour and class rather than the stilettos of the past. It’s also part of the lot of someone with type 1 diabetes I think that a focus on removing the risk of sore feet somehow feels more important.

Informatics is a really interesting place to work; male dominated and lots of suits and yes, mainly grey ones. We do have the occasional GP floating around who has a slightly more relaxed mode of dress. What is a girl to do in this space? I go for ‘middle of the road’ and then, sometimes, in the evenings or for events, dress up in colours and sparkles, like a peacock. I think it disconcerts them occasionally and I like that!

peapodSo what does all of this mean? Conversations of late have been making me reflect on why I always seem to choose roles that are a bit unusual. I do it because I like it. But then why do I seek to conform with my dress and shoes? I think it’s probably part of what can be referred to as cultural capital – assets that lead to social mobility. I need to fit in to be taken seriously and dress may be part of how I do this. Do I give up my identity as a result? I’m not sure. I think I express my identity in different ways – a business like suit with my tiny pea-pod necklace or a beautiful scarf.

My reflections are leading me to take a look again at how I present myself – am I expressing myself in the way I want to? Are you?

belt and badges