Nursing shortages

1. Nursing shortages aren’t what
they used to be…….

2. Nursing shortages…
• ..what we know
• How UK has responded in the past
• Current UK situation
• International context
• What next?

4. Shortages: what we know
• There is no universal definition of a nursing shortage;
increasing evidence of nurse supply/ demand imbalances in
many countries. Imbalances can be organisational, specialty
based, regional, national ……(cyclical-”boom and bust”)
• Supply of nurses in many countries, low income and high
income, is failing to keep pace with increasing demand [e.g.
Sub-Saharan African countries = shortfall of + 600,000 nurses
in relation to Millennium Development Goals targets]
• Gender-based discrimination continues in many countries =
nursing undervalued as “women’s work”.
• There is a link between adequate nurse staffing levels and
positive care outcomes.

5. UK and nursing shortages
• National policy control [£] of “supply”=
• =How many “new” nurses to train
• =What they are trained in……
• =How many nurses to employ in NHS/ how
much to pay them
• =How much £ to invest in their re-skilling
• =How many non EU nurses to allow into UK
• =when NHS nurses can retire…….

6. UK: history of nursing shortages
• 1932: Lancet Commission on Nursing
• 1939: Inter-Departmental Committee on
Nursing Services
• 1947: Ministry of Health Working Party on the
Recruitment and Training of Nurses
• 1972: (Briggs) Committee
• 1975 (Halsbury) Commission
• 1983 onward: - Nurses pay review body
• 2009: Prime Ministers Commission Nursing

7. UK: report on nursing shortages
• demand for care outstripping supply
• nurse staffing difficulties in some regions/
specialties
• increasing competition from other
employers
• “unjustified”/biased news coverage of
conditions in hospitals
• need for increased use of support workers
to “free up” nurses
• need for increased emphasis on staff
retention, attracting “married nurses”
back to the health workforce

8. UK: report on nursing shortages
• demand for care outstripping supply
• nurse staffing difficulties in some regions/ specialties
• increasing competition from other employers
• “unjustified”/biased news coverage of conditions in
hospitals
• need for increased use of support workers to “free
up” nurses
• need for increased emphasis on staff retention,
attracting “married nurses” back to the health
workforce
• (MINISTRY OF HEALTH, 1947)

9. Previous UK “solutions” to
shortages: Managing Supply
• Increase numbers in training
• Improve retention (and return)
• International recruitment
• Skill mix change- more support staff

10. UK- “new “ nurses from UK based
training
0
5000
10000
15000
20000
25000
1990-1
1991-2
1992-3
1993-4
1994-5
1995-6
1996-7
1997-8
1998-91999-2000
2000-1
2001-2
2002-3
2003-4
2004-5
2005-6
2006-7
2007-8
2008-9
2009-10

11. UK Trends: Number of new nurses registering
from European Economic Area (EEA), and “other”
countries 1993-2010
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
1993/4
1994/5
1995/6
1996/7
1997/8
1998/91999/002000/01
2001/2
2002/3
2003/4
2004/5
2005/6
2006/7
2007/8
2008/92009/10
Other
EEA

12. NHS Scotland- total (wte) Nursing and
Midwifery workforce 2001-2010 (ISD)

13. Staffing numbers, NHS England
1997 and 2009 (wte)
0
50000
100000
150000
200000
250000
300000
350000
400000
450000
1997 2009
Aux
HCA
EN
RN

14. Trends: % change in staffing
numbers, NHS England 1996-2009
(wte)
0
50
100
150
200
250
300
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
year
%
RN
EN
HCA
Aux

15. Nurses per 1,000 population,
OECD countries
Ireland 1
Finland
Switzerland
Iceland
Denmark
Norway
Luxembourg
Sweden
United States 1
Germany
Netherlands
Australia
New Zealand
Japan
United Kingdom
Canada
OECD
Czech Republic
France 1
Slovenia
Austria 2
Estonia
Slovak Republic 1
Hungary
Portugal 1
Poland
Israel
Spain
Korea
Greece 1
Mexico
Turkey 1
2008 (or nearest year) Change 2000-08 (or
16.2
15.5
14.9
14.8
14.3
14.0
10.9
10.8
10.8
10.7
10.5
10.1
9.7
9.5
9.5
9.2
8.8
8.1
7.9
7.9
7.5
6.4
6.3
6.2
5.3
5.2
5.0
4.8
4.4
3.4
2.4
1.3
05101520
Per 1 000 population
Professional nurses
Associate professional nurses
Nurses (no breakdown available)
1.8
1.6
1.9
1.4
2.
2
n.a.
1.5
0.7
1.4
1.3
0.1
n.a.
2
1.2
1.0
1.4
0.8
2
1.8
0.6
0.9
-2.1
1.9
n.a.
-0.6
2
0.8
n.a.
-4 0
Average annual gro

16. OECD countries: Increase in nurse
headcount 2000-2008
(compound annual rate)
1. Data include practising nurses and nurses working in the health sector as managers, educators, researchers, etc.
2. Data refer to all nurses licensed to practice.
• Source: OECD Health Data 2010.

17. Hospital nurses wages: PPP
comparison, 2008- $US (OECD data)
15
16
19
22
24
29
35
35
37
39
42
43
43
43
44
44
47
49
49
52
65
74
0 20 40 60 80
Slovak Republic
Hungary
Czech Republic
Turkey
Mexico
Slovenia
Finland
Italy
Portugal (2005)
Japan
Germany (2006)
Israel
Denmark (2005) 1
New Zealand
Iceland
Belgium (2005)
Norway 1
United Kingdom
Ireland
Australia (2007) 1
United States
Luxembourg
USD PPP, thousands

18. What next?
• 1970’s-2000’s- Focus was on supply of
nurses
• Supply side now not the priority (a risk)
• Focus now is on Managing demand and
on Skill mix change

19. Applicants for pre-reg nursing
education at HEI, 2000-2009

20. Projections: % Change in NHS nurses
2006/7 to 2015/16, England (wte)
-14
-12
-10
-8
-6
-4
-2
0
2
4
6
2006/7 2015/16
%
Buchan/Seccombe best case
Buchan/Seccombe worst case
WRT projection (est.)
(sources: Buchan and Seccombe /RCN Policy Unit,2007; WRT 2008)

21. Skill mix change: UK does not have
the second level nurse option……
Second level nurse?
UK NO…….so focus will be on the
assistant practitioner
Ireland NO
Australia YES
USA YES
Canada YES
New Zealand YES (restarted)

22. What next?: Managing demand
• Emphasis on labour cost containment with
no reduction in quality of care
• Different working patterns: e-rostering
• Adaptive/ flexible staff: re-skilling (CPD)
• Differentiated pay/reward?

23. What next? Skill mix change
• (Fewer?) graduate nurses, in
“advanced” roles, managing cases and
teams, diagnosing and prescribing
• Increased use of HCA and AP
• Increased emphasis on self care
• = will challenge what we mean by
“nursing”

24. In conclusion…..
• In the past, nursing shortages have been
“solved” by having “more nurses”
• Over the next 10 years the emphasis will
shift to having “more effective nursing”

25. Our views have increased the
mark of the 10,000
Thank you viewers
Looking forward to franchise,
collaboration, partners.

26. This platform has been started by
Parveen Kumar Chadha with the
vision that nobody should suffer
the way he has suffered because
of lack and improper healthcare
facilities in India. We need lots of
funds manpower etc. to make
this vision a reality please contact
us. Join us as a member for a
noble cause.

27. Contact us:- 011-25464531, 9818569476
E-mail:- nursingnursing@yahoo.in