Predicament The National Health Service

Introduction

The real world daily life of a nurse is very different from the school setting where everything is controlled by schedules and timetables and theoretical learning. This is why, for a nurse, resilience is not just an important virtue; it is a fundamental necessity of the profession. Preceptorship as a mode of learning goes a long way to build this resilience. This paper analyzes the present predicament of the nursing profession under the National Health Service and what a newly qualified nurse can do in relation to preceptorship and the building of resilience.

A report by BBC in 2018 indicated that the National Health Service (NHS) is too demanding on nurses, creating a hemorrhaging effect, which subsequently forces nurses to quit the NHS each year at a rate of 1 in every 10. The result of this is that the nurses who leave outnumber nurses who join by 3000. The remaining workforce therefore is left with a high amount of working pressure due to short handedness. Working pressure plus a reduced workforce equals a tremendously high risk of burnout (Spinetta et al, 2000). Many nurses request sick leave due to stress and overworking. Nursing is one of the most demanding occupations, with a higher affinity for and burnout as compared to other occupational groups (Grant, 2013). To address these challenges, some seek nursing dissertation help to explore strategies for improving working conditions and retention rates. The result of the shortage is that the nursing community is at a breaking point. The fact that the number of nurses who leave the NHS every year outnumbers those who join, newly qualified, indicates a serious shortage of staff. Digital data from the NHS, acquired by the Nursing Standard, indicates that by the year 2018, there were around 40,000 vacancies in the nursing sector in England alone. In 2018, Deloitte conducted a survey which cited work-life balance as a dominant factor influencing the nurses’ decision to leave because in most cases nurses work 12 hour shifts excluding emergencies.

Several scholars have conducted study into the matters of policy drivers influencing the well being of nurses and their motivation to work and have issued recommendations in reports with regards to the same. The Boorman report, focused on improving staff health and wellbeing within the NHS, proposed a list of 20 recommendations which may be used to achieve a healthier workforce within the NHS, aimed at achieving a better workforce than the present scenario posits (Boorman, 2009). These recommendations are divided into sections i.e. recommendations aimed at improving organizational behaviors and performance, recommendations for the achievement of exemplary service and recommendations for the inclusion in the NHS systems and infrastructure. One fundamental example is the recommendation for the provision by the government of staff health and well being services to prevent both work-induced and lifestyle related ill health as a way of showing the benefits of working under the NHS. Another recommendation includes the requirement of inclusion of staff health and well being in the national and legal and local governance frameworks. These recommendations have led to some key actions in policy change which included the formulation of the Workplace Management Guidance, NICE 2010. NICE guidelines provide substantive guidelines regarding aspects of the nursing community such as the promotion of the mental wellbeing of workers, physical wellbeing as well as fairness and justice among others. In addition, other steps such as promulgation of the NHS Constitution were taken to create an accountable board by providing guidelines for assessment of managers and set standards and target for employee health and well being. Objectively, these guidelines are supposed to solve the issues of worker stress and reduce to a great extent the menace of workers leaving their jobs and creating such staff shortages as reported above. So far the performance has been dismal (Deloitte, 2018).

Robertson and Cooper (2010) sought to establish the existence of links between well being, engagement and discretionary work effort. They established that where the there exists a vibrant workplace wellbeing approach; there also exists a high level of work effort therefore resulting in increased rates of discretionary effort. It is the belief of the authors therefore that, where the management creates the right kind of work environment, including where an employee feels like they have better control of their job, better work conditions and security, their employees are likely to increase the percentage of work effort that they put in. Organizations therefore have a responsibility to make this happen in order to achieve better yields.

The Stevenson and Farmer review in 2017, under direction of the UK Prime Minister, analyzed possible ways into how employers can better encourage their employees to remain and prosper in their occupations. The research found out that the UK workforce suffers a great deal of mental health and poor well-being. Their main recommendation was that good practice should be inculcated; encouraging practices such as employer-employee transparency and the use of government policy to support employers more effectively. There exists a need for the right management and leadership and authority of the policy makers to provide the core mental health standards (Stevenson and Farmer, 2017). These discussions evoke a rather pertinent question which still remains unanswered, what can the newly qualified nurse do for themselves to ensure they thrive and create a lifelong career out of nursing?

Research by such scholars and many more have lead to a myriad of policy formulations aimed at ensuring the thriving of nurses in the UK workforce. A discussion paper by the NHS in 2009, outlining the role of the nurse in the healthcare workforce, predicted a reduction of trained nurses in the future, which is being witnessed at present. The paper outlined several policy drivers which could create a more vibrant nursing workforce in the future especially in relation to newly qualified nurses; The first policy change proposed was the requirement that newly qualified nurses possess a degree-level registration for entry into the profession. This proposed an upgrade from the previous requirements, which shifted it to an intensive 3 year training split equally between theoretical learning and practical attachment. The reason for this change was based on factors such as the complexity of responsibilities undertaken by nurses, high levels of interaction with others of higher professions such as doctors and a growing desire to lure and keep only the highest quality of nurses.

In addition, preceptorship was noted as one of the most important factors of ensuring nurses remain motivated. Preceptorship is essential for newly qualified nurses. Preceptorship inculcates informal direct learning from more experienced nurses and keeping of records of everything learnt, confidence gained among others. In some places, employers have put up relevant preceptorship programs where newly qualified nurses are absorbed into immediately upon employment. There is however, still need for more employers to roll out intensive preceptorship programs, increasing support for more profession specific preceptorship programs among others.

In addition, preceptorship was noted as one of the most important factors of ensuring nurses remain motivated. Preceptorship is essential for newly qualified nurses. Preceptorship inculcates informal direct learning from more experienced nurses and keeping of records of everything learnt, confidence gained among others. In some places, employers have put up relevant preceptorship programs where newly qualified nurses are absorbed into immediately upon employment. There is however, still need for more employers to roll out intensive preceptorship programs, increasing support for more profession specific preceptorship programs among others.

Revalidation was introduced in 2016 as a way of ensuring high levels of performance of nurses and midwives in the UK. It was introduced as a requirement that every 3 years nurses and midwives submit applications for revalidation to enable continued practice. The process is aimed at ensuring the highest levels of adherence to policy standards set on individual nurses for example, an application for revalidation requires, among others, 450 practice hours, or 900 for those acting as both nurses and midwives, 5 pieces of practice related feedback, 5 reflective accounts written down and a health and character declaration.

This paper has noted that these policy requirements have focused more on the matters that can be handled by policy formulators and employers or leaders. The papers do not really address the issue from the focal point of the nurses or, more specifically, the newly qualified nurses. Policy drivers for change merely offer directions on what employers can do in order to keep vibrant the nursing workforce in the UK, leaving out specific programs or ways that can be used by the newly qualified nurses to ensure that they do not suffer the same fate as their ore experienced counterparts who have opted to leave the profession in spite of all the mechanisms and policies put in place to ensure or promote their mental health as well as physical well being.

This paper has noted that these policy requirements have focused more on the matters that can be handled by policy formulators and employers or leaders. The papers do not really address the issue from the focal point of the nurses or, more specifically, the newly qualified nurses. Policy drivers for change merely offer directions on what employers can do in order to keep vibrant the nursing workforce in the UK, leaving out specific programs or ways that can be used by the newly qualified nurses to ensure that they do not suffer the same fate as their ore experienced counterparts who have opted to leave the profession in spite of all the mechanisms and policies put in place to ensure or promote their mental health as well as physical well being.

Way forward for newly qualified nurses

Whilst there are vibrant measures put in place to ensure nurses are retained in their professions, evidence shows that these have not been enough to ascertain retention and reduce the rising levels of work overload and burnout. There is an absence of employee based strategy to overcome work stress and burnout which demoralize workers. Therefore, extra effort by individual newly qualified nurses has to be focused upon on the buildup of their resilience. There are several ways in which newly qualified nurses can do this;

Preceptorship is one of the surest ways in which newly qualified nurses can build up their confidence and resilience (Happell, 2009). Preceptorship involves the pairing up of a newly qualified nurse with a registered nurse as an instructor for a period of time. The instructor guides the student in processes and administers treatments in the presence of the student. Whilst this is aimed at building the working experience of the student, the instructor should also explain in details the requirement, both emotional and physical entailing the demands of the nursing profession. That way a student knows beforehand to prepare themselves mentally for the coming onslaught of work related issues and where such preparation is sufficient, resilience is created at an early stage and this will go a long way in building up the student’s lifelong nursing career. A good preceptor instructor will be a motivation on the hopes of the newly qualified nurse in terms of building self-confidence and a vibrant self-esteem, both of which are positive emotions and very important in ensuring good mental health and physical wellbeing.

Preceptorship is one of the surest ways in which newly qualified nurses can build up their confidence and resilience (Happell, 2009). Preceptorship involves the pairing up of a newly qualified nurse with a registered nurse as an instructor for a period of time. The instructor guides the student in processes and administers treatments in the presence of the student. Whilst this is aimed at building the working experience of the student, the instructor should also explain in details the requirement, both emotional and physical entailing the demands of the nursing profession. That way a student knows beforehand to prepare themselves mentally for the coming onslaught of work related issues and where such preparation is sufficient, resilience is created at an early stage and this will go a long way in building up the student’s lifelong nursing career. A good preceptor instructor will be a motivation on the hopes of the newly qualified nurse in terms of building self-confidence and a vibrant self-esteem, both of which are positive emotions and very important in ensuring good mental health and physical wellbeing.

Adherence to work policy with regards to health and safety may also be a factor that will stimulate a newly qualified nurse’s resilience against the work hazards . This includes knowing what they are entitled to as nurses and the national guidelines and policy. However, while knowing your rights may be an added advantage, it may also prove to be a downfall. Where a newly qualified nurse knows all the entitlements and responsibilities of the employers as regards their mental health and physical well being at work, any shortfall in the employers’ duty, or excessive workload that overshadows the required allocation may cause demoralization and in return force them to leave.

Understanding problem solving and goal setting may go a long way in ensuring a lifelong career for newly qualified nurses (Stephens, 2013). Upon employment, the nurse should be able to set long term goals and set up structures for problem solving to curb any arising issue that may create a compulsion to leave and seek out alternative careers. In addition, this will be a personal motivating factor for succeeding in the revalidation application required after every three years of performance. On the flipside, the revalidation application can be argued to be serving to increase the pressure put on nurses so as to adhere to the standards set as outlined above.

Integrating social support in the day to day activities of newly qualified nurses as a means of building resilience is essential (Lee at al, 2012). Creating support networks in the workplace beginning with preceptorship instructors, fellow newly qualified nurses, patients among others, creating consultation networks with supervisors and other qualified personnel may also be initiated as way to receive mental moral and emotional support for a healthier mental well being and better resolve.

Conclusion

The nursing profession is a basic necessity of the healthcare industry. The trend reported of a reduced number of nurses joining as compared to those leaving the profession is therefore a worrying issue. Research and recommendation has been conducted to try and curb this issue. Recommendations have been inculcated into policy drivers such as the NICE guidelines and the NHS constitution among others. Notably, most of the policies formulated are employer based and therefore there is need for employee based stratagem and incentives to work as motivating factors for newly qualified nurses to stay. Newly qualified nurses need to take personal initiative to correct personalized shortcomings, policy regulations can only go so far to try and ease working conditions by imposing rules on employers, individual nurses will need to build themselves up personally in resilience, and one of the ways is through preceptorship.

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