COMMENT

EDITORIAL BOARD Irene Anderson, Principal Lecturer and Reader in Learning and Teaching in Healthcare Practice, University of Hertfordshire Russell Ashmore, Senior Lecturer in Mental Health Nursing, Sheffield Hallam University Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Christopher Barber, Freelance Lecturer and Writer Dimitri Beeckman, Professor of Skin Integrity and Clinical Nursing, Ghent University, Belgium Jacqueline Boulton, Lecturer in Adult Nursing, Faculty Lead for student mobility, electives and global health, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London Beverley Brathwaite, visiting senior lecturer, Middlesex University Nicholas Castle, Head of Professions/ Assistant Executive Director, Hamad Medical Corporation Ambulance Service, Qatar Jothi Clara J Micheal, Group Director – Nursing, Global Hospitals Group, India Emma Collins, Nurse Consultant, Sexual Health In Plymouth, University Hospitals Plymouth NHS Trust Alison Coull, Lecturer at Queen Margaret University, Edinburgh Angela Grainger, Senior Lecturer, BPP University Michelle Grainger, Ward Manager, Moseley Hall Hospital, Birmingham Barry Hill, Programme Leader and Senior Lecturer, Northumbria University Helen Holder, Senior Lecturer, Nursing Studies, Birmingham City University Mina Karamshi, Specialist Sister in Radiology, Royal Free Hospital, Hampstead Jacqueline Leigh, Professor Nurse Education Practice School Health & Society, University of Salford Joanne McPeake, Acute Specialist Nurse/ Senior Staff Nurse in Critical Care; Honorary Lecturer/Practitioner in Critical Care, University of Glasgow John McKinnon, Senior Lecturer, School of Health and Social Care, University of Lincoln Michelle Mello, Deputy Director: Workforce Development / National Clinical Lead, Personalised Care Group, NHS England/ NHS Improvement Aby Mitchell, Senior Lecturer Adult Nursing, University of West London Ann Norman, RCN Criminal Justice Services Nursing Adviser and Learning Disability Nursing Adviser Joy Notter, Professor, Birmingham City University & Saxion University of Applied Science, Netherlands Hilary Paniagua, Principal Lecturer/Head of Doctoral Studies Faculty of Health & Well Being at the University of Wolverhampton Ian Peate, Director of Studies, Head of School, Gibraltar Health Authority Kendra Schneller, Nurse Practitioner, Health Inclusion Team – Vulnerable Adults and Prevention Services, Guy’s & St Thomas’ NHS Foundation Trust John Tingle, Lecturer in Law, Birmingham Law School, University of Birmingham Geoffrey Walker, Matron for Medicine, Cardiology and Specialist Nursing Services Poole Hospital NHS Foundation Trust Jamie Waterall, Deputy Chief Nurse, Public Health England; Honorary Professor, University of Nottingham Jo Wilson, Director, Wilson Healthcare Services, Newcastle Cate Wood, Research Fellow, Oxford Brookes University.

Future challenges for nursing Liz Charalambous, Teaching Associate, University of Nottingham, liz.charalambous1@nottingham.ac.uk)

Nurses and midwives account for 50% of the global health workforce and represent good value for money (World Health Organization (WHO), 2020). Lower nurse staffing levels in hospitals are associated with worse patient outcomes (Ball et al, 2014). Despite this, 1 in every 8 nursing posts remain unfilled, with 43 000 vacancies in England alone (NHS Digital, 2019).WHO (2020) estimates that to meet the Sustainable Development Goals on health and wellbeing, the world will need an additional 9 million nurses and midwives by 2030.

Furthermore, nursing is becoming increasingly complex, with pressures on service provision exacerbated by the pandemic, and patients living longer with multiple and complex comorbidities. Some 10% of the current nursing workforce are considering leaving the profession, with newly qualified and nurses nearing retirement more likely to leave (Health Education England, 2014). An anecdotal increase in the number of applicants applying to study nursing may go some way to address the problem. However, universities are limited in the number of applicants because of placement availability and staff to provide mentorship. Potential solutions can be explored through a range of different perspectives.

Globally, it is essential that a collaborative approach is taken to develop a strategy to protect and support nurses. Nationally, it appears that the current NHS system, rooted in the socialist ideology that underpins the NHS, seems outdated in a contemporary neoliberal infrastructure. Streamlining policy development by placing the NHS outside the political arena could provide a solution to workforce planning. More effective financial investment across all levels of healthcare would include financial support for nursing students as essential to address underlying problems.This is particularly relevant when considering the amount of healthcare expenditure when compared with similar-sized economies (Organisation for Economic Co-operation and Development, 2019). Effective financial investment could include a refocus of health care from individual factors to tackle the wider socioeconomic determinants of health, including housing, employment and education (Dahlgren and Whitehead, 2006) and towards more primary health care and disease prevention.

Organisations can demonstrate supportive leadership to encourage staff engagement and shared decision making, and invest in the enrichment of workplace culture, creative job design and systems working, effective use of technology and communication (NHS Employers, 2020). From a professional perspective, there are calls to protect the title ‘nurse’ by limiting it to those who are registered with professional regulators (Mitchell, 2021). Having nurse representation at global, national and local levels would ensure nurses are contributing to policy making and strategic development.The issue of resilience in nursing is concerning as it puts responsibility on individuals rather than organisations and governments taking responsibility for finding solutions. I suspect there is little individual nurses can do to impact workforce challenges without a change in the organisational infrastructure at a global, national and local level. Nurses must be engaged in the political process to have their collective voices heard; however, some nurses are reluctant to become political animals, particularly as the issue of strike action can be seen as controversial.

Despite a recognition of the challenges ahead in terms of workforce planning, and suggested recommendations about how to address them, I fear that, unless we act immediately, it may be too little too late, with not only the profession being at risk, but also global public health. BJN Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P. ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014;23(2):116-125. https://doi.org/10.1136/bmjqs-2012-001767 Dahlgren G,Whitehead M;WHO Collaborating Centre for Policy

Research on Social Determinants of Health, University of Liverpool. European strategies for tackling social inequities in health. Levelling up Part 2. 2006. https://tinyurl.com/shbt34dk (accessed 19 October 2021) Health Education England. Growing nurse numbers. Literature review on nurses leaving the NHS. 2014. https://tinyurl. com/5rj7um4f (accessed 19 October 2021) Mitchell G. Petition calls for protection of ‘nurse’ title for sake of patient safety. Nursing Times. Online. 15 June 2021. https:// tinyurl.com/23wz4xsn (accessed 19 October 2021) NHS Digital. NHS vacancy statistics England February 2015—

September 2019, experimental statistics. 2019. https://tinyurl. com/ym2dpac5 (accessed 19 October 2021) NHS Employers. Improving nurse retention: flexible retirement.

2020. https://tinyurl.com/c96ev7zv (accessed 19 October 2021) Organisation for Economic Co-operation and Development. State of health in the EU. United Kingdom: country health profile 2019. 2019. https://doi.org/10.1787/744df2e3-en (accessed 19 October 2021) World Health Organization. Nursing and midwifery. 2020. https://

tinyurl.com/5bntjadc (accessed 19 October 2021)

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