The pandemic is an opportunity to reset policy to tackle the “chronic, enduring problems” that nurses face, according to Anne Marie Rafferty, professor of nursing policy at King’s College London and president of the Royal College of Nursing (RCN).
“If I can use this phrase, Covid should be the circuit breaker for many of the ills which have plagued the profession for many years: let’s make that happen.”
Rafferty, who received a damehood for services to nursing in the Queen’s birthday honours list earlier this month, wants to see tangible recognition of the contributions that frontline nursing colleagues make. This includes not just better pay, but much stronger incentives in the NHS to stay in the job through “sustained long-term planning” and investment in the profession. This, according to Rafferty, should include equitable postgraduate training to allow nurses to progress their careers, and a shake-up of onerous working conditions, such as the demands of working 12-hour shifts that leave nurses feeling exhausted.
Given the widespread nursing shortage, which according to a March report from the Office for National Statistics saw 43,590 nursing vacancies in England alone, the stakes are high. While university applications for nursing in 2020 went up by 15% year on year, the challenge is to keep nurses in the profession once they qualify.
A report published in September by the King’s Fund cited figures for 2016-17 that showed that 28% of nurses and health visitors in England left their posts in hospitals and community services within the first three years of their service.
It follows a UK-wide RCN membership survey in July, which found that 36% wanted to quit this year. Of those, 61% cited pay as a factor, while just under half (44%) said it was due to the way nursing staff have been treated during the pandemic, and 43% blamed low staffing levels.
The key to retention, says Rafferty, is to invest “far more in the existing workforce to offer nurses a more rewarding career that makes them feel valued and happy to stay in the job”.
This year, the profile of nursing has been raised like never before as the World Health Organization’s decision to designate 2020 as the International Year of the Nurse and Midwife coincided with a global pandemic. While it has highlighted the valuable work healthcare staff do, it has also “put more and more pressure on an already highly pressurised service”, says Rafferty. Nurses have “dug very deep into their own reserves and resources to serve the public at this unprecedented time”.
Rafferty, who clapped NHS staff earlier in the year along with the multitude of the British public, says the attention that nurses have received needs to lead to real change, if nurses are to feel more valued. “We need to convert that support into a robust pay system that recognises and rewards nurses for their efforts, not just during the pandemic, but for the level of responsibility and complex decision-making they shoulder.”
The RCN is among 14 healthcare unions clamouring for pay talks to be brought forward. The unions want a 12.5% pay rise for NHS staff covered by the NHS Agenda for Change pay system, which the RCN argues is crucial to retain overworked and understaffed nurses.
Another “major force” for retention, says Rafferty, is continuing professional development (CPD), which allows nurses to continue with learning, education and development during their careers. It’s a win for patients too, she adds.
She laments the way CPD is always the first thing for the axe when budgets have to be cut. “If you start turning CPD into some sort of lottery, where you can’t predict that you’re going to be able to do that course to progress your career, you start interfering with people’s motivation and morale and that then can set people in a downward spiral.”
One theme of her work over the years has been looking at staffing levels. One European study she was involved in looked at patient-to-nurse ratios and the level of nurses’ educational qualifications. The evidence so far, says Rafferty, is that there is “a strong association” between higher numbers and better patient outcomes, but also how nurses are educated makes a difference as well. “The better educated you are, the better [the] outcome”.
She is also busy with her RCN presidency – an elected two-year role she describes as ambassadorial both in the UK and abroad, as well as being a voice for the RCN membership.
Rafferty had hoped to stand for election again to secure a second term. But in August she tweeted that she had been “disqualified”. This followed complaints that she and another candidate had breached election rules by using RCN Facebook platforms to promote their campaigns. The disqualifications provoked a petition from some of the membership that called for an extraordinary general meeting and an independent review of the presidential election process. The latter, and a general meeting, are now due to take place.
Meanwhile, the rules have now been changed regarding the use of social media during elections, and the presidential election is being run afresh. Donna Kinnair, RCN chief executive and general secretary, noted that the organisation is “embroiled in conflict at a time when our profession has never been more in the public eye”. Rafferty declines to comment on the saga.
Born and raised in Kirkcaldy, Scotland, to a coal miner and a nurse, Rafferty cites her mother’s influence on her subsequent career. “I think I was really inspired by her stories of nursing prisoners of war, in particular, in military hospitals in Scotland in the second world war, and also being a member of the civil nursing reserve. So yeah, it was really her stories that inspired me and also the ghoulishness of her nursing textbooks. They used to terrify me and I used to have nightmares about them but they sort of fascinated and repelled me in equal measure.”
Her interest in academia was first sparked at the University of Edinburgh when she found out that there was a nursing research department. She started to attend seminars and wangled a place on an international summer school on nursing research by agreeing to do the catering as a ticket in. The penny dropped: “This is the scene for me,” she decided.
She recalls being “quite angry” as a student about the way that nurses were treated and “perplexed” as to why they were not seen as “power players” when it came to influencing policy. This has led to “a lifelong career of turning that frustration into academic study, and the lifelong passion and interest in trying to make change”.
Lives: Islington, London.
Family: In a relationship.
Education: St Andrew’s High School, Kirkcaldy, Fife, Scotland; University of Edinburgh (Integrated BSc); University of Nottingham (MPhil); University of Oxford (DPhil).
Career: 2011-present: professor of nursing policy, King’s College London; 2004-present: dean, Florence Nightingale School of Nursing and Midwifery, King’s College London; 2007-08: Department of Health, policy adviser on NHS next stage review (secondment); 1995-2004: senior lecture/director, centre for policy in nursing research/head of health services research unit, London School of Hygiene and Tropical Medicine; 1994-95: Harkness Fellow, University of Pennsylvania, US; 1991-95: lecturer and admissions tutor, Department of Nursing and Midwifery Studies, University of Nottingham; 1990-91: nurse teacher, John Radcliffe Hospital, Oxford; 1988-1990: course tutor, Open University; 1987-89: part-time lecturer, John Radcliffe Hospital, Oxford; 1986-87: part-time lecturer, King’s College London; 1982-86: staff nurse, professional surgical unit and research assistant, Queen’s Medical Centre, University of Nottingham; 1981–82: staff nurse/deputy sister, Royal Infirmary, Edinburgh.
Public life: DBE for services to nursing; president, Royal College of Nursing; fellow, US National Academy for Medicine; president/founding director, European Nursing Research Foundation; fellowship of the Royal College of Nursing (FRCN); American Academy of Nursing (FAAN); fellow, the Academy of Medical Sciences.
Interests: Foodie experiences with friends, film, music, drama, tennis, travel, cycling, keeping active.