Practice nurses need ‘voice’ in decision-making to improve retention

Lack of recognition, feeling undervalued and lack of involvement in decision-making are three key areas that need to be addressed if practice nurse retention is to be improved, a study suggests.

Nurses working in primary care settings during the Covid-19 pandemic felt largely “forgotten” and undervalued, with many considering future career changes, according to those behind the research.

“A key factor is being included in decision-making on significant changes to general practice”

Helen Anderson

It suggested that involving nurses in decision-making on significant changes to general practice could be a key factor in staff retention, with study participants highlighting it as an issue in need of tackling.

Practice nurses who took part in the study also wanted their managers to demonstrate better understanding of the roles they have and to pay them appropriately.

In addition, they wanted more efforts to raise awareness among colleagues, the media, and general public of the role played by nurses in primary care.

University of York researchers conducted interviews and focus groups with 40 nurses across England to understand how working during the pandemic had affected their wellbeing and job satisfaction.

Their study showed that decisions on re-shaping general practice services during the pandemic, and going forward, were taken by GPs and practice management with little input from the nursing staff.

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This was despite most of the nursing staff’s work requiring face-to-face interactions for the duration of the crisis, noted the study authors.

For example, the setting up of Covid-19 vaccination centres and administering vaccines to patients was largely done by nurses in primary care.

Study participants stated that this was a significant undertaking, which practice nurses felt was unrecognised by colleagues, the media and general public.

Many nurses in the study also reported that there were differences in their experiences of the pandemic compared to doctors, but that little provision was made for this.

Therefore, many felt this negatively impacted on their mental health and some faced burnout, leading them to leave general practice or the nursing profession altogether, noted the researchers.

Another participant in their research highlighted that nurses had lots of ideas on how healthcare could be delivered to increase the benefits to patients.

However, the nurse told the researchers that they were not invited to the decision-making table and so did not have the opportunity to share their experience.

Another stated that the value and the benefits nurses could offer was not often publicly highlighted, and it was not widely known that they have specialist skills in things like long-term conditions.

Other nurses in general practice cited remuneration and terms and conditions of employment, including sick and maternity pay, which they said did not reflect NHS terms and conditions.

For example, practice nurses were among those left out of a one-off bonus scheme that was pledged as part of the 2023-24 pay deal, and which was worth a minimum of £1,655.

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Lead study author Dr Helen Anderson said: “Nurses have a very specialised role within general practice, which includes delivering the bulk of long-term condition management, such as diabetes and asthma care, immunisation and vaccination programmes, and other essential care that can’t be delayed and requires in-person consultation.

“But this often goes unrecognised within the profession, by their employers and society in general,” she said.

In addition, she said that, while many of the nurses they spoke to for the study told them they felt “forgotten” pre-pandemic, this was further exacerbated during Covid-19.

As a result, it led to nurses “feeling undervalued and accelerated considerations to move out of the profession,” said Dr Anderson.

She said: “Despite considerable changes to general practice during Covid, which saw new technological interventions and an increase in phone and online consultations, much of the work that nurses carried out simply had to go ahead in-person.

“But against a backdrop of considerable stress, anxiety, and health risks, much of which has been undocumented in research on the pandemic so far,” she noted.

The researchers highlighted that general practice nurses in England saw around seven million patients a month and 84 million in a year.

However, they said that a report from the Health Foundation, published in July, had predicted that one quarter of general practice nursing posts in England could be vacant in 10 years’ time.

As a result, the retention of nursing staff has become vital for the future of the NHS, at a time when retention of GPs was also an issue, warned the study authors.

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Dr Anderson said: “We found there were three key areas that could make nurses feel more valued in their position, which could help with future job retention rates beyond the Covid-19 pandemic.

“A key factor is being included in decision-making on significant changes to general practice,” she said.

“The second is for management to demonstrate understanding of the roles that nurses have, and remunerating them appropriately, as it was often pointed out to us that colleagues seemed to be unaware of what nurses were doing on a daily basis.

“Lastly it was important to our study participants that there was more awareness raising of the ‘invisible’ role they play with colleagues, the media, and general public, to improve understanding of the highly skilled work that they do,” she added.

The study, funded by the General Nursing Council for England and Wales Trust, has been published in the Journal of Advanced Nursing.

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