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Wales CNO seeking to improve ‘domestic pipeline’ of nurses

Wales’ chief nursing officer has said she is cautiously optimistic that she can pull off her action plan for the profession, despite an ominous financial forecast by the Welsh Government.

Sue Tranka, chief nursing officer (CNO) for Wales, told Nursing Times she was “ever the optimist” but also “quite the pragmatist” regarding making progress on her priorities.

“It’s important for me to build and grow our domestic recruitment pipeline”

Sue Tranka

She outlined upcoming changes, in particular, to preceptorship and clinical supervision, as well as the introduction of a band 4 nursing position, that she was planning to introduce to boost the “domestic pipeline” of registered nurses in Wales.

Ms Tranka made the remarks during the CNO Wales Annual Conference, held in Cardiff last Friday (13 October).

Opening the event, the CNO reiterated her five broad priorities for 2022-24 which remain unchanged from when she first took up her post: leading the professions; workforce; making the professions attractive; improving health and social care outcomes; and professional equity and healthcare equality.

She told Nursing Times: “[The priorities] run for the next year and we’re not going to take any focus off them because I believe, as a composite, they will give us a lot of benefits – but I can’t deny workforce is our greatest challenge.

“So, our real focus for the next year will be on how we continue to generate our student training numbers and continue to generate internal recruitment, because it’s important for me to build and grow our domestic recruitment pipeline.”

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Ms Tranka confirmed that a set of preceptorship “principles” will be published soon for health boards in Wales.

She said these principles would be nothing revolutionary, but would set in stone expectations for preceptorship across the country.

“We’ve been using [preceptorship] as an intervention for a long time for newly-qualified nurses,” said Ms Tranka.

“We’re not going to reinvent the wheel necessarily, but what we’re doing is putting [the principles in place] to be consistently applied across every health board.”

She continued that, as part of this, health boards will be told they must have someone trained in the principles of preceptorship.

A focus will also be placed on retaining senior nurses as these staff play an important role in supporting the newer nurses.

More on the CNO Wales conference

“It also will say that preceptorship does not stop at the end of year one,” Ms Tranka said.

“It will say that after year one you will step quite smoothly and successively into clinical supervision, and that someone will pick [you] up.”

Ms Tranka said that, at present, clinical supervision after preceptorship is ad-hoc and something “people do if they have the time for it”.

The upcoming publication from the CNO office will, she said, solidify it as a standard for health boards.

The move in Wales follows the introduction of a new preceptorship framework in England, as reported by Nursing Times.

Ms Tranka also mentioned that her office had been investigating the possibility of creating an Agenda for Change band 4 nursing position, similar to that of nursing associates in England, to act as a pathway for someone to progress from lower-banded clinical staff to registered nurse.

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The CNO said the final details of this scheme were still to be determined, but that it would “definitely widen access” to nursing, and give current assistant practitioners – such as healthcare assistants – a more clear way to qualify as band 5, if they would like to.

She said: “Currently, there isn’t a clear pipeline; If they want to train to be a nurse they have to step out of their current roles, give up their job, and they get loss of earnings.

“This is about a pathway which enables them to retain their job, and continue to train as a nurse, possibly like an apprenticeship model – I don’t know yet.”

She said that more details would be available by the end of the month.

Asked if this new band 4 position will emulate the nursing associates scheme, Ms Tranka said: “I’m trying to ensure we have a pipeline; whether they will be called nursing associates or not I am not entirely certain.

“For me, this is not about a title, it’s about – what does the pathway entail for these nurses?

“I’m not sure I necessarily want to replicate the nursing associate model, not that there’s anything wrong with that. I just don’t know what the outputs are going to tell me.

“And when I’m informed by the decisions that have been taken, then I can make a decision together with key partners. And then we can work with our ministers to understand what it is we want to put into place.”

The CNO said that, while domestic recruitment would be her priority, this newly-improved pipeline would continue to be supported by ethical international recruitment.

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“We’ve seen a really great trend in vacancy rates declining,” she said. “That needs to continue.”

Welsh health and social services minister Eluned Morgan, speaking at the conference on Friday, pledged to continue to protect the NHS “as far as possible” from the “economic turmoil” of the last year, but said “tough decisions” by the Welsh government were on the horizon.

Ms Tranka told Nursing Times that she believed her priorities would not be impacted by any hypothetical cuts to health budgets.

“I am ever the optimist, but also quite the pragmatist, I think,” she said.

“And so, it’s really important for us to put our efforts into the opportunities in those priorities that are going to have the highest impact for our workforce.

“There will be decisions that we will have to make along the way, dependent on what challenges we come up against, in order to make some changes and adapt and pivot to those.

“When I set my priorities, most of those priorities, were on a cost neutral-ish basis. We had a few things that were going to be we had a cost impact, and that had been costed ahead of time.”

The CNO acknowledged, however, that some of the issues within her priorities were “forever issues”, meaning they are long-standing and not quick fixes.

She added: “I often say that turning the ship on these issues – recruitment, retention, attraction, and kindness within the profession – is going in the right direction, but it is at glacial pace.

“We’ve got to recognise that this is about taking us on a massive cultural journey, as well as doing those other tangible things along the way.”

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