Nurses buoyant despite staff cuts eroding job satisfaction

Learning disability nurses are struggling to do their jobs properly because of inadequate staffing, however the level of ‘overall engagement’ is rising, suggesting buoyancy in the face of crisis, according to the 2016 NHS Staff Survey.

Learning disability nurses are struggling to do their jobs properly because of inadequate staffing, however the level of ‘overall engagement’ is rising, suggesting buoyancy in the face of crisis, according to the 2016 NHS Staff Survey

Picture: iStock

What do learning disability staff think of the organisations they work for? Do they have fulfilling jobs – and how do they rate the standards of care at their workplaces?

These questions were put to professionals as part of the 2016 NHS staff survey, completed by 423,000 staff in England and published in March this year.


of learning disability nurses in England experienced violence in previous 12 months (Source: NHS staff survey 2016)

The survey results are broken down into different categories of NHS organisation and by staff grouping for certain questions.

Only 32% of the 37,384 staff who responded from the 28 mental health/learning disability trusts surveyed believe their organisation has enough staff to allow them to do their job ‘properly’. This is the same proportion as the overall NHS average.

Salford University lecturer in learning disability nursing Dan Redfearn says the figures tally with reports he has received in recent years from learning disability nurses – that their jobs are becoming more demanding because there are fewer staff. ‘There is more pressure now than a few years ago. It’s not necessarily because of cuts, but people are leaving and not being replaced.’

Holding together

RCN general secretary Janet Davies says of the staff shortages: ‘This is another reminder for the government of how NHS staff across the board are straining to hold things together. Ministers should offer nurses and healthcare assistants a pay increase that keeps pace with the cost of living and not another real-terms cut.’


of mental health/learning disability staff were 'satisfied' or 'very satisfied' with flexible working patterns (Source: NHS Staff Survey 2016)

Without this ‘people will be deterred from joining the nursing profession and others will feel they have no choice but to leave it,’ she says.

Just 61% of staff at mental health/learning disability trusts were happy that the standard of care in their organisation would be good enough for their own friends or family members. The figure was higher across all NHS trusts at 70%.

The survey also revealed that 26.1% of learning disability nurses had experienced violence in the previous 12 months, compared with the NHS average of 15%.

Mr Redfearn says it should not be seen as inevitable that violence in learning disability settings is higher than in acute trusts. ‘When service users in learning disability services are violent it is generally because they have an unmet need that they cannot communicate. It doesn’t make it acceptable but it does make it more understandable.’

Peter Woodward, a nurse and senior lecturer in learning disabilities at the University of Greenwich in London, says the question of whether staff had experienced ‘physical violence’ was too vague.

‘There is no indication on how serious the assault is. If staff were seriously assaulted in a mental health unit it would warrant having a different category from, say, a child in a special educational needs school pulling a nurse’s hair as she adjusts the footrests on their wheelchair. It appears these would be recorded as the same.’

Job satisfaction

The NHS staff survey is carried out every year, but there is little variation in the 2016 results for mental health/learning disability trusts compared to those from 2015. Many responses are the same, while others differ by only a few percentage points.


of learning disability/mental health trusts believe their organisation has enough staff to do the job properly

(Source: NHS Staff Survey 2016)

Some positives are emerging, however. Job satisfaction at mental health/learning disability trusts has risen gradually since 2012. Statisticians calculate an indicator of satisfaction from zero to five based on survey responses, and for mental health/learning disability staff in 2016 this stands at 3.87 – an all-time high. The ‘overall engagement’ of learning disability nurses was 3.95, compared with 3.69 for mental health/learning disability staff in 2012.

The figure combines staff members’ perceived ability to contribute to improvements at work, their willingness to recommend the organisation as a place to work or receive treatment, and the extent to which they feel motivated and engaged with their work.

Mr Redfearn says of the improved engagement figure: ‘A good team pulls together in difficult circumstances, and the improving result could be down to the camaraderie they are experiencing with the rest of their team, rather than an indication of improvements at the macro-management levels in their organisations.’

What does the head of NHS England say about the survey?

NHS England Chief Executive Simon Stevens focused on positives when summarising the survey results across the NHS, pointing out that of 32 key findings over 80% were more positive than last year. 

‘Perhaps surprisingly, given the well understood pressures, it’s encouraging to see that front-line NHS staff say their experience of work continues to improve,’ he remarked. However, Mr Stevens had to admit that there is ‘much to be done to ensure staff are properly supported, and local NHS employers are now being incentivised to better support the health and well-being of their own staff.’

He added that the survey is produced as a resource for NHS trusts and commissioners to help them improve staff experience. The NHS inspectorate and the Care Quality Commission will use the results to ensure essential safety and quality standards are met, and NHS Improvement looks at the findings to identify variation between organisations and help them focus on areas needing attention.


Areas where mental health/learning disability trusts score well

For some aspects of working life, mental health/learning disability staff gave very positive responses, often scoring higher than colleagues in the NHS as a whole. These concerned team meetings, the availability of flexible working and the quality of support from senior managers:

  • Some 66% of staff at mental health/learning disability trusts ‘agreed’ or ‘strongly agreed’ with the statement: ‘The team I work in often meets to discuss the team’s effectiveness’. The overall NHS average was 60%.
  • On opportunities for flexible working patterns, 58% of mental health/learning disability staff were ‘satisfied’ or ‘very satisfied’. The NHS average was 52%.
  • Some 91% of learning disability nurses said they felt their role made a difference to service users.
  • Another question focused on whether staff had ever felt pressure from managers to come to work. Across all trusts 26% said yes, but among mental health/learning disability trusts the figure was 20%.


Further information

Christian Duffin is a health writer

This article is for subscribers only