We need to speak up about why being a nurse is fantastic
England’s new chief nurse Ruth May believes this message is key to recruitment and retention
England’s new chief nurse Ruth May believes this message is key to recruitment and retention
When Ruth May got the news that she had landed the top job in nursing, she was with her daughter Lucie. ‘She was running around the room, very excited – “Mummy’s a CNO!”.’ Lucie, eight, of course had no idea what a chief nursing officer for England does; her excitement was a sign of her enthusiasm for all things nursing: ‘She identified mummy being a nurse.’
Dr May recalls this happy moment after showing me a photo on her tablet computer of Lucie proudly wearing the new children's gender neutral uniform, part of an initiative in primary schools that she hopes will open young minds to the possibility of a career in nursing.
‘Nursing runs through me like a stick of rock’
After a long career at the highest level in health – she has been a trust chief executive, an NHS England regional director, and moved to the CNO post from the nurse director role at NHS Improvement (NHSI) – I wonder if the former theatre nurse still sees herself first and foremost as a nurse. ‘Absolutely, I still see myself as a nurse,’ she insists. ‘I’m a nurse like a stick of rock, I guess. In my heart, I’m a nurse.’
The biggest policy this CNO is likely to be involved in delivering is the recently-announced NHS Long Term Plan, which seeks to modernise and reshape services to meet the complex needs of our ageing population.
The Long Term Plan makes a commitment to improve the working lives of all NHS staff, and acknowledges that for its aims to be met, ‘the NHS will need more staff, working in rewarding jobs and a more supportive culture’.
Addressing work-life balance
So what needs to happen now to make nurses want to stay in their jobs? Many are worn down by excessive pressures and the lack of professional development; the idea of sacrificing yourself endlessly for the job is wearing thin, I suggest.
‘We all have a responsibility to talk well of each other and talk well of the profession’
‘Absolutely,’ says Dr May. ‘I recognise the challenges completely. But you [the nursing press] also have a role, and I in particular have a role, in articulating what is fantastic about our profession. We all have a responsibility to talk well of each other and talk well of the profession.’
Are employers doing enough to enable nurses to do the job and have a life? ‘There are lots of great employers doing just that,’ she says. She points to participants in NHSI’s staff retention programme, running since 2017 and now to be introduced in all trusts. These are ‘supporting their staff, to be able to speak up, to have flexible working’.
The Long Term Plan (which builds on the earlier Five Year Forward View) is a road map for more holistic care, to be achieved by breaking down conventional barriers between organisations, embracing new technology and shifting the focus to prevention and care in the community.
‘The Long-Term Plan is do-able’
No one is arguing with its aims, but many nurses are sceptical about whether these can be achieved, given that nursing shortages in England currently stand at 41,000.
Despite these concerns, Dr May insists it is ‘do-able’: ‘The Long Term Plan is a fantastic opportunity to set out the vision, set out the ambitions, over the next ten years. I genuinely believe it’s do-able – and we have to do it. I’m delighted there’s a focus on mental health.’
‘Flexibility is a key part of the retention work we have been doing’
But she adds: ‘Without sufficient workforce that is motivated and has the skills and abilities to work at the top of the licence, the Long Term Plan can’t be delivered. That’s why there is a big piece of work now on the workforce implementation plan.’
Will work-life balance be a key part of the workforce implementation plan? ‘Certainly, flexibility will be, it’s a key part of the retention work we have been doing.’
‘Like me, many nurses are juggling roles’
Dr May is one of the few very senior nurses I have interviewed who has a young child, but she doesn’t claim any particular insight into the need for flexibility or work-life balance. ‘I’m just a normal person, juggling being a mum as well as the chief nursing officer. There are many nurses caring for children and indeed caring for elderly parents. It’s normal.’
Dr May says her encounters with nurses – and she travels around England meeting as many as possible, even working the odd shift in uniform – suggest that ‘many thousands of nurses are proud of their profession’. She reads me an email from one long-serving nurse who heard her give a presentation recently and was inspired to write and tell her how she has no regrets and loves being a nurse, despite working with limited resources. The CNO believes this positive story about nursing is not heard nearly enough. It is why the first of her four priorities as CNO (see box) is ‘pride in nursing and celebration of the profession’.
Ruth May’s four priorities as England’s chief nurse
- Celebrate the profession – ‘Yes, there are challenges, but there’s also pride’
- Workforce – NHSI was commissioned by the previous health secretary, Jeremy Hunt, to look at retention. The first cohort to benefit comprised 35 trusts: ‘Now the plan is to roll out to all’. Dr May is also prioritising making nursing more appealing to young people: ‘We want to be working with schools in a much more co-ordinated way to attract the 16 and 17 year olds into nursing and midwifery. We want joined-up work’
- NHS Long Term Plan – ‘maximising the contribution of nurses and midwives’
- #teamCNO – the inclusive hashtag represents Dr May’s commitment to the idea of collective leadership: ‘It’s not just me, it’s the whole of the nursing profession, acting as one voice’. If nursing can ‘really celebrate our profession, I believe we can tackle the knotty issues about how we can recruit sufficient nurses and midwives into the profession’
Fulfilling the tensions of the role
Dr May took over from Jane Cummings in December. When I interviewed her predecessor last year, just after she had announced she would be stepping down, she spoke of the tension that comes with the role – the expectation some nurses have that their CNO will agitate publicly for nursing, like a union leader free to criticise the government, when in fact the CNO is a professional lead and the job is about advising ministers and exerting influence discreetly. Professor Cummings acknowledged that not being able to speak out publicly was at times frustrating.
When I mention this to Dr May, and ask how she sees the role, she suggests she can fulfil both sides of the job comfortably. ‘I see myself as doing all of this. I absolutely see myself as an advocate for the profession, working as a board member of NHS England and NHS Improvement, and advising the department of health and the secretary of state.’
Dr May’s appointment was warmly welcomed. But along with the congratulations there were some notes of caution about what she will be able to achieve, given that the CNO post has been relocated in the new NHS Executive Group, a combined management team for NHSI and NHS England. The merging of leadership for the two organisations is intended to bring closer collaboration between them, and cut running costs by 20%, but critics fear it will distance the CNO from ministers and weaken nursing’s influence.
Addressimg concerns over loss of influence
Acting RCN general secretary Dame Donna Kinnair said Dr May would be a ‘powerful and passionate voice for nursing in England,’ but added: ‘The nurse leadership voice is crucial to the broad health and care policy debate. Ministers need that perspective inside government as well as in the NHS and the RCN still wishes to see a chief nurse post reinstated at the Department of Health and Social Care.’
So how does Dr May plan to address these concerns? ‘I think it’s been addressed since I’ve been appointed,’ she says. ‘A fortnight ago, the secretary of state invited me to be his professional nursing adviser – to him and the Department of Health and Social Care. I’m the first CNO to be actually in the Department of Health and in NHS England and in NHSI – that gives me a unique ability to influence policy and government. And it also gives me the opportunity to put the voices of nurses and midwives at board level – just like directors of nursing [in provider organisations].
‘I’ve got an opportunity as CNO to influence policy and government and take responsibility and accountability for nursing and midwifery across England. It’s a huge privilege to be the lead nurse at NHS England and NHSI and the Department of Health and Social Care.’
NHS Long Term Plan – a voice of dissent
At a board meeting of NHS England on 31 January, attended by Dr May, a nurse in the public gallery interrupted the speakers to condemn the ‘very self-congratulatory way’ the board members were discussing the NHS Long Term Plan.
London palliative care nurse Gay Lee said the board had ‘only talked about the good aspects’ of the plan. ‘One thing I do want to say, which I have not heard in this meeting, is any real concern about the workforce that is going to do all this wonderful work.
‘We haven’t got enough staff now, we haven’t had enough budget since 2010 to train staff, we haven’t got any workforce strategy. We need something now.’
Ms Lee said she had been a nurse for 40 years: ‘I have never seen the NHS in such a bad state as it is now, and it upsets me a lot.’
NHS England chair David Prior responded at the meeting by saying the workforce was ‘fundamentally important’ and ‘crucial to delivering the Long Term Plan’.
Nursing Standard’s online news story of the incident attracted many readers’ comments congratulating Ms Lee for speaking out, with some suggesting she had been fobbed off by the board members.
When I raised this with Dr May, she revealed that as soon as the meeting was finished, she sought out Ms Lee. ‘I had a conversation with her, and yes she had a real story to tell about the pressures she is facing right now. I don’t believe she was fobbed off.’
Dr May added that Lord Prior also spoke to Ms Lee.
Routes into the profession
Dr May is a member of the national group that is developing the workforce implementation plan, which she says is due to be delivered to the health secretary at the end of March. She is leading on the group's nursing and midwifery work.
Unsurprisingly, she can’t reveal details –‘it hasn’t yet been finalised, we are still working on the priorities, and what resources we have. I’m very clear we need to invest in our current staff’ – but as you’d expect she is supportive of the direction of travel for the nursing workforce, already set out in the Long Term Plan.
The plan explicitly acknowledges the undergraduate degree as the primary supply route for new nurses. But it also gives a renewed commitment to broadening access to nursing and the development of roles such as the nursing associate. ‘I will ensure people are aware of the routes into nursing, but the undergraduate route is the most obvious,’ Dr May says.
‘I absolutely support the role of the nursing associate’
She has no truck with the idea that such roles undermine the profession or present a threat to patient safety. ‘I absolutely support the role of the nursing associate. Of course, we will need to make sure they are safely deployed. They are a very welcome part of the workforce.’
Urgent action on learning disabilities nurse numbers
Nor does she fear that targeted measures to recruit students for the most hard-pressed specialties risk creating shortages in other branches of nursing – something Council of Deans of Health chair Brian Webster-Henderson called ‘robbing Peter to pay Paul’.
A campaign to promote nursing generally as an attractive career option is necessary, she says, but so is ‘urgent action’ to stop ‘numbers dropping off a cliff’ in learning disabilities nursing: ‘We need to do both.’
Far from being daunted by the scale of nursing shortages in England, Dr May points out that at least we now know what we are dealing with – something she suggests hasn’t always been clear in the past. ‘We know it is 41,000 because now we are counting; we didn’t necessarily know before. Now we know, we can take the necessary action to deal with it.’
As Dr May settles into her role, hard-pressed nurses will be watching closely to see just what she'll do to help the government turn that ambition into reality.
Thelma Agnew is commissioning editor, Nursing Standard