The fight for fair pay and safe staffing is “not finished”, the chief nursing officer (CNO) of the Royal College of Nursing (RCN) has said.
In an interview with Nursing Times, Professor Nicola Ranger reflected on the challenges facing the nursing profession in recent years and what the UK might be able to learn from colleagues oversees in how to tackle them.
“This is a setback, but we still as the RCN have to advocate for our nurses and our profession”
Professor Ranger joined the RCN as chief nurse in December 2022, describing the role as the “professional voice for the college”.
She had come from King’s College Hospital NHS Foundation Trust where she had been chief nurse and executive director of midwifery since July 2019.
Prior to that she was chief nursing and patient safety officer at Brighton and Sussex University Hospitals NHS Trust for two years, and director of nursing at Frimley Health NHS Foundation Trust for over four years.
Professor Ranger said it was the coronavirus pandemic which prompted her move to the RCN.
She explained that, during the height of the pandemic, King’s College Hospital NHS Foundation Trust had more than 780 patients occupying hospital beds with the virus, with more than 140 patients on ventilation.
“I loved being a chief nurse, I loved leading fantastic nurses, I loved patients contact but I would say the pandemic probably changed me,” she said.
She added: “For nearly three years, I saw what my nurses did, what they sacrificed, what they’d seen, who they’d looked after.
“And I do not believe that post-pandemic we put [in] enough infrastructure to look after our nurses, so that really bothered me.”
In addition, Professor Ranger said she became upset about the normalisation of corridor care and hospital overcrowding and that nobody was “really spending enough time to stop it”.
She added: “I just felt I couldn’t do it anymore, and [that] I needed at this point in my life to do nothing else but advocate for the profession I love, and for nurses that I absolutely have had the honour to lead. And that’s why I’m at the RCN.”
As CNO of the RCN, Professor Ranger said she was directly involved with leading on key workforce, patient safety and staffing issues, as well as overseeing all of the RCN’s forums and championing the college’s global position.
Additionally, she is responsible for moving forward resolutions which have been passed at RCN Congress, an annual event where members of the college come together to discuss and vote on matters of importance to the profession.
Professor Ranger said there were a few moments at RCN Congress this year, held in Brighton, which made her tearful due to some of the harrowing testimonies shared by nursing staff.
She said she became particularly emotional during discussions around the impact of corridor care on staff and patients because of her own experience of the issue as chief nurse during the pandemic.
“It was so powerful for me to think how much that upset me as chief nurse but [also] to hear directly from our frontline caregiving staff, who hated it as much as me,” said Professor Ranger.
“It really made me think that this is a wake-up call [and] we have to sort this out for patients and for nurses.”
The RCN’s ongoing campaign for safe staffing is one of Professor Ranger’s greatest priorities for her time in post.
“Anyone that’s worked with me knows I am obsessed with staffing because it is the bedrock of wellbeing for nurses and recruitment and retention, and it is the bedrock of outstanding patient care,” she said.
However, Professor Ranger said that it was important to recognise that unsafe staffing levels were a “symptom of the whole system”.
She added: “We are one system, and until we start investing [in] and valuing all bits of the system, it’s very difficult to see how it’s going to get better for patients.”
Meanwhile Professor Ranger argued that the UK had “so much that [it] could learn from other countries” regarding key issues facing the profession.
She was among the RCN representatives who spoke at the International Council of Nurses (ICN) Congress, held in Canada last month.
Speakers at ICN Congress highlighted the negative impact that international recruitment practices from places like the UK were having on some countries.
During one session, a nursing professor from the Philippines, Dr Fely Elegado-Lorenzo, warned that the “poaching” of nurses from the Philippines by international recruiters has led to the country now struggling to meet the health needs of its own population.
Professor Ranger said: “I heard [Dr Elegegado-Lorenzo] say that they really can’t look after their own population – that really hit me hard.”
“I thought actually we all need to take a step back now because we’re far more connected [than we realise].”
A report by the Nursing and Midwifery Council, published yesterday, revealed that internationally educated nurses and midwives now account for one in five of the professionals on the NMC register, and between September 2019 and March 2023 they were responsible for more than two-thirds of the increase in the register.
Professor Ranger said international nurses were “such an asset” to the UK – something which said she became even more clear during and after the pandemic.
However, she argued that if countries wanted to achieve the ICN and World Health Organization’s main goal, which is universal health coverage for the world, then places like the UK have “got to do something different” from plugging staffing gaps through mass international recruitment.
“Any racism and discrimination is just shocking”
“It cannot be right that one in five nurses in the UK are internationally educated because there is something about what we’re doing to other countries,” she said.
She argued that the UK needed to come up with a proper domestic recruitment plan, to get more people to join the profession.
Professor Ranger said: “It really hit me at ICN Congress that we needed to do something different.
“We’ve genuinely got to get it together without the politics, put patients first and have a domestic recruitment plan, because we are having a detrimental impact to the rest of the world in the long term.”
The NMC report also revealed that internationally educated nurses had been crying at the end of shifts and have been left traumatised because of the racist and derogatory comments they face.
Professor Ranger said: “The NHS wouldn’t have survived without our international nurses and it’s absolutely right that we treat them well, and they’re part of our teams and we look after them.
“Any racism and discrimination is just shocking.”
She added that ICN Congress was an opportunity to hear what other countries were doing to try and “get equality, diversity and inclusion right” and “stamp out racism within the profession”.
“There were some very powerful testimonies, particularly from the American and Canadian nurses associations, I took a lot from that,” said Professor Ranger.
She added that stamping out racism was an area of particular focus for the RCN, following the damning findings of the Carr Review published last year.
The independent review into the RCN’s governing council found that Black, Asian and minority ethnic staff did not feel welcome in RCN Council.
Separately Professor Ranger said she came back from ICN Congress “very motivated from learning from other countries” and that it made her realise that the fight for better working conditions for nurses was “not over”.
Over the last year the RCN had held a series of high profile strikes in a dispute with the government over NHS pay and safe staffing.
However, in June the union failed to obtain another six-month strike mandate when its postal ballot did not receive enough votes to meet the required 50% threshold.
As such, the union announced that its nurse strikes would be coming to an end for now.
Professor Ranger said: “Despite the fact that we got [a] 43% [turnout], which wasn’t enough for the legal threshold to take strike action, of the 43% of nurses that voted 85% voted in favour.
“Over 100,000 nurses [voted for strike action] which is a phenomenal number of nurses.”
Professor Ranger added that the RCN was now listening to its members and its governing council, to help decide what it will do next in the fight for fair pay and safe staffing.
She said: “The clear message from Pat [Cullen] and the executive team [is] this is not finished.
“Our nurses are not happy, they are not happy with how our profession is valued, how they can’t do their job well – so we are refocusing.”
Professor Ranger said she learned from other countries at ICN Congress that things like the strike ballot were “hurdles that you have to get over”.
She added: “This is a setback, but we still as the RCN have to advocate for our nurses and our profession.”