Why experienced nurses are an important but neglected occupational group in workforce strategy planning
The purpose of this article is to discuss the terminology used to describe long-serving nurses and midwives. This discussion is needed because, as a unified occupational group, they rarely feature in discussions in relation to workforce retention and development. This piece seeks to start a conversation about, and to raise the visibility of, this population as an important, yet neglected, entity in workforce strategy planning. It puts forward a new perspective to recognise the long-serving nurse as an asset in the NHS workforce, who deserves specific consideration and workforce planning.
Citation: Buaki-Sogo MA et al (2023) Workforce assets: recognising the value of long-serving nurses and midwives. Nursing Times [online]; 119: 11.
Authors: Maria A Buaki-Sogo is a full-time PhD student; Sally Goldspink is associate professor, health and social care; Hilary Engward is associate professor, applied social science; all at Anglia Ruskin University.
- This article has been double-blind peer reviewed
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How can we best describe long-serving nurses and midwives to recognise and unlock their hidden value? As an occupational group, they rarely feature in the literature and evidence, so this piece seeks to start a conversation about why that might be, and to raise the visibility of this staff population as an important, yet neglected, element of workforce and strategy planning.
Background and context
To set the scene, it is useful to know about us as authors. I (Maria Buaki-Sogo) am studying for my PhD and the other authors are my supervisors. My PhD project focuses on the role of long-serving nurses/midwives. I am a dual-qualified nurse and midwife, with 17 years’ experience, so I come to this subject with an intrinsic interest in the legacy of nurses and midwives. There is also an urgent practical need to amplify the visibility of this group as a strategic aspect of future workforce planning.
My research is funded as part of a wider project exploring the professional nurse advocate and professional midwifery advocate roles in relation to long-serving nurses and midwives in the East of England region. East Suffolk and North Essex NHS Foundation Trust is seeking to understand and support their long-serving nurses to remain professionally active, which is also a pressing national priority. As Marie Alexander, associate chief nurse (education and research) at the trust, says: “We value our experienced nursing and midwifery colleagues, and want to develop our understanding of their experience in the workplace and how this might influence their decision to remain in the workforce.”
It is thought that, in their current roles, long-serving nurses may already be providing pastoral support, thereby inadvertently emulating the Advocating for Education and Quality Improvement – also known as A-EQUIP – model of restorative clinical supervision and acting in a similar capacity to professional nurse advocates.
“I am seeking to identify what terms long-serving nurses and midwives think best represent them”
What is the problem?
The need to increase the visibility of long-serving nurses is imperative. During, and since, the Covid-19 pandemic, the demands on NHS staff have significantly increased pressures in the workplace, and they continue to escalate – as indicated by the approximately 34,000 nurses who left their jobs in 2020-21 (Stacey, 2022). With so many nurses now leaving the register, there is an urgent need to retain experienced, knowledgeable staff in the NHS.
This discussion is also in line with the key principles to support retention of registered nurses and midwives via targeted interventions at different stages of their careers, outlined by Wilkinson-Brice and May (2022) and NHS England’s (2020) people plan, which suggested that exploring job satisfaction may help mitigate further crisis. This would be in addition to recent attempts to improve current retirement plans through proposed NHS pension scheme regulation changes, as outlined in the Department of Health and Social Care’s (2023) McCloud judgement report.
Acknowledging and defining long-serving practitioners as vital may inspire more training and development opportunities for future generations of nurses (Wray et al, 2009). It is my experience of learning from, and giving to, other nurses and midwives that prompted my thinking about who those legacy nurses and midwives are. What strikes me is that my colleagues probably did not consider themselves as legacy makers but, rather, as professionals who had been doing their job over a number of years. Some were close to retirement, but others were long qualified, continued with CPD and seemingly quietly just got on with their job.
What is known?
Focus on retention in the NHS is not a new priority and issues had been identified before the Covid-19 pandemic. Markowski et al (2020) identified flexibility, reasonable adjustments to shift patterns, professional recognition, mentoring opportunities and financial considerations as important reasons to remain professionally active. However, during the pandemic, Theodosius et al (2021) identified burnout, exhaustion and work pressures as recognised key reasons for nurse attrition, and suggested that nurses who could retire early might consider taking the opportunity to do so, instead of prolonging their professional career in the NHS.
Such factors point to the complexity in how we understand the nursing workforce. However, what is missing is the explicit recognition of long-serving nurses – those who have been professionally active for many years, but are not necessarily at retirement age.
This is perhaps unsurprising – long-serving nurses are seldom present or recognised in formal documentation and literature. It has been acknowledged that, although there is a developing interest, there remains a lack of clarity as to who experienced or long-serving nurses might be (Jones and Pearce-Smith, 2021). This stems from an ambiguity in the literature and guidance, as the terminology tends to lean towards an assumption that a long-serving nurse equates to one who is approaching retirement.
Theodosius et al (2021), for example, refer to “pre-retirement nurses” as those aged >50 years, and key terms used across literature include ‘older nurses’ and ‘retirement-age nurses’, to name a few. Haines et al (2021) proposed that, by focusing on pre-retirement nurses, we may be suggesting, implicitly, that they are in the process of leaving, thereby possibly dismissing the positive side of their long-serving career. This point resonates with me: I consider myself to be a long-serving nurse/midwife, but I am in my late 30s and retirement is far in my future. It is currently unclear where staff like me sit in such discussions. We, therefore, recommend that, when referring to nurses on the register who have been practising for >15 years, the term ‘long-serving’ be considered more appropriate than ‘pre-retirement’.
I am not saying this group is unseen or not valued, rather that there are discrepancies in how long-serving staff are identified and perceived. In my experience, nurses with a long service record are sometimes recognised by their local organisations by, for example, being given an award for that service. As the full value of this population as an entity is only starting to be recognised, we must think carefully about the best term to use to capture this group so there is parity between how we understand who they are and the terms we use to refer to them.
There are moves towards developing affirmative terms that align well with long-serving nurses. Haines et al (2021) introduced the term ‘legacy nurses’, inspired by the concept of the Legacy Mentor project conducted by Clauson et al (2011), where nurses were described as practitioners aged ≥55 years with a wealth of knowledge. However, specification of the legacy mentor term is left open to individual organisations’ interpretations and, is subsequently, unclear.
The purpose of legacy mentor roles tends to be aligned with nurses who return to practice after retirement to share their knowledge and experience, and provide pastoral support to newly qualified or early-career nurses (Haines et al, 2021); as such, the legacy mentor term is not relevant to many nurses in the NHS.
From a disciplinary perspective, I understand the value and the legacy left to me by colleagues with substantial experience that was accumulated over many years. This, in turn, makes me consider what my legacy is, not only to future nurses, midwives and the profession, but also to patients, as detailed in this reflective note:
“The practitioner I am today is the outcome of outstanding role models… I had the opportunity to come across nursing and midwifery natural leaders, who taught me to uphold and maintain professional values and standards, to always practise with integrity and to recognise the value of experience. Therefore, it is essential that nursing and midwifery long-serving practitioners are part of workforce conversations moving forward because the legacy I was given by them is the legacy I will be giving to generations to follow me.”
Older literature, such as that by Andrew et al (2005), does point to the value that experienced nurses provide to those who are entering the profession, especially in relation to skills acquisition, professional career development and supporting students who are close to transitioning to become registered practitioners, as highlighted by Zilembo and Monterosso (2008). In addition, both Storey et al (2009) and Wray et al (2009) stated that experienced nurses were seen as the fundamental pillars of the profession and as pivotal in passing the baton to the generations to come. However, although useful, these works are dated – the NHS workplace context, post pandemic, is different from what it was previously.
While retention figures during the pandemic improved – despite an increased workload and the toll that unusual levels of bereavement events took on nurses – it is unclear what direction these trends will take now that Covid-19 pressures have eased; however, individual staff experiences in the workplace during the pandemic may directly influence future career decisions (Kelly et al, 2022).
The context of the recent past suggests an even greater need to explicitly highlight the work of influential nurses who inspire and motivate practitioners to pursue a career in nursing. As such, this group should be supported to remain at the heart of the profession and continue to be an important part of our professional foundations. We suggest, therefore, that the term ‘long-serving’ is a better descriptor as it:
- Encompasses all nurses who practise for an extended period;
- Directs attention towards a person’s contributions;
- Focuses on experience, rather than seniority or age, as a measure.
Our discussion points to what skills and values long-serving nurses inherently encompass, and how these can be applied in their professional sphere.
The knowledge gap
The term ‘long-serving’ is useful to draw attention to this population, but the problem remains in defining, in detail:
- Who the long-serving nurse might be;
- How they want to be represented;
- What they bring to the profession that needs to be formally recognised.
To understand this better, my research is using narrative inquiry to obtain first-person accounts of the experiences of nurses and midwives who self-classify as long serving. The qualitative method places their experiences within the sociocultural contexts of where they practise within East Suffolk and North Essex NHS Foundation Trust. This will incorporate nurses and midwives who entered the professions via different routes, including as nursing associates, through registered nurse degree apprenticeships, and via direct entry and postgraduate nursing and midwifery pathways.
Understanding differences across such routes is important – some are for mature learners who may have been healthcare support workers. The aim is to understand:
- Who considers themselves to be long-serving practitioners;
- How they came to be such;
- What opportunities they feel are available to them;
- What barriers they experience;
- How they feel about their contributions to staff and/or patient experience.
The intention is to provide recommendations as to how professional careers can be prolonged to prevent early attrition. Importantly, in terms of formal recognition, I am seeking to identify what terms long-serving nurses and midwives think best represent them.
This research is timely and essential: the NHS’s (2019) long-term plan outlines the aim to reduce vacancy rates in the NHS to 5% by 2028. Our intention to listen to, and understand, the issues from long-serving practitioners themselves has practice-based implications, as recognised by Marie Alexander: “We anticipate that this research will provide us with important, trust-based insights that we can share with our broader networks to inform our future long-term workforce development and planning.”
It is vital to talk about the role of long-serving professionals at all levels. We will start the dialogue by exploring conversations taking place at individual level; these insights can then be used to inform organisational- and national-level discussion. Here, leadership is needed to empower nurses and midwives to use that professional advantage and conduct research on the issues that directly affect them so they can help take the workforce agenda forward. Box 1 gives an overview of conversation points suitable for different levels.
Box 1: Conversation points at different levels
Macro – national level
How can long-serving practitioners be explicitly evident across national policy documents (such as the NHS’s people plan, NHS Long Term Workforce Plan and Nursing and Midwifery Council guidelines and regulations)?
Meso – organisational level
What organisational policies can be developed to incorporate the findings of this research? How can long-serving practitioners be explicitly evident across organisations?
Micro – individual level
What are clinical practitioners’ views on long-serving nurses and midwives?
The outcomes of this project will enable us to think more clearly about the NHS workforce, and to consider how different professional careers can be supported within the organisation.
By starting a conversation about the experience, role and value of long-serving nurses and midwives, we can find out more about this group, and the variation within it, from their perspective. These understandings can be used to meaningfully inform long-term workforce and strategy planning. Addressing long-serving nurses and midwives, referring to them by using more-appropriate terminology and giving them a sense of identity may be a key step towards disciplinary acknowledgement, recognition and appreciation so the value of experience can shine.
- In the current workforce retention crisis, it is vital to be aware of the needs of newly qualified nurses
- Better acknowledgement of long-serving practitioners may inspire new staff to stay in the profession
- It is important to raise the visibility and profile of long-serving nurses
- A key starting point is to establish a clear definition of this occupational group
- Retaining the knowledge and skills of experienced nurses will have a positive effect on care
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