The regulator for nursing and midwifery says its first annual ‘spotlight’ report on the profession is highlighting concerns about pay coupled with inconsistent support for new entrants and international nurses facing racism.

The Nursing and Midwifery Council (NMC), set up to support professionals to uphold high standards,  says its new report tells ‘a powerful story’ of contemporary practice.

This report highlights a number of concerns across the sector, in terms of staff support, financial assistance, staffing levels and discrimination in the workplace.

Andrea Sutcliffe, NMC Chief Executive and Registrar, says some of the findings are troubling:

“There are more than 788,000 professionals on our register, whose knowledge and skill are vital to all our health and wellbeing. But on the rare occasions that care goes wrong, it’s often down to common factors getting in the way of the safe, effective and kind care people have a right to receive.

“We’re shining a light on those factors, including further evidence of racism and discrimination. We’ve spoken to some international recruits who have shared troubling stories about their formative months in UK practice. Supporting every professional to thrive is key to retention of staff, and to ensuring high-quality care for people.”

Nurses and midwives told the NMC that financial instability facing the nursing workforce amidst the cost of living crisis is one of many challenges, saying that pay does not adequately reflect the level of responsibility held.

The report adds: ‘This feeling of being underpaid and undervalued is exacerbated by working long hours, often without a break.’

Commenting on the report published today, Eileen McKenna, Associate Director, RCN Scotland, said it echoes the findings of the RCN student finance survey:

“The NMC’s report underlines many of the issues we’ve raised repeatedly. Nurses at all stages of their nursing career journey need far better support to provide the quality of care they want to and continue in the profession. 

“The cost-of-living crisis, lack of opportunities to supplement their income and long delays in being reimbursed for expenses on clinical placements are creating a financial black hole.

“The Scottish government must boost the financial package for nursing students and establish a regular review of the level of support to make sure it rises in line with the cost of living.”

Key issues with workplace culture are highlighted by the NMC, with the pressures of staff shortages being exacerbated by cases of bullying, hostility or people being sidelined.

The report cites ‘unrealistic expectations from managers’ to fulfil duties outside of scheduled hours or experience and an emphasis on getting the job done at the expense of personal wellbeing.

One nurse in Scotland said:

“There seems to be service-wide burnout going on at the moment. It has a massive knock-on effect, almost a toxic effect where, if I go looking for support, other people go ‘well I never got that when I qualified, I got chucked straight in’.”

Not a warm welcome

Internationally educated professionals were particularly likely to cite low pay as a downside of working in the UK with the high cost of living, with 40% saying they would be unlikely to recommend practicing in the UK to other international professionals.

RCN Scotland’s Eileen McKenna says that international staff must not be attracted to Scotland “simply to fill gaps”, adding:

“The NMC’s report provides more evidence why the Scottish government’s focus must be on efforts to stop our experienced staff leaving and making nursing an attractive and rewarding career choice.

“The Ministerial Nursing and Midwifery taskforce is the Cabinet Secretary’s opportunity to act, to tackle the nursing workforce crisis and to develop the sustainable nursing workforce Scotland needs.”

Many international professionals are experiencing discrimination that impacts patients – from not feeling equally respected to racist and derogatory language.

Earlier this year, the Royal College of Physicians of Edinburgh’s Dr Mary Ann Ferreux told healthandcare.scot that structural reforms are needed in across healthcare for people facing racism, highlighting a lack of diversity at the decision-making table and “good intentions” met with poor implementation.

The NMC survey cites abuse from members of the public and people using services involving ‘explicitly racist language’, while discrimination from colleagues often related to being undervalued or having their authority undermined.

An internationally educated nurse in Scotland shared:

“It is difficult to give the best of yourself if you are looked down upon or treated unfairly and differently from other people.”

Sharing their findings today, the NMC said: ‘Discrimination exists in health and care, and there is evidence that it undermines the care people receive. By fostering more inclusive workplace cultures, employers and leaders can help ensure every nurse, midwife and nursing associate is able to thrive.’

Ms McKenna told healthandcare.scot:

“Any form of racism or discrimination must be tackled robustly.

“The Royal College of Nursing remains resolute in standing against racism and all forms of discrimination and inequality, and will continue to work with the NMC and other agencies to find ways to tackle and eliminate inequality across all forms of healthcare and healthcare regulatory processes.”

Read more: RCN calls for urgent investment in nursing; Mr Yousaf: “Scotland is a great place to work”; A pharmacist on the frontline; Diversity in healthcare – what can we do?; Organisational change needed for women in healthcare

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