REC Health and Social Care: Integrating Agency Nurses into the NHS

By Victoria O'Brien, REC Policy Advisor

Tuesday 12th August 2014

The King’s Fund recently reported that the nursing workforce has increased by almost 9,000 over the past six months, now standing at 315,000 - the highest on record. However, they question whether these levels will be sustainable when money becomes tighter later in the year. Safe staffing on our wards is, of course, more than just a numbers game; it’s about recruiting and retaining a motivated workforce with the right skills mix. This is why REC Health and Social Care is taking an active part in the Nursing and Midwifery Council’s ongoing consultation on revalidation and the Standards of conduct, performance and ethics for nurses and midwives, and why we are taking a closer look at staff morale on our wards. 

Interestingly, the latest version of this code focuses explicitly on teamwork, calling on all nurses and midwives to “work cooperatively within teams and respect the skills, expertise and contributions of your colleagues”. Considering the highly politicised rhetoric around agency nurses in recent weeks, it is perhaps a message employers and policy makers should be heeding more. 

Media coverage that questions the competency and compassion of agency nurses often pits agency nurses against their NHS colleagues. This is despite the fact that many agency nurses are former long-term permanent employees of the NHS, or indeed continue to combine agency work alongside permanent or part-time roles. This was the certainly case for many of the nurses we interviewed as part of our recent report Flex Appeal: Why freelancers, contractors and agency workers choose to work this way. 

For all those grappling with retention and safe staffing levels within the nursing workforce, the news that NHS workers may be facing another year of pay restraint will be course be a cause for alarm. However, the resounding message from the interviews and focus groups we conducted with agency nurses for the Flex Appeal report was that flexibility was just as important – if not more – to their decision as better pay.  Indeed, several of the nurses we interviewed explained how they had been offered permanent roles but had opted to continue to work on a temporary basis. 

“I have small children and I don’t really like doing nights … I was already doing [temporary work] and I was finding that I enjoyed my shifts more because I didn’t have pressure on me. And I didn’t have the politics and it was freedom, so I thought I am going to do this all the time. I can’t imagine ever going back.” 

Of course, that’s not to say that temporary work does not present its own challenges. However, aside from issues such as income insecurity, what emerged particularly strongly was that some agency nurses continue to feel isolated and discriminated against in the workplace. One nurse that not one of his peers had talked to him during a 14-hour shift. Another described their struggle to win over colleagues: 

“I think perhaps sometimes it’s because it’s a new face and they think ‘oh dear, going to have to carry this person through the shift’. But once they get to know you, you are a good worker and you get on with your work, and you know what you’re doing. They can see that and they warm to you.”

Greater focus on the psychological contract between agency workers and their employers and colleagues is central to not only improving patient safety but staff morale and workforce retention in general. And the good news is that NHS Employers need only make small adjustments to integrate their agency nurses onto wards, to dramatically enhance these workers’ performance. With little central leadership and coordination on this issue, REC Health and Social Care is keen to hear members’ stories of how they have worked with clients on agency worker induction and appraisals. If you would like to share your feedback, contact victoria.obrien@rec.uk.com. You can watch testimonials from frontline agency nurses about their experiences and motivations on our campaigns page.