Kenyan Nurses and the Crisis of NHS Nurse Staffing
We’re publishing a guest post today by Dr. Ann Bradshaw, a retired Lecturer in Adult Health Care, about the scandal of the Government’s failed efforts to import nurses from Kenya in a vain attempt to solve Britain’s nursing crisis.
The U.K. nurse staffing crisis shows that the current system of recruitment, retention and training of nurses is not working.
In July 2021, the U.K. Government made a Memorandum of Understanding with the Kenyan Government to take 20,000 of its 30,000 unemployed nurses to Britain. I didn’t see this publicised in the press and thought it strange that Kenya has so many unemployed nurses.
Then I saw in Nursing Times that the Kenyan Government would be taking a cut of these nurses’ salaries. Then I saw that this was denied by the U.K. Government.
Then I saw that Kenyan nurses were failing English language tests. Then, on November 11th, I saw that this U.K. recruitment of nurses from Kenya was being halted because Kenya is on its list of countries facing a shortage of health workers.
So why is there such a problem recruiting and retaining nurses in the U.K.? Why has the U.K. Government been forced to look to Kenya for nurses? I have argued elsewhere (see here and here) that the move to become academic by the nursing elite was not primarily intended to improve care for patients – its primary objective was to improve the status of the profession and divorce it from medicine.
This revolutionary change to make nursing academic has had, from the evidence that I have adduced, a disastrous impact on both recruitment and retention of nurses. Much of this so-called academic body of nursing literature is esoteric and of extremely dubious academic quality. Indeed, the highly ranked, prestigious, international nursing journal, the Journal of Advanced Nursing, admits this in an editorial by two U.K. nursing professors titled: “Is academic nursing being sabotaged by its own killer elite?”
In my view, nursing’s ‘killer elite’ is the Blob, and it is not merely killing the ‘academy’, it is killing the purpose of nursing: care for the patient. This has been clear to me long before this editorial. Very many of the published ‘research’ papers I read were shoddy methodologically and irrelevant to the needs of patients. Anonymous peer review rejections sent to me over the years, when I sought to publish articles critically analysing these pieces of research, revealed reviewers’ biased ‘gate-keeping’. Reviewers’ comments were devoid of knowledge and revealed a lack interest in any critical thinking.
It seems to me that so-called ‘academic nursing’ is an emperor with no clothes and a means of protectionism. That is why there is a chasm of division between the needs of NHS patients and the wants of the nursing academy. Nursing professors and lecturers generally do not work on the wards. They are the university nursing Blob, divorced from the concrete realities of practice. That is why the NHS cannot use student nurses as part of the NHS workforce thus immediately solving the nurse staffing crisis. It is why the U.K. looks to Kenya to provide nurses for the NHS. Surely this is a scandal?
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“the move to become academic by the nursing elite was not primarily intended to improve care for patients – its primary objective was to improve the status of the profession and divorce it from medicine“
Similar to the foolish trend to over educate police officers:
All new police officers in England and Wales to have degrees
“All new police officers in England and Wales will have to be educated to degree level from 2020, the College of Policing has announced.“
I agree and have seen this in many professions – instead of teaching people how to do their jobs, you invent buzzwords to make “what we do every day” sound technical/intellectual.
Teach people the buzzwords instead of how to actually be useful. A recipe for disaster.
Mark – maybe that is true; Surgeons did the same when they evolved from being barbers. I think the outcomes of that were better for patients. I am a ‘trained’ nurse – I have no nursing degree – but I recall the ‘good old days’ to which everyone seems to want to return of nursing and they were not all good. In the meantime, our population has aged incredibly, patient acuity goes up but stays shorten and the NHS continues to be a bottomless pit. So many moving targets to say definitively if it’s better but definitive evidence of better care – across the world – by graduate nurses. But another variable is that essential nursing care becomes the squeezed middle as medics devolve tasks and nurses fill the vacuum. There is never an excuse for poor care – but there is often a reason.
What are the reasons then fellah?
All we will have is educated idiots without experience of life and still think they have the right to bully and disrespect people. Education does not equal common sense or intelligence.
I agree. Project 2000 destroyed the old system of vocational sister/staff nurse + enrolled nurse + student + auxiliary that worked brilliantly into reduced number of degree based sister/staff nurse, loss of bedrock ENs, staffing wards with care assistants and students hauled off to a classroom. Result, slow motion disaster.
Control by the self-justifying flim-flam academy that has wrecked so much.
The reasons are a great deal more complex than Ann alludes to (Declaration of interests – I’m a nursing professor and former Editor-in-Chief of the Journal of Advanced Nursing). Much of what she says is true – many of us don’t work in practice but nursing students spend 50% of their time in clinical practice (as they have always done and in the first degree programme at Edinburgh it was 60% with the vast majority of the graduates remaining in practice and in the less ‘glamorous’ field of nursing) and that is where we emphasise that they must learn. We teach them other skills which nursing graduates need: anatomy & physiology; appraisal of evidence and – yes indeed – a few of the more wishy washy stuff like sociology (which medics also learn). The reasons we are short of nurses are very complex – some of what Ann says is probably true but we have massive waiting lists for places, demonstrable instances of where many come in simply for the bursary with no intention of remaining either at university or in nursing (this is not systematically gathered but anecdotal from many students), we lose many along the way in the… Read more »
The problem with that sort of data is that it is once again ‘data from a man in a straitjacket’ as an attempt to dissuade consideration of a policy that is suggesting taking the straitjacket off. We have a graduate mechanism. It’s called ‘becoming a doctor’. That is the graduate mechanism for getting into medicine. Nursing should be the vocational apprenticeship mechanism for getting into medicine, and which therefore requires a different structure to get the best out of people. Otherwise you select for the wrong people, and just end up in competition with the rest of society for a small set of individuals. Nursing should start with the raw material of people who wish to start work at 16 or 18, and who have the requisite level of care and compassion to be good at nursing. It should select more like the military does for soldiers, with a particular eye out for the nuggets of gold that can rise through the ranks. What your data is telling us is that the vocational training mechanism is substandard and needs improving. You are more likely to survive if your nation has two training systems, and that therefore is capable of getting… Read more »
Mr Watson: “data are”.
Mr Grey: “data is”.
First round goes to Mr Watson.
Nursing and being a physician is comparing apples and oranges.
My daughter-in-law is an ITU nurse, she used to work in London, more recently she has worked in South Wales. In London if adjustments were needed to the ventilator, for example, she could change them; if the same was required in South Wales sh had to get a physician to do it as she wasn’t allowed to.
Yes there those of us who have become nurse practitioners and can see, treat and discharge patients in primary care, including prescribing medication. Are we physicians, a resounding no, although a prescribing nurse practitioner is as qualified as an FY1 doctor, we are primarily still nurses.
What about paramedics? They are degree based.
I’d rather see a nurse specialist about something in their speciality than a GP.
I don’t know why you don’t see a nurse before each GP visit where you explain to them and they translate into medic for the GP.
Then make sure the GP notes are correct.
As a nurse practitioner I was allowed 15 minutes per patient whereas GPs had 10 minutes. We tend to be less blinkered on the reported problem but approach with a more open mind.
The son of a friend of the family was complaining of abdominal pain, reduced appetite. He was seen in A&E and they said it was wind. Contacted his GP, who discounted anything of concern over the telephone, to take painkillers. No improvement over next 48 hours. Mum phoned my wife and the discussion came round to the son’s situation. I spoke to him over the phone and talked him through doing a specific test on himself. From this test I deduced he might have an inflamed gall bladder. Mum took him to walk in centre, referred to surgeons at nearest acute trust. Admitted following proper hospital tests he was diagnosed with inflamed gall bladder due to gall stones.
My nephew has been a paramedic for many years. Through his hard work, he has now achieved a Masters in Medicine. He is an Advanced Paramedic and intends to continue his education to a Doctorate level, he is Primary Care, first on the scene to save lives and has done so many he cannot count. He made a miraculous cliff-face rescue while serving on the Air Ambulance. At one time in his early days, he was delivering more babies than the local midwives. This is vocation and dedication to his profession. He does not act with grandeur because he is educated to advanced levels. He does his job without exception to the highest levels. He chose to continue his education and achieve qualifications that were not necessarily required. Continued training as a paramedic of course was required, but further education was not. But my mother has suffered under the hands of Nurse Practitioners, almost losing her life due to misprescribed medication that a consult threw across the consultancy room when he found out and was angry. Putting less qualified people into more qualified posts requiring more involved study to the levels required is not the answer. Train more doctors, more… Read more »
5) Socialism only ever produces one thing, misery.
What’s a nursing professor when it is at home. You do not nurse, so your title is irrelevant. Educationally you are a Professor but do not think for one second that you can now offer nursing comments. Use your nursing qualification and get back to work. You are the biggest problem with nursing. Glorious titles but no extra skill.
I can see both sides, but your post is glorious:-)
Correct, which is why the way forward is to create your own journal, peer reviewed by like minded individuals and publish there – while marketing the hell out of it.
Institutional takeover and transformation has been the game for many years. The solution is new institutions.
This goes back to that period in the late sixties when all the polytechnics were becoming universities. Suddenly everyone wanted a degree. It was the same in the armed forces – whereas in my time you could join the air force as a pilot with five O levels, by the time I became an instructor it was impossible to recruit 18 year old pilots because they wanted a degree. By the they came out of university they had lost interest in flying and many had been ‘woked’ along the way’. It was the same with nurses.
The polytechnics didn’t become universities until 1990, I went to Leicester Poly in 1975 and it didn’t become De Montfort university until 1990. The polytechnics were funded by local government with the degrees given by the CNAA.
For my first job as a systems engineer the requirement was HND or degree and progression was through on the job training.
It has been only over the past 30 years that degrees became the minimum requirement.
Thus first degrees have been diluted and it is now postgraduate qualifications that have taken their place.
I think an academic degree helps with formal IT architecture.
While I don’t directly use Formal logic, combinatorics, Set Theory or predicate calculus every day, knowing it helped vastly up the quality of systems I design (well more stop anti-patterns by my staff), although it does make explaining WHY “do this not that” harder.
Bradshaw is spot on. During the 1990s takeover of British nursing by the universities many voices were critical of the sacrifice of the NHS nurse education system on the altar of professional status. Those running the academic departments increased their power, status and financial resources, at the expense nurses’ vocational and public identity: https://pubmed.ncbi.nlm.nih.gov/9756219/
We’re haggling with Africans for the purchase of coffles of workers, in order to set them toiling at a literally shitty assigned task, which they cannot choose to stop doing.
That seems… somehow familiar.
I would also suggest that the loss of Nurses’ homes is also a major factor.
Previously it was possible to pack one’s nubile young daughter off in the knowledge that she would have a safe place to sleep, and a protective adult in the house who would keep the young strumpet under control.
A quick CV. From 1979-2002 I was a systems/software engineer. I was made redundant in 2002 Started my nurse training in 2003 Registered in 2006 with Dip HE in nursing the adult Topped up to BSc Nursing Followed by PGCert in Advanced Practice I did hands on nursing care for two years on a ward, which I did enjoy, before switching to A&E, where I’d set my sights. Following this I was a triage nurse and finally a nurse practitioner. An advanced nurse practitioner undertakes a similar role as an FY1 physician, I wasn’t advanced as I didn’t have time to complete my prescribing course before retiring. Whilst in A&E I wrote a literature review on the impact of overcrowding in emergency departments which was published in Emergency Nurse. Did the education level make me a better nurse? For me personally I would say yes. yes some of the lectures were a bit woolly, but there were others that were necessary. The problem with the pre project 2000 system is that it could became a bullying culture, not like it was shown on Angels in the 70’s, a culture that still exists, particularly in A&E. It is hierarchical, I enquired… Read more »
I used to know a lecturer in nursing, whilst looking through notes for a lecture the next day all I could see was an attack on the Tories, it was full of Thatcher this and Thatcher that (never Mrs Thatcher). When I asked what this had to do with Hygiene, nominally thev purpose of the lecture I was told it was vital that new nurses understood the threat to the NHS from the Tories
Dorian – I completely agree – and have changed my view on this – that the loss of ENs was disastrous.
Lucan – I have absolutely no idea why graduates are better than non-graduates (I can only speculate) which means that I can also only speculate in the other direction.
Very grateful for comments on my comment!
Might be worth noting that Ann is not alone in her view – I recently published this editorial which does not accord with my view (currently Editor-in-Chief of this journal: The rise and fall of university-based nurse training: https://youtu.be/mGFdWcJU7-0 If anyone wants a pdf email me on nepeditor@outloook.com
Fascinating the answer to a nursing shortage is “hey, no problem, we will get nurses from Kenya, the Philippines, India, wherever. Yes UK nurses, this is your worth….NOTHING? You were the at frontline during the initial Covid outbreak. While GPs cowered at home, you slept in overnight at hospitals to piecemeal together some sort of continuity of care. When you were issued minimal PPE, you carried on. Over the years, you have worked tirelessly, understaffed, overworked to care for your patients. Finally, your government mandated experimental biologicals despite the fact you were all exposed to Covid, possibly had it (the health authorities could not be bothered to test you for T cell immunity) while they spent millions on track and trace and other useless programs. If you didn’t comply to the vaxx mandate you were fired. Wow, didn’t see that coming, did you?
Yes nurses, you are simply not valued by this government. You are expendable. Good riddance thanks for the help, we have new people coming in Good Bye. No appreciation or loyalty for all you have done. Do you get it yet?
My wife is a long-time serving nurse, she says the real problem with the NHS & why no one stays is management & administration.
She found a niche out of the BS which is the only reason she stayed for more than 15 years. Nurses know how to nurse, they just need to be left alone to get on with it.
The only experience I personally have of the NHS was a GP referral for an incredibly minor ailment, the level of bureaucracy & time-wasting was unfathomable, an appointment to make an appointment for an appointment to discuss an appointment to discuss if I was eligible for treatment, I gave up & it healed itself, i’ve never seen a doctor since, that was 20 years ago.
The primary purpose of the academisation of nursing was to set nurses up as an interest-group to be played-off against doctors. It was indeed, as the writer suggests, nothing to do with improving standards of patient-care.
Can anyone stand up the claim that there are 30,000 unemployed nurses in Kenya?
Apologies – wrong link to an article put up earlier:
Might be worth noting that Ann is not alone in her view – I recently published this editorial which does not accord with my view (currently Editor-in-Chief of this journal: The rise and fall of university-based nurse training: https://www.sciencedirect.com/science/article/abs/pii/S1471595321001177 If anyone wants a pdf email me on nepeditor@outloook.com – correct link above
I have written before about this. There are many nurses in the NHS who no longer nurse. They are doing many other types of roles within the NHS. There is a problem with retitling these nurses because their pay is linked to their nurse grades. If the new titles were included on the scale of nurse grades. The true number of nurses now working in the NHS would be revealed and thus the extreme shortage of nurses would be apparent. Too many nurses are qualified as specialist nurses without the ability to work on multiple types of wards. This is an easy exercise to reform. All nurses should be fully trained to work and experience all types of health care. Only after two years of service in multiple roles may they then specialise. It just takes someone to take responsibility and implement these changes. This service is not a sacred cow, it should not be considered as ‘hands-off.’ Changes need to be made and soon not after an Inquiry or consultation. This state of affairs cannot continue to leave workers desperate for help, And additional HCAs is not the answer either. They work very hard but without the nursing qualifications… Read more »
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I put this down to a political motivation by someone whose name, I think, was Bliar.. He wanted to keep the youth unemployment down to a vote-winning level by proposing that an amazing 50% of the youth were seriously in need of the rigours of an academic degree.
So we have ended up with a lot of BAs who are serving burgers in McDs, maths graduates who would have failed previous years A-level papers but who work for the Government, nurses who would have failed A-level Biology, but who are too highly qualified to empty a bedpan….
But none of the people we really need to run a developed country well…..plumbers, electricians, carpenters, builders, car mechanics (even EVs need maintenance), – these are the skills which we need.
And we have failed our children!