Project Title:

Longitudinal Study of Nurses in Scotland: workforce dynamics [Extended]

Project Number:

2014_003

Researchers:

Iain Atherton (University of Stirling)
Richard Kyle (University of Stirling)
Rosie Neall (University of Stirling)
William Ball (University of Edinburgh; Extension)

Start Date:

18 July 2014

Summary:

Background

Nurses are crucial to care provision given they are the health professionals with immediate round the clock patient contact. Nursing care is labour intensive with few real alternatives that ensure high care standards. Studies have demonstrated the importance of nursing to the wellbeing of patients. A very recent multi-country study suggested a decrease of one patient in a nurse’s workload was associated with a 10% decline in mortality (Aitken et al. 2014). The same study also found that having degree level nurses was associated with a similar decline in mortality. The recent report into poor care at Mid-Staffordshire highlighted the role played by short-staffing (Francis 2013)). The nursing workforce is unquestionably one of the most important dimensions to ensuring care in today’s health service.

The ageing of the nursing workforce is thus a cause for concern. One third of nurses in Scotland are likely to retire in the next decade (ISD, 2014). Over that period the proportion aged 75 years and over, those with the highest prevalence of comorbidities, is anticipated to markedly ? (ONS 2013). And Scotland is not alone (CfWI 2013). These retirements cannot easily be replaced given that these older nurses also represent a considerable body of experience. Policy thus needs to be put in place to ensure the development of a sustainable workforce. Little evidence is thus far available with regards to the long-term career trajectories of nurses and it is to this gap that this study is focused.

Aims

Scotland’s population is ageing. Not only does this demographic trend potentially lead to a greater demand for health care staff but it may also reduce supply as the dependency ratio steadily increases. Whether for demographic, economic or policy reasons the nursing workforce in the UK is itself ageing with a notable proportion likely to retire in the next 10 years (a third of all nurses in Scotland). Policies to ensure the sustainability of the nursing workforce require evidence as to what influences people to become nurses, and to either remain in or to exit the workforce. Such evidence is, however, lacking. We intend to use the SLS as a basis for addressing this research gap.

Aim: To understand the dynamics of the nursing workforce in Scotland over time and the implications of health and wellbeing for retention.

Research questions:

• What was the socio-demographic composition of the nursing population at point of the 1991, 2001 and 2011 censuses?
• What was the working situation of nurses at point of the censuses and how did this change for individuals over time?
• What factors influenced entry and exit from the nursing workforce?
• What was the health situation of nurses and what are the implications for future workforce planning?

[Extension 2016-2017]

This extension to the current project will form the basis of a PhD thesis. We aim to publish two articles in peer-reviewed journals. Additionally, we aim to attend national and international conferences to present preliminary findings and methodological discussion based on this project.

Background:

Inequalities in health persist within the UK and many other countries despite improving trends in average life expectancy. Men living in the most deprived areas of England can expect to live in good health for 16 years less than men living in the least deprived areas (ONS 2015).

Inequalities in health have previously been demonstrated in a single occupational group of civil servants (Marmot 1978) and research focusing on the health of Nurses should add value to the literature as they represent a reasonably socio-economically homogenous population with high levels of health literacy.

This project can add to the growing literature looking at mortality variations between Scotland/Glasgow and the rest of the UK. It should be particularly pertinent to existing work which explores the phenomenon of ‘excess mortality’ (i.e. higher mortality even after accounting for deprivation).

Aims:

To undertake combined analysis of separate UK longitudinal studies, linked to a UK-wide index of multiple deprivation, to assess the presence and extent of health inequalities within and between the UK Nursing work-force.

To determine whether deprivation can explain any variation between Scottish and English/Welsh Nurses’ self-reported health.

To assess indicators of selective migration for potential effects they may have on patterns of variation in self-reported health.

References:

Aitken, L.H., Sloane, D.M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., Diomidous, M., Kinnunen, J., Kozka, M., Lesaffre, E., McHugh, M.D., Moreno-Casbas, R., Rafferty, A.M., Schwendimann, R., Scott, P.A., Tishelman, C., van Achterberg, T. and Sermeus, W. (2014) Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study, The Lancet doi.org/10.1016/S0140-6736(13)62631-8

CfWI (2013) Future nursing workforce projections: starting the discussion, London, Centre for Workforce Intelligence

Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery office

ISD (2012) Statistical Disclosure Control Protocol Version 2.3 http://www.isdscotland.org/About-ISD/Confidentiality/DISCLOSURE-PROTOCOL-VERSION-2-3_FULLVERSION.PDF (last accessed 6 November 2014)

ISD (2014) NHSScotland workforce statistics https://isdscotland.scot.nhs.uk/Workforce/Publications/2014-02-25/Nursing_and_Midwifery_SIP_D2013.xls (last accessed 6 November 2014)

ONS (2013) Projected Population of Scotland (2012-based): national population projections by sex and age, with UK comparisons http://www.gro-scotland.gov.uk/files2/stats/population-projections/2012-based/2012-pop-proj-publication.pdf (last accessed 6 November 2014)

Related Outputs (viewable on CALLS Hub):

• 1 in 5 rural nurses nearing retirement
• The devil’s in the demography: Comparison and change in the remote and rural nursing workforce in Scotland between 2001 and 2011 using representative longitudinal data
• Exploring the ‘Scottish Excess’ with eDatashield and linkage of an adjusted Index of Multiple Deprivation
• Health Inequalities in British Nurses
• What can the health of Nurses tell us about inequalities?
• Know Thyself: Utilising routinely collected data to gain insight into the social determinants of nurses’ health
• Protective effects of nurses’ health literacy: evidence from the Scottish Longitudinal Study
• The Nurses’ Lives Research Programme: enabling practice through new insights to population health using routine data about nurses
• Harnessing secondary data to enhance nurse education: Approaches and applications from the Nurses’ Lives Research Programme