Nursing manpower: recent trends and policy operations

The total number of nursing and midwifery staff rose by 17 per cent from 1976 to 1982. The aim of this paper is to provide a detailed analysis of what this substantial investment actually meant in terms of grades, types of hospital and region. Total numbers in the general hospitals rose by 24 per cent compared to 97 per cent in the geriatric hospitals, 12 per cent in mental illness hospitals and 28 per cent in mental handicap hospitals. There were very significant changes in the balance of grades. Within the general hospitals total hours available from registered nurses rose by 11.4 per cent. This averaged out from a fall of 2.8 per cent in Sisters hours and a rise of 34.6 per cent in Staff Nurse hours. Hours from Enrolled nurses rose significantly and those from student and pupil nurses fell whilst hours from nursing auxiliaries rose by 70.6 per cent. The balance of decision implies that registered nurses were becoming, on average, less experienced. The paper a1so examines changes in RAWP-1osing and RAWP-gaining regions. RAWP-losing regions in general economized on untrained staff in order to recruit more qualified staff. In general the extra nurses went as much into long-stay care and into the community as into general hospitals and the more technological areas. Local managers' decisions seemed to reflect a different approach from that adopted by some of the leaders of the profession. Local managers have continued to recruit enrolled nurses and nursing auxiliaries, even in the general hospitals. This paper concludes with a discussion of policy options at a time when nursing faces an unprecedented reality of nil growth in manpower. In broad terms there are only 2 million hours a week of registered nurse time available for the whole of general nursing. The manpower context is one in which there will be little increase in nursing time: the probability of particular shortages in general nursing; a need for more flexibility than in the past as most of the investment in priority care is now in the wrong place, and one in which there are strong disincentives to training. The authors suggest that there should be more attention to methods of increasing the skill level of the existing work-force through in-service training: there could be more personal career and retraining plans in areas such as psychiatric care which are subject to rapid change. There should also be a new approach to rationing out available resources at the local level. Districts need to examine how the existing resource is being used and weigh up competing claims in terms of their effect on services. The authors estimate that shortagee of particular types of nursing manpower are likely to be an increasingly serious constraint on changes in patterns of care.