It’s no secret that the NHS is under a critical amount of pressure. Latest reports indicate that 24,000 nursing positions are vacant and our new research shows experienced nurses are facing serious challenges in the job because of increased demands on their time.
Our new research report reveals that NHS pressures are hindering ethical practice and caring among UK nurses – with eight in ten nurses questioned saying that they were not always able to work in a caring and compassionate manner.
The findings show that staff reductions, time pressures, bed management and administrative tasks are all stopping nurses from being able to spend the amount of time they would like with each patient.
Many nurses also reported that conflicting demands on their time left them feeling as though they were not able to offer care in as compassionate a way as they would like. Some said they are reduced to tears on a daily basis and that shortages in nursing numbers was negatively affecting their ability to care for patients.
Rules, codes and pen-pushing
In our research we also looked at the extent to which nurses rely on what’s known as “virtue-based reasoning”. This basically means thinking about what is the compassionate or honest thing to do when facing ethical dilemmas in the workplace.
We found that experienced nurses rely, if anything, less than nursing students on their own moral compass to make decisions. This is an important finding because not being able to exhibit your moral character at work is a well-known predictor of burnout. Burnout tends to happen as a result of long-term stress in a situation or job that, for whatever reason, you’re highly committed to. So the more you care about your work, the more likely you are to experience burnout.
This is in contrast to our studies of other professions – such as lawyers and teachers – where reliance on virtue-based reasoning is shown to increase with experience.
What this means in real terms is that in nursing, considerations of the right thing to do in moral dilemmas are reduced to a mechanical adherence to written rules and codes. This means for nurses, the job becomes something of a tick-box exercise that is inherently unprofessional and demotivating.
The good news however is that nurses are still entering the job for the right reasons. Students nurses in particular, consistently name moral motivators such as care and compassion as the principal reasons for joining the profession. And both student nurses and established professionals reported viewing the job as a vocation.
We also found that despite these significant institutional pressures nurses still feel they can work autonomously and feel supported by colleagues. Many of the nurses we spoke to also said they still felt it was possible to maintain a level of emotional engagement with patients and their profession, which is encouraging.
These findings are drawn from survey and interview data from 696 participants, including first-year undergraduates in nursing and final-year students about to enter employment at the end of initial training. We also spoke to established professionals who have been in practice for five years and interviewed educators from UK schools of nursing.
Overall, the findings of our study paint a sad picture of the current state of nursing as an ethical profession in the UK. And recent figures which show a 96% drop in nurses from the EU registering to practice in the UK post-Brexit adds to the gloom.
Ultimately, our research shows there is an increased pressure on nurses to get each decision right – under constraints of time and resources. And, for those on the job, to be able to choose the option that is both best for patients, but also ethically correct, requires careful deliberation and the capacity to exhibit professional wisdom.
The ability of the nurse to make such decisions on behalf of patients goes right to the core of what it means to be a nurse, whose first responsibility is to the patient.
As a short-term solution, more needs to be done to help nursing students develop the psychological and moral traits that may help them prosper under these averse conditions. But looking to the long term, the whole situation cries out for a rethink of governmental priorities regarding the future of the NHS.
Kristján Kristjánsson receives funding from the John Templeton Foundation.