Nurses in Northern Ireland are regularly coming on duty to find they are one or two members of staff down with “no hope of filling” gaps in rotas, according to the director of the Royal College of Nursing for the country, who says chronic shortages are taking their toll on staff wellbeing.

In an exclusive interview with Nursing Times, the director for the RCN in Northern Ireland warned health services there were “seriously struggling” now with the worst of the winter months yet to come.

“The worst situation of all is when the duty rota is done and there are gaps everywhere” Janice Smyth

Janice Smyth said the region’s health and social care trusts were increasingly relying on agency staff to fill nursing shifts, but it had got to the point where even agencies did not have the numbers needed to make up the shortfall.

Meanwhile, the widespread use of agency nurses was putting additional pressure on hard-pressed permanent staff who had to show them the ropes at the same time as doing their own work.

“The biggest concern for nurses is they are going on duty, whether it be the community, mental health, learning disability or hospital, and the people working alongside them are from bank and agency and may not necessarily know the client group or that clinical area,” said Ms Smyth.

“That puts an additional burden on the registered nurses that are there, because they are trying to support their agency colleagues while caring for patients at the same time,” she said.

“But the worst situation of all is when the duty rota is done and there are gaps everywhere and no hope of filling them – and that is where we are at the moment,” she warned.

Her comments come after Northern Ireland’s chief nursing officer Charlotte McArdle noted earlier in the week in an interview with the BBC that there were “no quick solutions” to the current shortage.

“Even the agencies cannot provide the number of nurses that are needed to fill the gaps in those rotas and nurses are coming on duty to discover they are meant to have X number of registered nurses and X numbers of healthcare support staff in the team and finding they are one or two down,” Ms Smyth told Nursing Times.

Janice Smyth Janice Smyth

She maintained this winter season was different to others due the level of demand for services, ongoing staffing shortages and because efforts to transform health and care services and relieve some of the pressure on embattled emergency departments had ground to a halt due to the collapse of the Northern Ireland Assembly.

“This year is different to other years because nurses believe everything that can be done by directors of nursing and managers is being done and the problem we have got lies outside individual trusts – it’s a systemic problem,” she said

Ms Smyth said nurses on the ground felt they were finally being listened to but the system-wide changes that were needed were not being made.

“In the past, nurses would have said that managers didn’t listen to them and there appeared to be a gap between managers and the frontline – that is not the case now,” she said.

“They say they feel very engaged and everybody is trying to work together to do the best thing for patients,” she said. “They know that everybody there is doing everything they can, yet they also know that is not making a difference.

“The solutions for many of the difficulties we have are well-known in the profession and the profession just needs the support of the system,” she told Nursing Times.

Charlotte McArdle Charlotte McArdle

Ms McArdle and the region’s department of health recently set out a number of steps designed to boost nursing recruitment and retention, including an international recruitment campaign with a target of recruiting 622 nurses by 2020.

The department has increased pre-registration nurse training places from 650 to 900 in a bid to increase the supply of new nurses.

Other initiatives include work to improve recruitment processes, a return to practice programme and a pilot scheme that sees administrative staff take on some of the admin tasks currently done by nurses.

Ms Smyth said the RCN supported these measures, although she feared the department may struggle to hit its international recruitment goal despite recent changes to English language testing requirements set out by the Nursing and Midwifery Council.

“Our CNO absolutely understands the issues and has led discussions around what some of the solutions would be to support the workforce during this time of significant challenge,” she said.

“The profession has been engaged in those discussion and all of these measures set out by the CNO and the department are things that will support nurses until we are able to grow our workforce,” she said.

“Nurses feel let down by the leadership of our system and by the lack of political leadership” Janice Smyth

However, she identified one key area that needed much greater emphasis was the need to promote the health and wellbeing of nursing staff, with sickness absence rates in Northern Ireland ranging from 9-10%.

“That means ensuring they do get their breaks and the opportunity to have a family life,” she said. “It means they don’t get asked to work on their days off, it means they are not put under pressure to do additional shifts, that their nutrition is looked after whilst they are at work – it means looking at flexible working arrangements and how we accommodate nurses’ aspirations.

“All of those things will help with staff health and wellbeing. Departments must accept the pressures we’re putting staff under is creating work-related stress and making them ill and means they are absent from work,” she warned.

“Unless we take that seriously we can recruit nurses but we are going to continue to lose nurses,” added Ms Smyth.

She said the RCN had been particularly concerned over the Christmas period, when it emerged some trusts were appealing on social media for staff who were supposed to be off duty to come into work.

Collapse of devolved government

Another big concern was that efforts to revamp health and social care services were being hampered by a lack of direction from the top and the political impasse in Northern Ireland where the main parties had failed to agree a power-sharing deal.

macmillan northern ireland Stormont

“Demand is growing and we have got a report on the table about transforming our services – we have had several of these reports – and just as we were about to start to make some inroads our assembly fell, so we haven’t see the transformation we need,” she said.

“The services we were meant to build up in our community have not happened, alternatives to coming to an emergency department and arrangements for people with long-term conditions who need more care in the community just haven’t been put in place. Because of the political impasse there is no sense that is going to happen any time soon,” she said.

She told Nursing Times that most nurses she spoke to were keen to see a health minister in place – even if that had to be under direct rule by the UK government.

“Nurses feel let down by the leadership of our system and by the lack of political leadership and those two things need to be addressed,” said Ms Smyth.

She added: “The majority of nurses I have come into contact with will say their preference would be for a locally elected minister here but if that is not possible a direct rule minister – but a minister.

“Between them all, they have to agree whether we are going to have an assembly or direct rule, but we have to have somebody who is accountable,” she said.