Nurses need a ‘voice’ in decision-making to improve retention, research shows

Nurses working in general practice during the Covid-19 pandemic felt largely ‘forgotten’ and undervalued, with many considering future career changes, according to the findings of a recent study.

Researchers at the University of York conducted interviews and focus groups with 40 nurses across England to understand how working during the pandemic had affected their well-being and the factors that contributed to job dissatisfaction.

The study showed that decisions on re-shaping general practice services during the pandemic, and going forward, were taken by GPs and practice management with little input from the nursing staff, despite most of their work requiring face-to-face interactions for the duration of the crisis. 

General practice nurses in England see seven million patients a month, and 84 million in a year. A recent report, however, predicted that one quarter of general practice nursing posts in England could be vacant in 10 years’ time, so retention of nursing staff has become vital for the future of the NHS, at a time when retention of GPs is also an issue.

One participant in the University of York study noted, for example, that nurses have lots of ideas on how healthcare can be delivered to increase the benefits to patients, but they are not invited to the decision-making table and so do not have the opportunity to share their experience.  

Dr Helen Anderson, from the University of York’s Department of Health Sciences, said: “Nurses have a very specialised role within general practice, which includes delivering the bulk of long-term condition management, such as diabetes and asthma care, immunisation and vaccination programmes, and other essential care that can’t be delayed and requires in-person consultation, but this often goes unrecognised within the profession, by their employers and society in general.”

A nurse in the study stated that the value and the benefits nurses can offer is not often publicly highlighted, and it is not widely known that they have specialist skills in things like diabetes, women’s health, respiratory, and other long-term conditions. 

Dr Anderson said: “Despite considerable changes to general practice during Covid, which saw new technological interventions and an increase in phone and online consultations, much of the work that nurses carried out simply had to go ahead in-person, but against a backdrop of considerable stress, anxiety, and health risks, much of which has been undocumented in research on the pandemic so far.

“Many of the nurses we spoke to told us that they felt ‘forgotten’ pre-pandemic, but that this was further exacerbated during Covid-19, which led to nurses feeling undervalued  and accelerated considerations to move out of the profession.”

One of the areas highlighted was the setting up of Covid-19 vaccination centres and administering vaccines to patients - work that was largely delivered by nurses. 

Study participants stated that this was a significant undertaking, which they felt was unrecognised by colleagues, the media and general public.

Another way in which nurses in general practice felt undervalued was in their remuneration and terms and conditions of employment, including sick and maternity pay, which do not reflect NHS terms and conditions. 

Many nurses reported that there were differences in their experiences of the pandemic compared to doctors, but that little provision was made for this, and therefore many felt this impacted their mental health and some faced burn-out leading to nurses leaving general practice, or the nursing profession altogether. 

Dr Anderson said: “We found there were three key areas that could make nurses feel more valued in their position, which could help with future job retention rates beyond the Covid-19 pandemic. 

“A key factor is being included in decision-making on significant changes to general practice.

“The second is for management to demonstrate understanding of the roles that nurses have, and remunerating them appropriately, as it was often pointed out to us that colleagues seemed to be unaware of what nurses were doing on a daily basis.

“Lastly it was important to our study participants that there was more awareness raising of the ‘invisible’ role they play with colleagues, the media, and general public, to improve understanding of the highly skilled work that they do.”