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The needs of newly qualified nurses

07 March 2024
Volume 33 · Issue 5


Sam Foster, Executive Director of Professional Practice, Nursing and Midwifery Council, considers the importance of providing the right support to nurses who are new to the register

The UK government workforce plans all have a focus on growth. However, it is critical that, alongside any growth in our profession, we need to focus on retention. The evidence base regarding retention is concerning, particularly for early career nurses. If we do not pay more attention to this, any growth that occurs will not benefit the public. The landscape in which nurses are operating is challenging.

In its open council meeting in March, the Nursing and Midwifery Council (NMC) (2022) highlighted key recurring themes that have arisen as part of its discussions on the findings of public inquiries and reports into a range of healthcare and workforce issues:

  • Fear of regulators and disciplinary processes
  • Poor leadership and governance and management of staff
  • Persistent cultures of denial and blame
  • Fear of speaking up or raising concerns
  • Poor communication and working relationships among multidisciplinary teams
  • Failure to listen to concerns and to prioritise the voices of people who use services as partners in care, and failure to provide compassionate, kind care
  • Lack of regulatory alignment and data sharing among regulators and more widely across the health and social care system
  • Clinical isolation, leading to divergence from mainstream best practice
  • Race inequalities and discrimination, including a failure to provide just and inclusive working environments for Black and minority ethnic professionals to progress their careers.

The NMC (2023a) Spotlight report into the experiences of nursing and midwifery professionals new to the register shows that, where professionals lack the right support at the outset of their practice, the consequences can be significant. Furthermore, it is stated that this can affect an individual's confidence, sense of being able to practise safely and whether they intend to stay in their profession.

The NMC Principles of Preceptorship (2023b) is the recommended approach to supporting newly qualified practitioners – this, however, is only guidance and not mandated. It states that preceptorship should welcome and integrate the newly registered nurse, midwife or nursing associate into the team and place of work, help them grow in confidence, and begin their lifelong journey as an accountable, independent, knowledgeable, and skilled practitioner. However, the Spotlight report sadly details that professionals' experiences of preceptorship support and supervision in England vary widely.

The King's Fund (West et al, 2020), at the request of the RCN Foundation, explored the causes and consequences of poor mental health in nurses, which resulted in the publication of the report The Courage of Compassion. The work recommended the ‘ABC’ of nurses and midwives' core work needs: autonomy, belonging and contribution, with an aim to facilitate wellbeing and motivation at work and to reduce workplace stress. The report contains eight recommendations designed to meet these three core work needs, focusing on:

  • Authority
  • Empowerment and influence
  • Justice and fairness
  • Work conditions and working schedules
  • Teamworking
  • Culture and leadership
  • Workload; management and supervision
  • Learning, education and development.

For people to flourish and thrive at work, it states that all three work needs must be met. To complement recommendations, the work of West and Chowla (2017), and the changes to culture and leadership across nursing and midwifery through ‘compassionate leadership’, are also recommended.

Earlier this year, the RCN Foundation and The King's Fund (2024) released the findings of a joint project, ‘Follow your compassion’, exploring the lived experiences of newly qualified and registered nurses and midwives in a variety of healthcare settings across the UK. The project focused on colleagues who had qualified and/or joined the workforce during the pandemic and its immediate aftermath. The findings have been launched as a website.

The work highlights the enormous challenges facing newly qualified nurses and midwives. The launch event, where the stories were bought to life with senior leaders, revealed several themes for focus:

  • Psychological safety
  • Leadership
  • Culture
  • Voice
  • Student experience
  • Commitment.

Supporting this newly qualified nurses and midwives will be a central tenet of the RCN Foundation's work in 2024 and beyond. It is the development of plans in relation to this work that will be important for all of us to consider.