A National Survey exploring the profile of registered nursing staff working in acute medical units: Research Report

1 EXECUTIVE SUMMARY
This research report builds on previous work entitled ‘a profile of nurses working in acute
medicine units: what is the future’(Lees and Myers, 2010) which examined three key things;
why nurses choose to work in acute medicine, why they stay in the speciality and why some
nurses leave.
Acute medicine is a rapid growing speciality and alongside this growth is a need to
understand and address the evolving workforce issues; in particular the education and
potential training to support the nursing development required. With this in mind, the
original study from 2010 was enhanced to a multi-site enrolment, totally 29 AMUs across 9
regions who responded to the survey.
It was conducted between 2010/11 in two phases, namely collection of demographic details
followed by details concerning motivations and personal insights into the acute medicine
workforce. Survey Monkey (on-line commercial platform) was used for both elements of
the data collection. The qualitative data gathered has provided an rich insight into the
perspectives of the nurses who work in acute medical units and from this an understanding
of the current workforce issues. It is hoped that the research will inform the future
recruitment, retention and the shape of the nursing workforce in acute medicine.
Key Messages:
 67% of the nurses surveyed expressed that they feel very positive about working in
acute medicine with only 2% expressing negative aspects.
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 Reasons to stay in acute medicine were expressed as positive for the variety of work
and experience gained.
 Reasons to leave acute medicine were cited as being due limited career progression,
lack of resources (staffing) and lack of recognition of acute medicine as a speciality
for nurses.
 Would nurses working in acute medicine make the same choice if they had the
opportunity to start their career all over again? 85% of the nurses surveyed said yes,
that they would make the same choice.
 It was expressed that acute medicine is not yet adequately recognised outside of the
clinical area itself as a developing speciality for nurses. This has consequences for
nurse development and recruitment of staff.
 The fast pace, relentless workload and staffing shortages were frequently cited as
being the most morale reducing and de-motivating factors. This has consequences
for the retention of nursing staff.
 The diversity of patients, challenges and teamwork were frequently cited as morale
enhancing and motivating factors.
 The key qualities and skills required to work in acute medicine were defined in the
following categories, namely, organisational, communication, clinicaland personal
skills. For example, personal skills frequently cited were ‘keeping calm under
pressure’.
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 Core areas for skills training were broadly identified across ten areas with arterial
blood gas sampling/analysis, CPAP, x-ray interpretation and dementia training
forming the most frequently suggested skills areas by those who participated in the
research.
Recommendations:
This research paints the current landscape in acute medicine, which continues to need
revisiting, amidst technological advances, increased patient acuity, an ageing population, all
of which creating an ever-increasing diverse workload. Four key recommendations have
been drawn which are clear way-markers to aid the directions of travel for those working to
begin to shape the future nursing workforce in acute medicine.
Lead nurses from acute medicine units should undertake a skills analysis across all nurse
bandings, to identify the gaps/the current training needs of their staff mapped against the
skill areas, suggested in this research. To keep this work updated it is further recommended
that this is repeated yearly, by individual nurses prior to appraisal. This process will assist in
identifying personal development plansand continuing professional development, set in
context the wider needs of acute medicine.
A thorough understanding of the nursing workload/dependency within acute medicine units
is urgently required to keep pace with the acuity and volume of patients assessed and
admitted. Current workforce tools DO NOT provide sufficient information to ensure acute
medicine units are able to set their staffing levels adequately/safely. This is a piece of work
which would prove valuable alongside the RCN staffing guidance fro general wards.
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Staffing duty rotas need to be developed to take account of the potential for burn out and
high stress levels; it is suggested that adequate time for staff development and CPD are
considered with each new rota. It maybe possible for AMUs to consider developing different
types of nursing roles (new) where management, research, service development and
training could be incorporated into job descriptions legitimising the development
ofsupporting professional activities into job plans.
Acute medicine units without advanced nursing roles need to consider their development in
the context of the skills and training needs analysis. These types of roles provide for clinical
career progression and align with increasing patient acuity in acute medicine.
Notwithstanding, these roles will need to have a supporting structure in place for continued
training and development.
Liz Lees
Nurse Representative (Society for acute medicine).