Poor pay, bullying, violence in the workplace, staff shortages and inflexible working environments. These are just some of the endemic issues that have haunted the nursing profession nationally for decades. Yet, in Wales and the South-west, numbers of student nurses are dramatically increasing, by up to 90 per cent at some universities, several of which have two-year waiting lists. So what's going on in these areas and why are students rushing into a profession that has been plagued with problems?
The answer is simple, according to Dr Barbara Green, the Head of the School of Health Science at Swansea University. "There has never been a better time to go into nursing. Nurses today can expect lots of challenges and opportunities. It's an exciting time with lots of changes."
The first of these changes addresses the severe shortages of staff, which not only affects nurses' morale and stress levels, but also their ability to carry out tasks effectively. Significantly, Jane Hutt, the Health Minister for Wales, announced a much-needed staffing boost last month, bringing 6,000 nurses into the workforce by 2010. Similarly, the Government has pledged an extra 35,000 nurses for England by 2008. With 794 nursing vacancies recently reported in Wales and thousands being recruited from overseas a costly measure coupled with the fact that 24 per cent of registered nurses are set to retire in the next five years, such action is welcome news for health professionals.
However, these targets are not solely about resolving shortages. Ten new hospitals are planned for Wales, and modernisation and expansion work is underway in Derriford and Gloucester Royal Hospitals in the South-west. It seems there has never been such a need for nurses.
As 9 per cent of the workforce leave each year, retention of experienced staff is paramount. Last week, a £6m nursery strategy was announced to expand the Government's childcare strategy, a key part of the drive to recruit and retain healthcare staff for the NHS. On top of the £70m already announced for on-site nurseries, the new funding for this current year will extend flexible provision all round the country, enabling staff to book places in after-school clubs, holiday playschemes and with childminders.
"Family-friendly policies are increasing in the area," says Ken Terry, the Head of Health for the South-west at UNISON. "It's not as speedy as we'd like it to be, but it's going in the right direction."
Cindy Dockree, a nurse at Derriford Hospital, is benefiting from the improved measures put into practice in Plymouth. "By staff request, we recently changed to longer shifts, because coming in each day for short shifts was playing havoc with our social lives. There are also team-building initiatives to improve staff morale and recently we were rewarded with a day's holiday after a particularly busy time. Working conditions are much better than they used to be and staff feel more valued." In addition, they have a keep-in-touch scheme, whereby new mothers are invited to attend coffee mornings and given information about their rights. A staff support co-ordinator is available to organise new working arrangements and child-care solutions.
Training for nurses is also improving. A new professional body, Health Professions Wales, has been set up by the Welsh Assembly, starting in April this year. "There will be more joined-up thinking about education provisions for the healthcare workforce within Wales, which is good news," says Dave Galigan, the Head of Health for Wales at UNISON. A series of multi-professional programmes for nurses, including a Clinical Leadership Programme and Leadership Workshops for Nurse Executives, has also been introduced. From April 2003, nurses will also be given a higher profile in Wales, when 22 local health boards come into effect. Nurses will be key members of these boards.
Significantly, this autumn also sees the introduction of midwifery training at degree level in Welsh universities. In 2004, a degree in nursing will come into effect, taking over from the current diploma. "The idea is to make nursing more attractive to students, as well as a push for professionalism," says Sharon Hall, a nurse on the Welsh Leadership Programme and member of the Nursing and Midwifery Council.
However, some fear this could worsen staffing problems, with graduate nurses looking outside the profession. Dr Barbara Green, who undertook her doctoral research in graduate education and nurses, disagrees. "All the research evidence shows that they would stay within the profession. It's likely that some would go into areas where they get more autonomy, such as in the community."
Pay, ever at the centre of health debate, is an increasing issue for the South-west. "It's a beautiful area to live and consequently there has been a significant increase in the number of people who buy second homes in the area, pushing the cost of house prices up," explains Ken Terry.
Madeleine Jephcott, the deputy director of nursing at Derriford Hospital, agrees. "Whereas in the past our nurses have been able to buy houses at reasonable prices, this is likely to change over the next five years. However, the cost of living is still cheaper than in major cities."
From October this year, Powys health trust has thankfully vowed to scrap the two-tier pay system for nurses. Currently, 60 per cent of NHS nursing staff are employed on local contracts, earning up to £3,000 a year less than colleagues on national pay rates this system will be abandoned. Newly qualified nurses can now expect a maximum of £15,445 per annum within the NHS. And with unions in the process of demanding increases, the news could get even better.
Greg Dix, 31, is a Registered General Nurse at the Cardiff and Vale NHS Trust. "I always wanted to be a nurse. It's a very rewarding job. When a patient comes in with a broken leg, in agony, and leaves on crutches, you feel satisfied that you contributed to their well-being. I also like the interaction between relatives and patient.
"I trained as an Enrolled Nurse in Cardiff and undertook the conversion course to qualify as a Registered General Nurse, as well as the Diploma in Orthopaedic and Trauma Nursing.
"At the moment, I'm teaching practical clinical skills to students, such as taking blood pressure and temperature. I also facilitate learning for students in the clinical areas and provide education and support for mentors in practice.
"I've travelled to New Zealand working as a nurse. I stayed for over two years, in Auckland and Christchurch. It was a great experience, and I also met my wife. I'm lucky. I can probably work anywhere, which is part of the reason why I decided to go into nursing.
"On my return, the Trust encouraged me to attend the University of Glamorgan one day a week to study for a BSc (Hons) Professional Practice in Nursing. I graduated with a 2.1.
"Despite the bad press, there are good opportunities for nurses. My degree was funded, I'm now an H-grade nurse – so I am earning a decent income – and there is always further training on offer within the trust. I have a five-week-old baby boy, so I really benefit from our family-friendly working policy, offering flexible hours. As a new dad, I was given two weeks' paternity leave, which is unheard of in most professions."