Mamsey House has experienced many of the issues relating to well-publicised stories regarding nurse retention and recruitment. In the UK, there are currently 24,000 nursing vacancies, and recruitment into the nursing home sector, especially where I am in rural Somerset, has been very hard for us. We have attempted recruitment through a variety of means and have concluded that recruitment of nurses from overseas is our best option.
Recruitment agency costs (upwards of 10% – ie. £3000 per nurse) is compounded by the competition for nurses with other nursing homes. This is resulting in other ‘sweeteners’ now being required: paying for flights, providing airport pick-ups, finding and furnishing cheap accommodation, providing interest free loans. From January 2016, the recruitment of nurses has become harder with the impact of mandatory English language examination requirements.
Due to the shortfall in available nurses, the industry is now recruiting foreign staff with a European PRN (Provisional Nurse ID). These foreign nurses have no experience of working in the UK and, therefore, have a European PRN. When they have secured employment in the UK, they must then apply to the Nursing and Midwifery Council (NMC) to have their PRN registered as a PIN. Once the PIN is received, then they may work nursing shifts in the UK.
Of all the frustrations that I could raise around this nursing situation; I am particularly discouraged by the NMC’s PIN Registration Process. It is taking too long. It was generally accepted in September 2015 that the process would take four to six weeks to complete. The average wait time, in March 2016, is now over four months. During the first three months of employment, care homes, therefore, have to pay the new foreign nurses at high rates to simply work as carers, whilst in the interim also paying for agency or temporary nurses. Without a shift nurse, there is no nursing home.
We believe the process is inefficient. Applicants provide their required documentation and initial NMC registration fee, and are then put in an NMC queuing system. There is no feedback for at least 10 weeks (currently 70 working days), before a case officer is allocated. There is no Queue ID, or visibility of the number of applicants or current wait time. This makes staffing, rota planning and management impossible for providers. After the 70 working days, a case officer will review the application and, if any detail is missing, then this is requested. The applicant must then re-submit any missing forms, which take 10 to 15 working days to scan. They are then not provisionally checked; the applicant must wait a further 70 working days for another case officer to be allocated. If the documentation is correct, then the receipt of the Final Declaration and addition to the NMC Register is another 15 to 20 working days.
There is no service level agreement for managing the turnaround of PINs. I understand there to be around 20 European Case Officers. When I enquire as to the status of a PIN application progress, the telephone queuing system indicates that the number of frontline call operators is also inadequate.
We do not have enough nurses in the UK, and combined with the new IELTS examinations, we are now also dissuading foreign nurses from supporting us in the UK, because we are making them wait four months for a PIN. Foreign nurses come to the UK to earn money, and they initially have to wait four months before starting work at a nurse pay rate. This only increases the likelihood of their leaving employment and thus compounds the issue of nurse attrition rates in the UK.
I have recently written to my local MP to raise the following question in Parliament, ‘Is it acceptable that given the various barriers-to-entry facing EU nurses, that the NMC compounds the issue of nurse shortages with an average PRN to PIN processing time of over four months?’
To give this context, here’s a situation I am currently facing, which I feel is quite common across the country. I have recently recruited three Polish nurses. One of these new staff started employment with us at Mamsey House on 12th January – at a competitive industry pay rate, with an expected nurse PIN registration date of 10th January 2016.
On 1st April, I was advised that a realistic target date for his PIN receipt is 14th July 2016. Meanwhile, I am paying our new nurse an above normal rate as a care assistant, for which he is vastly over-qualified, whilst I potentially have an inadequate number of nursing staff and, therefore, the threat of paying a temping agency an above-industry pay rate of £22 per hour for six months at 35 hours per week.
What can be done about the situation? How can we address the nursing shortage if our own processes are a hindrance?
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