The challenges of recruitment in respiratory care

By the very fact that you’re engaged with the Together in Respiratory platform, it’s clear you have an interest in all things respiratory. However, respiratory nursing as a specialism has found it difficult to recruit qualified nurses recently, even before the global COVID-19 pandemic.

Taking action to address vacancies

When I think back to January 2019, the nursing vacancies situation in Northern Ireland was so severe that the nurses and health care assistants had to take industrial action for the first time in the RCN’s history. The campaign received so much support from within the profession and from the public because it addressed fair pay and conditions and safe staffing levels for nurses.

Nurses realised for their concerns to be heard, there was no other option but to take such action. There was a shortfall of over 2,000 vacant Registered Nurse posts across the hospital and community. This was compounded by newly qualified nurses tending to choose areas such as Emergency Medicine and ICU. There appeared to be a similar situation all across the UK. Nurses seemed to have little interest in working on a respiratory ward, especially at Band 5 level.

Attracting nurses to respiratory

Before the COVID-19 pandemic, a rotational programme was introduced by our Trust’s Lead Nurse team to attract more interest to our respiratory wards – especially for newly qualified nurses. It involved the nurses embarking on four placements, each lasting four months, moving between acute respiratory inpatient wards across two hospitals and a community respiratory team.

The initiative incorporated a comprehensive preceptorship programme with 16 classroom-based clinical skills days, protected time to develop their practice and meet individual learning needs. The nurses were then supported with a move to a permanent position in their chosen area at the end of the programme.

We promoted the programme through an online recruitment drive, developed in collaboration with the Human Resource department. The event was advertised through the Universities, RCN and social media outlets. Interested nurses could register and submit their application online. Interviews were no longer held in person, and the nurses were given an interview time slot when they registered. The event saw numerous nurses presenting via Microsoft Teams on why they had chosen a career in respiratory nursing. Speakers included staff nurses, ward sisters, clinical educators, nurse specialists and consultant nurses. This was a live event but was also recorded to reach a wider audience at a time convenient to them.

Highlighting the breadth of respiratory nursing

The numerous experiences recounted gave a sense of the breadth and depth of respiratory nursing, from the highly technical skills required for the complex and deteriorating respiratory inpatient to long-term condition management and palliative care. They all described the crucial knowledge and skills required to manage a respiratory patient. It demonstrated a truly holistic patient-centred nursing as they can impact all aspects of the person’s life. The community respiratory team outlined their essential role in managing care out of the hospital, in clinical decision-making, and in co-producing care plans with patients on an ongoing basis. Strong professional support and working within a multi-professional team is also an essential aspect of respiratory nursing.

Several speakers also described the role of primary care nurses working as nurse practitioners and practice nurses. Their promotion of autonomous decision making and diagnosis, promoting self-management and empowering patients to become experts themselves all contributed to improved quality of life for respiratory patients and their wider family/carers.

There was a satisfying level of interest in this programme, but the initiation was hindered by the necessary and rapid response required to tackle the COVID-19 pandemic.

How respiratory care responded to COVID-19

When we were hit with the COVID-19 pandemic in March 2020, the way nurses worked changed dramatically. Large numbers of nurses were redeployed and had to learn new acute respiratory interventions and skills.

The response to COVID-19 from the respiratory nursing teams was phenomenal across all health sectors. This often meant delivering training in several practices, including:

• continuous positive airway pressure (CPAP)
• high flow nasal oxygen therapy
• other oxygen modalities.

For some, it also meant assessing the deteriorating respiratory patients or offering respiratory palliative care across the hospital. Others were needed to support redeployed staff in managing the terrified COVID positive patients. Under all this pressure, the respiratory nurse specialists and ward-based teams excelled. So too did the respiratory community teams by showing leadership in the COVID centres. Many nurses supported frail elderly residents within the Independent Sector whilst tackling the fear and isolation suffered by patients across our caseloads

Never before had the provision of oxygen therapy been such a fundamentally important element of care. Respiratory nurses assessed, reviewed and ensured adequate supplies across both acute and community Trusts.

All healthcare teams have delivered care above and beyond any expectation throughout this past year. I admit I may be biased in saying that respiratory nursing should be standing proud of their immense achievement in caring and supporting patients at their greatest time of need whilst doing the same for their colleagues who were not so familiar with respiratory care.

Will this possibly lead to additional interest in our speciality? We will just have to wait and see.