Follow Your Compassion

In 2023, in partnership with the King’s Fund, we created Follow Your Compassion – a project which depicts the everyday lived experiences, thoughts, and feelings of 22 newly qualified and registered nurses and midwives, in a variety of health care settings across the UK.

Origins

Follow Your Compassion is a companion piece to The Courage of Compassion (2020), a report by The King’s Fund and RCN Foundation which explored nurses and midwives’ experiences of leadership during the pandemic, and set out the ABC framework of core work needs underpinning compassionate leadership.

The catalyst for this project is a profound workforce crisis in health and care, and unprecedented numbers of nurses and midwives leaving both professions and is an attempt to bring the reality of this crisis to life.

The Study

During 2023, 22 newly qualified and registered nurses and midwives, working across a variety of settings in the UK, kept personal journals using words, audio, photography, and video, describing both their work and their relationship to work. Their day to day lived experiences and perspectives were powerfully brought to life, giving voice to notions rarely heard. 

Findings

Not all recounted experiences were negative, some described positive experiences of training, management, culture, and clinical practice. However, the overwhelming consensus from participants was that of feeling unprepared, anxious, silenced, and exhausted. Troublingly, participants also expressed experiences of working within psychologically unsafe teams and departmental cultures, and a chronic and pervasive fear of making a career-ending clinical mistake.

Following this, managers and leaders of both nurses and midwives met with the project team to explore the themes that had emerged, becoming explicitly clear that of none of this is new. Most managers and leaders described similar experiences from when they were newly qualified, with a few suggesting that these experiences and feelings are inevitable and worse still, necessary to help set apart the best practitioners. It is important to add that some managers and leaders defend the various support structures and processes in place for newly qualified staff inside their organisations and some newly nurses and midwives did state they had support, reinforcing that there is a huge disparity between the experiences of newly qualified nurses and midwives and this itself is problematic.

Outputs

The cultural transmission of these norms, attitudes, and behaviours identified in Follow Your Compassion is concerning, particularly as a huge level of responsibility is being imposed almost immediately after qualifying, further exacerbated by, an emotionally demanding workload along with staff shortages and poor pay. The practice of nursing and midwifery is becoming increasingly transactional, potentially eroding the caregiving purpose that drew people to these professions in the first place. Leaders need to actively listen to the experiences of newly qualified staff and recognise their needs as essential to providing high-quality care. 

For as long as these norms persist, it means issues of recruitment and retention in both professions will continue and potentially accelerate - without both the right cultural conditions and structural arrangements, the experience of newly qualified staff, and therefore the issues around retention, will not improve. 

Learn more about Follow Your Compassion and the lived experience of the 22 nurses and midwives that took part. Explore the website and hear their voices.

Deepa Korea, Director of the RCN Foundation, said “This work highlights the enormous challenges facing newly qualified nurses and midwives, from chronic excessive workloads and under-staffed wards, to generally poor working environments. It also describes their experiences of harmful workplace cultures full of anxiety, judgement, and exhaustion – environments in which compassion is at times, absent. We simply can’t afford to continue to lose so many talented and dedicated staff so early in their careers. That’s why supporting newly qualified nurses and midwives will be a central tenet of the RCN Foundation’s work in 2024 and beyond I firmly believe that if we get it right for our newly qualified nurses and midwives, we will get it right for the profession as a whole.”

Suzie Bailey, Director of Leadership and Organisational Development at The King’s Fund said “These experiences of newly qualified nurses and midwives show that action must be taken quickly and consistently to make the NHS a more attractive employer. While most staff we talked to are proud of their work and want to stay in the service, their experience of coming to work is not always pleasant. There must be a stronger focus on developing cultures where staff can flourish, including through compassionate, inclusive, and collective leadership which can be pivotal to the physical and mental health of staff. Staff wellbeing is not only important for the future of the workforce, but also directly impacts the quality-of-care patients receive.”