The nurses and midwives who documented their working days and nights for this project offer powerful and urgent insights into the state and future of both professions, and about the health and care system more broadly. Across their experiences, and despite the very different settings and locations for their work, six themes stand out:

Cultures characterised by chronic excessive workloads, fear, anxiety and exhaustion are common. These are cultures to be endured, where incivility and a general lack of concern and care for the development and welfare of newly qualified staff is often present, and frequently administered not only by more senior colleagues, but by peers only a few months further along in their career. 

Cultures characterised by chronic excessive workloads, fear, anxiety and exhaustion are common. These are cultures to be endured, where incivility and a general lack of concern and care for the development and welfare of newly qualified staff is often present, and frequently administered not only by more senior colleagues, but by peers only a few months further along in their career. 

The gap between theory and practice appears significant, while the quality and consistency of placements and preceptorships is variable and often poor. In the context of a workforce crisis, it’s perhaps not surprising that students should have little chance to be supernumerary and instead come to be relied upon as core members of diminished departments and teams, but students are often parachuted into cultures that are harmful in many ways, further undermining their learning, safety, and the safety of patients.

The gap between theory and practice appears significant, while the quality and consistency of placements and preceptorships is variable and often poor. In the context of a workforce crisis, it’s perhaps not surprising that students should have little chance to be supernumerary and instead come to be relied upon as core members of diminished departments and teams, but students are often parachuted into cultures that are harmful in many ways, further undermining their learning, safety, and the safety of patients.

Feeling safe enough to ask questions, raise concerns, make mistakes and learn is central to the induction of newly qualified staff, their retention, and the quality of care given in any health care team. Common instead are belittling experiences of unkindness, impatience, judgment, and sanction. The climate of fear and anxiety this promotes is profoundly unsafe.

Feeling safe enough to ask questions, raise concerns, make mistakes and learn is central to the induction of newly qualified staff, their retention, and the quality of care given in any health care team. Common instead are belittling experiences of unkindness, impatience, judgment, and sanction. The climate of fear and anxiety this promotes is profoundly unsafe.

Newly qualified nurses and midwives have questions, ideas, and perspectives on what goes on in the workplace that might be used to drive service improvement. They have a valuable voice. But a voice is no use if no one is listening, and too often newly qualified staff are either silenced by the cultures they work in, or ignored by more senior colleagues consumed by their own operational and clinical pressures.

Newly qualified nurses and midwives have questions, ideas, and perspectives on what goes on in the workplace that might be used to drive service improvement. They have a valuable voice. But a voice is no use if no one is listening, and too often newly qualified staff are either silenced by the cultures they work in, or ignored by more senior colleagues consumed by their own operational and clinical pressures.

Good management and leadership sets standards and cultivates the culture of a team and department. Relational and compassionate leaders create safety and the conditions in which newly qualified staff can learn, be further developed, and ultimately retained. Management and leadership of this kind is out there, but it is operating in a context of huge financial and operational pressure, which creates a dominant organisational priority for efficiency. In this pressured environment, too much of the management and leadership present pursues this efficiency by succumbing to the attitudes and techniques of command and control.

Good management and leadership sets standards and cultivates the culture of a team and department. Relational and compassionate leaders create safety and the conditions in which newly qualified staff can learn, be further developed, and ultimately retained. Management and leadership of this kind is out there, but it is operating in a context of huge financial and operational pressure, which creates a dominant organisational priority for efficiency. In this pressured environment, too much of the management and leadership present pursues this efficiency by succumbing to the attitudes and techniques of command and control.

The experience of newly registered nurses and midwives who trained internationally warrants special mention, not least because the NHS (in particular) has become so reliant on recruiting these staff as a fix for the workforce crisis. But their experience follows a familiar historical pattern of high hopes and dashed expectations. The reality is that in many of the same ways newly qualified staff are let down, internationally trained staff are also let down. In addition, their skills, qualifications and experience are often dismissed, and they must navigate – largely unsupported and ill-prepared – a new way of life, language, culture, and system of health care often filled with discriminatory attitudes and hostility.

The experience of newly registered nurses and midwives who trained internationally warrants special mention, not least because the NHS (in particular) has become so reliant on recruiting these staff as a fix for the workforce crisis. But their experience follows a familiar historical pattern of high hopes and dashed expectations. The reality is that in many of the same ways newly qualified staff are let down, internationally trained staff are also let down. In addition, their skills, qualifications and experience are often dismissed, and they must navigate – largely unsupported and ill-prepared – a new way of life, language, culture, and system of health care often filled with discriminatory attitudes and hostility.

Despite many of the dispiriting and challenging experiences described by the nurses and midwives who took part in Follow Your Compassion, there are reasons to be hopeful. There are positive accounts of colleagues, cultures and management, and feelings of enormous pride and determination throughout. And then there is the passion for both nursing and midwifery, which won’t save either profession, but does create the goodwill that remains a vital ingredient in services that, without it, would surely fail. And finally, there is the compassion shown to patients, who are often entirely unaware of the quiet internal battles being fought by the newly qualified staff caring for them.   

This project isn’t about providing recommendations for what should happen next, these can be found in The Courage of Compassion (2020), which clearly articulates action that is consistent with the themes presented in this project. The aim of Follow Your Compassion is much simpler. It is to present the experiences of newly qualified and registered staff unfiltered, so that they might be seen, heard and understood better. 

As you explore the website, the hope of the project team and participating nurses and midwives is that you will hear, understand and have compassion for newly qualified staff. And that you will follow your compassion to whatever determined action you can take to help address the urgent challenges facing both professions, and the wider health and care system.