Nursing and midwifery - Listening Project: You shared, we listened

1. The Ministerial Nursing and Midwifery Taskforce

In February 2023 the Ministerial Nursing and Midwifery Taskforce (the Taskforce) was established to build on efforts to make Scotland the best place for nurses and midwives to come and work. The Taskforce had the ambition to:

“to recognise and value the contribution of the nursing and midwifery professions in Scotland by building sustainable and skilled nursing and midwifery workforces, with attractive, varied career choices across the four pillars of practice (clinical practice, facilitation of learning, leadership, and service improvement), fair work and flexibility, where all are respected and empowered, and where staff actively choose to stay in Scotland’s Health and Social Care workforce their whole career.”

The Taskforce was led by the Cabinet Secretary for Health and Social Care and brought together workforce experts in nursing and midwifery, and representatives from the health service, regulator, professional organisations, trade unions (Royal College of Nursing, Royal College of Midwives, Unison and Unite), academia, NES and Scottish Government.

The Taskforce agreed to collaboratively develop a workplan of recommended actions to deliver long-term change. To do so, four subgroups were established with each examining and making recommendations on one of the four identified and agreed themes: Attraction, Education and Development, Wellbeing, and Culture and Leadership. Retention was identified as a priority area for each of the subgroups (Scottish Government, 2025).

Table 1 Overview of the focus of the four subgroups

The scope of the work of the Taskforce did not include pay, terms and conditions or non-pay aspects of the 2023 pay settlement because these were being considered in a separate process.

1.1 The Listening Project

To ensure the recommended actions of the Taskforce took account of the views from current and future nursing and midwifery staff, a series of engagement activities were organised under the banner of the Listening Project. These activities focused on identifying challenges that have an impact on the daily work and wellbeing of nursing and midwifery staff, students and academics and on their views to improve the situation. The Listening Project ran from August 2023 until June 2024 and consisted of three phases.

Phase one: The Pulse Poll survey (Aug-Sept 2023)

The Pulse Poll was an online survey for staff and students of the nursing and midwifery professions and consisted of a mix of open and closed questions. The aim was to seek views on key areas for the Taskforce to focus on, including attraction to nursing and midwifery, education and development of the current and future workforces, wellbeing, leadership and culture, and retention among the professions. In total, 2818 responses were received, representing a broad spectrum of areas of nursing and midwifery and across every health board area in Scotland. The Pulse Poll responses helped to give a baseline understanding of the issues that staff perceived as important.

Phase two: Focus groups with staff and free text survey (November 2023 – June 2024)

In the second phase of the Listening Project, Scottish Government officials conducted a series of in-person focus groups with nursing and midwifery staff. These discussions led to a deeper understanding of the complexities and nuances of information shared by staff, which could not be gleaned from the Pulse Poll survey alone. In-person focus groups were held in all territorial health board areas (in both acute and community settings) and most national health boards. Over 80 in-person focus groups were held and were attended by 462 individuals.

To give staff who could not attend the in-person focus groups the opportunity to share their views, another eight national virtual focus groups were held. These were attended by 122 staff. In addition, an online free text survey was launched with similar questions as in the focus groups, receiving 607 responses.

Phase three: Focus groups with students and academics (February - May 2024)

In phase three, Scottish Government officials held five virtual focus groups with nursing students and one virtual focus group with midwifery students; in total 27 students attended. Seven focus groups were also conducted with academic staff (attended by 30 staff in total) from a variety of Higher Education Institutions (HEIs) across Scotland. The aim of these focus groups was to hear from students about what it is like to study to become a nurse or a midwife in Scotland, and from academic staff about their experiences of teaching in the profession.

Overview of the Listening Project engagement activities

Phase one: Aug-Sept 2023

• Pulse Poll online survey (n=2818)

Phase two: Nov 2023- June 2024

• In-person focus groups across Scotland with staff (n=462)
• National virtual focus groups with staff (n= 122)
• Free text online survey (n=607)

Phase three: February – May 2024

• Focus groups with students (n = 27)
• Focus groups with academics (n = 30)

The letter “n” is used to represent the number of participants.

1.2 Analysis and reporting

Analysis and reporting took place throughout the Listening Project, and preliminary findings were shared and discussed with the Taskforce subgroups to help shape discussions on the proposed recommended actions. The Scottish Government Listening Project team developed frameworks to support a better understanding of the information gathered in each phase, taking account of overlap and differences to reflect the varying contexts of midwifery and nursing across Scotland. See Appendix 1 for further details on the methods.

This report presents overarching issues and experiences heard in each phase of the Listening Project. These include views across the different workplace settings and roles, as well as views shared by midwifery and nursing staff and/or students and academics, to ensure different views are represented.

Whilst the professions of midwifery and nursing differ significantly in many aspects, as do the fields of nursing, there were many areas of similarity, irrespective of field or profession. Differences and similarities in views heard have been highlighted.

When discussing feedback that specifically related to an issue from the focus groups or free text survey, the total number of those expressing those viewpoints varies across each theme. Therefore, phrases such as most and many do not relate to a specific number, but to a proportion of viewpoints expressed as part of this project. A few quotes have been edited for readability and some content has been removed or changed to shorten quotes or protect anonymity, but the meaning has been retained.

Inevitably issues outside the scope of the Taskforce were raised during the Listening Project. These were shared with the relevant people outside the Taskforce, taking care to protect the anonymity of those who participated and their employing organisation. When an issue raised was deemed serious enough to require further escalation for follow up, permission was sought from participants and any identifiable information about the respondents was removed prior to this escalation. In all Listening Project matters, public protection and protection of those who took part remained at the forefront throughout the project.

Strengths and limitations

A strength of the Listening Project was the interaction between staff, students, academics and the Scottish Government which gave the opportunity to build rapport and take account of the wider context of the participants. Another strength was the large number of nursing and midwifery staff with a diverse range of roles, backgrounds and perspectives, and from a wide variety of settings across Scotland. Using multiple data collection techniques allowed for a comprehensive picture of their experiences and enabled data triangulation by comparing different datasets and the findings with the wider literature.

Participation in the Listening Project was voluntary and depended on the willingness and availability of the participants. As such, some might argue that it may be possible that those with very positive or very negative experiences were more motivated to participate. Also, due to the nature of the job, frontline staff might have found it difficult to attend the in-person focus groups. To counteract this, additional focus groups (in-person and virtual) were held and the supporting survey was set up. Doing this helped to increase opportunities to take part. It was noted that those in more senior roles were more likely to have some control over being able to make the time to attend and engage with the Listening Project. This was taken into account during the focus group facilitation and subsequent analysis.

In phase three, student nurses and midwives were recruited, as were nursing and midwifery academics. For midwifery in particular, challenges were experienced when attempting to recruit both students and academics and the number of participants was lower than anticipated. However, it is important to note that, proportionally, when considering student nurse and midwife numbers in particular, the numbers recruited were proportionally equal across these groups. It is also important to recognise that whilst the numbers recruited were small, the experiences and issues raised were frequently repeated across the focus groups, suggesting that the information captured was relevant and reflective of students and academics experiences. Finally, it is also important to note that for nursing, all fields of practice and all four years of academic study were represented by the students who took part, and for all participants across both students and academics, care was taken to ensure geographical representation from the North, East and West of Scotland.

Finally, nurses and midwives from NHS, social care, independent and third sectors were invited to take part. However, it is important to report that, overall, a small number of participants were employed within social care, the independent or third sector environment. Due to capacity and the timelines for this project it was not possible to extend recruitment to address this. Therefore, the findings in this report reflect mainly the perceptions of the NHS workforce.

A note on language

The term ‘patient’ is used to refer to care provided to people who use health and care services. The term ‘patient’ was commonly used by the Listening Project participants, though less so in the midwifery settings. However, we are aware that this is not a term used across all health settings, especially not in social care.

The term “non-registered staff” is used to refer to health and care support staff. A number of different terms are used within health and social care settings across Scotland, for example “Healthcare Support Worker” and “Clinical Support Worker” therefore for consistency, one common term is used. However, we are aware that this is not a term used across all health settings, it is simply for consistency.