Understanding the experiences of nurses, midwives and nursing associates: How linking data can make a difference

It is now a decade since I sat in the Nursing and Midwifery Council’s (NMC) headquarters in London and presented ideas around how data about nurses, midwives and nursing associates could provide a solid base for research. People often say that good things take time, and that's definitely true when it comes to the NMC's data. 

So much has happened in the intervening nine years. It’s not long when you consider everything that has had to happen. Not least the ESRC’s funding of ADR UK, and associated centres. And then when we started working in earnest towards this specific project, around three years ago now, there has been the dedication and foresight of our colleagues in the NMC (they have been and are amazing) - and crucially the Office for National Statistics (ONS), with their invaluable experience, skills and infrastructure.

The combined effort of SCADR, ONS and the NMC resulted in nursing and midwifery registrant data being made available for research via the ONS Secure Research Service, for the first time. This success enables data about professionals registered with the NMC to be linked with data from the 2021 Census for England and Wales. This linked dataset will be available soon for accredited researchers to apply to access via the Integrated Data Service.

I am also delighted that the NMC Register linked to Census 2021 – England and Wales dataset has been adopted by ADR UK as one of their flagship datasets. That’s an important development for two reasons. Firstly, it will considerably increase the capacity to utilise that resource, to answer questions so key to the nursing and midwifery professions. Secondly, the ADR UK Fellowship opportunities are offered for those wishing to complete their research project using data from a flagship dataset. For applicants wishing to apply for a Fellowship using this NMC-Census 2021 linked data, they should please register their interest before 28 March 2024 and try to attend an online information event on 7 March.

Why nursing and miwifery?

My reason for wanting to see this linked dataset happen is to address a need for a robust social science of these key professions. We know very little about the social circumstances of nurses or midwives. We hear stories of nurses using foodbanks and have seen strikes happening across the UK. Even when I was in clinical practice, quite a few years ago now, it seemed clear to me that many of the challenges that led people to question their future careers were fundamentally specific to their situations. Some were single parents struggling to manage childcare around their shifts. I and others struggled to afford housing locally and looked to move to less expensive parts of the country.

Yet data that enables issues such as the implications of the family circumstances or the housing market for these key professions has been lacking. Until now.

What can the data show us?

The de-identified NMC Register linked to Census 2021 – England and Wales dataset is a starting point but an important one. The register itself includes valuable information including;

  • professional characteristics
  • indication of how long since initial registration
  • country of initial training
  • whether they (for nurses or those registered as both nurses and midwives) are registered as nursing with children, learning disability, mental health, or – like me – adults; 

Add in census data and you have the basis for understanding the social dimensions of these professions. Just a glance at the areas covered by the census, and made available through the Integrated Data Service, gives indication as to the scope of questions that can be answered.  

The potential just jumps out:

  • international migration
  • housing
  • the labour market...

...I could go on and on (as my colleagues will testify that I often do!).

Future potential

What really adds to analysis potential are longitudinal dimensions. ONS have not only linked data from the NMC Register of 2021 to the Census 2021–England and Wales dataset, but will also link NMC data from 2018 and 2022 to create additional datasets (with some potential that 2023 may be added). The additional datasets provide indication of dates when people dropped off the register in the three years between 2018 and 2021. That means that there will be linked data relating to former registrants who ceased registration prior to census enumeration. That’s got potential for answering questions around retirement and retention.

Then there are geographical questions this data can answer. The census includes a wealth of questions around where people live, with geographies including NHS Health Regions (for England), local health boards (for Wales), and local authorities. Then there are important questions to be answered around migration, internal and international. As already mentioned, the register includes indication of country of initial training. There is indication from the census of country of birth, intention to stay in the UK, and year of arrival. Variables are also available indicating migrations within the 12 months prior to the census. The longitudinal nature of the register data further expands geographical analysis (and note that register data only is included for the whole of the UK).

These are only some of the potential analysis that this data can enable. The suggestions are likely influenced by my own experiences as a nurse, and then my later studies in demography and geography. Further developments, beyond the scope of this particular call, will enable linkage to other datasets that can expand the potential questions that can be answered, to the benefit of nurses, nursing associates and midwives, and given their roles, to the wider public.

My hope is that we can see a network of researchers using this data. In the initial phase, this will include those who are successful with the ADR UK Research Fellowships using the NMC Register linked to Census 2021 – England and Wales dataset, as well SCADR’s researcher, Michelle Jamieson, who is working with me in ADR Scotland and who will be the first person to analyse this data. In the longer term, and with a view to expanding capacity, we need people doing PhDs that enable them to develop the skills needed to analyse this kind of data, from within the nursing and midwifery disciplines themselves, but also drawing on the diversity of expertise across the social sciences.

Finally, this work has been driven forward by some amazing people with whom it is just a joy to work with. First and foremost are colleagues from the NMC (and a big shout out to Caroline Kenny), and to the Office for National Statistics - there are lots of people here who deserve shout outs, but let me particularly highlight the work of Alan Cotterill (who has managed processes brilliantly), and Nathan O’Conner (who is finishing the linkage as I type). Then there is everyone in our stakeholder group, not least of all our ADR Scotland Public Engagement Manager, Harriet Baird, and ADR Scotland Communications Manager, Jane Barr.

Finally, a huge shout out to ADR UK and ESRC whose funding is making a difference to these professions at such a critical time.

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