Table 6 Integration of quantitative and qualitative findings to facilitate mixed methods meta-inferences

Data indicates that patient safety was the most important factor encouraging nurses’ decision to strike (M = 5.85, SD = 1.67), followed by staff shortages (M = 5.57, SD = 1.49). 

The level of importance between the two factors was not found to be significant (p = .072).

It's untenable:

“It is mostly about patient safety, and I do really feel that patients’ safety is a massive issue at the moment…” (Participant 1).

“There's so many things to patient safety. And having more staff makes it safer.” (Participant 6).

“My main reasons are safety of patients, I want safer staffing levels”. (Participant 10).

Expansion:

Staff shortages pre-cede patient safety and the two factors are inextricably linked. Staff shortages result in not enough nurses to adequately care for patients and thus, patient safety becomes compromised. In addition, staff shortages put undue pressure on nurses making the job untenable. This results in nurses increasingly leaving the profession and the NHS which further exacerbates staff shortages and compromised patient safety.

Those participants that cited pay as a factor that encouraged their decision to strike were significantly more professionally motivated than self-motivated (p = <.001).

Money talks:

“Yeah, so for me I do okay, my salaries alright. It's not about me. It’s about the system as a whole.” (Participant 5)

“Yeah, I'm talking about the profession as a whole. I mean personally I'm fine.” (Participant 9).

“No, it's actually not about my personal struggles financially. For me it's a much bigger issue than that.” (Participant 12).

“I'm not doing this for me… it’s for the new nurses coming through. My heart breaks for them coming through on their big debts… I don't think they should have to pay for their training.” (Participant 3).

“So, first of all the students lost their bursaries, and then they had to pay student loans… So on that basis I decided to strike. It wasn't for me, it was for encouraging young people”. (Participant 2).

Confirmation:

Pay was a factor that encouraged participants decision to strike primarily because an increased level of pay would serve as an incentive to attract people to join the profession and to stay in the profession, rather than for individual monetary gain. Increasing the rate of pay for nurses was therefore seen as the first step toward, and integral to addressing the recruitment and retention crisis.

Expansion:

The qualitative findings helped to identify a further insight into pay and professional motivation that wasn’t captured by the quantitative findings. This was in relation to student and newly qualified nurses. Increased pay was deemed especially important for these groups due to the costs of tuition fees and the vast debts that student nurses incur to do their training. Participants stressed that student nurses shouldn’t have to pay for tuition fees and the abolition of the student nurse bursaries in 2017 was widely criticised.

Those participants that cited unmanageable work demands as a factor that encouraged their decision to strike were significantly more professionally motivated than self-motivated (p = <.001).

It's untenable:

“The staff that we do have are being utilised so much that they're burning out… it's no wonder they're leaving.” (Participant 10).

“I'm talking about retention, absolutely. So many nurses who potentially might have worked a little bit longer towards retirement… leaving early or, going to work elsewhere in a job that's less stressful, less responsibility. You know, so we are haemorrhaging those experienced nurses.” (Participant 11).

Confirmation:

Unmanageable work demands encouraged participants decision to strike because it was viewed as an important reason why nurses are leaving the profession and the NHS. Making the demands of the job more manageable was therefore seen as integral to addressing the retention crisis and making nursing a more attractive career prospect.