A workforce in jeopardy - identifying the challenges of ensuring a sustainable advanced HIV nursing workforce.

Introduction: HIV services in England face substantial challenges arising from financial pressures and changes to commissioning. A sustainable HIV specialist nursing workforce will be vital to enable them to respond to those challenges. This paper examines the current workforce situation in HIV services across the country. Methods: This mixed method study involved semi-structured interviews with 19 key stakeholders and with 44 nurses / physicians from 21 purposively selected HIV services across England. Data were interpreted using a framework analysis approach. Findings: 'Building a career in HIV nursing' identified problems associated with retention and recruitment. Changes in commissioning are disrupting common career routes from sexual health to HIV nursing and a perceived lack of clear career pathway was seen as a barrier to recruitment. 'Developing a specialist workforce' explored professional development of the current workforce which was hampered by poor access to funding or study time for advanced study, and the absence of an HIV-specific advanced nursing qualification. Conclusion: The HIV nursing workforce, which provides an increasing proportion of HIV care, is facing serious recruitment and retention challenges. A strategic approach to workforce development and training is essential to overcome systemic barriers and secure the next generation of skilled practitioners