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'We need an independent body to set standards and develop education'


Whose job is it to provide strategic leadership to support nursing and education developments, asks Susan Hamer

Working at the policy-practice interface is not the sexiest bit of nursing - there are certainly more glamorous areas of practice. None the less, like most nurses, I believe the work I do is important and makes a difference. I also know that I am seeing all the symptoms of a crisis emerging in nursing.

The succession of NHS reorganisations has had a real impact on how we develop nursing practice. Nursing, unlike medicine with its royal college structure, doesn’t have a single organisation tasked with setting standards and implementing them. What we have is a raft of networks that rely on enthusiastic leaders supported in their endeavours by their employers. These networks are vital to how we learn and develop practice.

Clearly, the needs of employers varies, as does their interest in particular areas of practice. So, at a trust level, nurse leaders are rightly focused on transactional activities, such as safety and infection control. At a national level, our most senior government nurses, in their two roles, focus on transformational gains - vision, culture and compassion. We used to have an integrated form of regional leadership that brokered across the boundaries, but no more. Importantly for the quarter of nurses not in the NHS, all these networks can be difficult to access as many new employers fail to understand their duty to the wider system, and how nurses learn.

“I am seeing all the symptoms of a crisis emerging in nursing”

What really brought it to the head for me was the debate around the Nursing and Midwifery Council. Yes, it had been developing other activities, such as its excellent work on adult safeguarding as a way of being proactive but, apparently, this was not its job to do, which is probably right, but then just whose job is it? In the past, we could second senior nurses on development opportunities to work on national projects and their employers valued the opportunity it presented to staff and the NHS. No more - the local focus simply won’t allow that and you have to beg to get nurses out of organisations.

So, like all the best practitioners, I am looking for a new solution to the problem for English nursing… yes, I have said it, because I am envious of the other home countries, in particular Northern Ireland.

In Northern Ireland, with a nurse workforce of about 23,000, funded by their health department, is the Northern Ireland Practice and Education Council for Nursing and Midwifery. It is this organisation’s job to provide strategic leadership to support nursing and midwifery practice and education developments. It receives significant funding to do so. Now, there is a country that takes nursing seriously. If we had the equivalent, we would have nearly £10m to do the same.

Do I think I could make a business case for that in these times of hardship? Yes, I do. We are surrounded by a cottage industry of initiatives that don’t get the funding they need to make a big difference fast enough. The consequence is unsustainable changes. It is not one person’s or organisation’s job to get the right people in the room to talk about the difficult stuff and get consensus on the way forward. We need educational innovation to link with practice innovation. We cannot announce £100m for technology to support nursing practice and have no way of driving it through - but we have.

I have studied innovation and practice development for many years. I have also coached teams for many years and what I do know is we have a real problem, which is getting worse. It is not one nurse leader’s job to sort this out but it should be somebody’s and some organisation’s job to do. We need a solution for nurses.

Susan Hamer is organisational and workforce development director at the National Institute for Health Research Clinical Research Network


Readers' comments (5)

  • I agree there should be something similar to what our medical colleagues have. And because the arena of nursing is so huge, rather than try and reinvent the wheel, why not just copy them. After all, the college of Emergency Nursing, or the college of Orthopedic nursing.. it could sit at the table with our medical equivalent.. this does not seam to complex to me.

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  • what's a policy-practice interface?

    what are transformational gains?

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  • Silly me, I thought I paid £75 a year for the strategic leadership from a professional body.

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  • Very well said. The NMC has woefully failed at this (and many of it's other tasks). The gap between theory and practice is growing. Nurses have never had 'spare time' so every new initiative steals time from another area and creates a culture of endless, unsustainable (and often seemingly pointless) change. It's about time the NHS understood it's most valuable resource, Nurses time!

    Also if we're looking at medical and AHP models why are we the only profession that drops it's newest members in at the deep end with little to no support. Junior doctors have 2 hours teaching a week and most professions rotate junior staff and have structured development programs for the first few years of practice.

    Our biggest problem is many senior nursing managers are completely out of touch. They talk ideals and work to placate trust boards, keeping their distance from the reality on the ground. Some seem to advocate a 'Nurse by numbers approach' where blindly following an ever growing series of policies and protocols is commended and the use of clinical judgement (often in the patients best interest) is frowned upon, even disciplined.

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  • This acknowledges that both the NMC and the RCN are unfit for an essential purpose.

    The NMC is simply unfit - it's failing in too many crucial responsibilities to the public and the professionals it regulates.

    The RCN is trying to get more income to support its bloated structures and a its vain attempt be a pukka trade union outside the TUC support networks. This means that the professional side (the art and science of nursing) is neglected and their membership is now too big and diverse to address this properly.

    NHS management has taken nursing for granted and ignored falling standards and poor resources for too long. The Francis report will highlight the problems which have resulted & the failures of professional leadership & management.

    Nursing needs a new Florence Nightingale to get out there and kick some a***.

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