PM's commission on the future of nursing at a glance

1 A pledge to deliver high quality care

Nurses and midwives must declare their commitment to society and service users in a pledge to give high quality care to all and tackle unacceptable variations in standards. The pledge complements the Nursing and Midwifery Council Code, the NHS Constitution and other professional codes and regulatory standards. Nurses and midwives must use it to guide their practice, adapting it to their work settings, and regulators and employers must ensure that their codes, policies and guidance on nursing and midwifery support it.

2 Senior nurses’ and midwives’ responsibility for care

All directors of nursing, heads of midwifery and other nurses and midwives in senior management roles must uphold the pledge, accept full individual managerial and professional accountability for the quality of nursing and midwifery care, and champion care from the point of care to the board. Directors of nursing must maintain clinical credibility and act with authority to ensure that their organizations enable high quality care. As board members they must be accountable for agreeing the shape and size of the nursing and midwifery workforce.

3 Corporate responsibility for care

The boards of NHS trusts and other health employers must accept full accountability for commissioning and delivering high quality care, ensure clear lines of accountability and authority for care throughout their organizations, and appoint a director of nursing to champion care at board level. They must ensure that their cultures and structures recognize and support directors of nursing and senior nurses and midwives to execute their responsibilities fully in relation to quality and safety.

4 Strengthening the role of the ward sister

Immediate steps must be taken to strengthen the linchpin role of the ward sister, charge nurse and equivalent team leaders in midwifery and community settings. These clinical lead roles must have clearly defined authority and lines of accountability and be appropriately graded. They must drive quality and safety, and provide active and visible clinical leadership and reassurance for service users and staff in all care settings. Organizational hierarchies must be designed to ensure there are no more than two levels between these roles and the director of nursing. Heads of midwifery should report to the board directly or via the director of nursing.

5 Evaluating nursing and midwifery

Gaps in the evidence base for the evaluation of nursing and midwifery must be clearly identified to determine what further research is needed, and further steps taken to commission, fund, disseminate and utilize research on their social, economic and clinical effectiveness.

6 Protecting the title ‘nurse’

The Nursing and Midwifery Council must take urgent steps to ensure public protection and safety, and to allay current confusion about roles, titles and responsibilities, by protecting the title ‘nurse’ and limiting its use solely to nurses registered by the Council.

7 Regulating nursing and midwifery support workers

Some form of regulation of non-registered nursing and midwifery staff, including health care assistants and assistant practitioners, must be introduced to protect the public and ensure high quality care. The government and stakeholders must urgently scope and review the options, and recommend what type and level of regulation are needed.

8 Regulating advanced nursing and midwifery practice

The Nursing and Midwifery Council must regulate advanced nursing practice, ensuring that advanced practitioners are recorded as such on the register and have the required competencies. Stakeholders must also consider how to reduce and standardize the proliferation of roles and job titles in nursing. The Midwifery 2020 programme should consider whether midwives working in specialist and consultant roles need advanced level regulation.

9 Building capacity for nursing and midwifery innovation

Fellows should be appointed to promote nursing and midwifery innovation in service design and delivery, as champions of change and leaders of transformational teams that raise standards and embed innovation and excellence through peer review and support. Development of the entrepreneurial skills that nurses and midwives need to lead and respond to changing demands and innovative models of care must be included in pre- and post-registration education and training.

10 Nursing people with long-term conditions

The redesign and transformation of health and social care services must recognize nurses’ leading role in caring for people with long-term conditions. Care pathways must be commissioned for service users that maximize the nursing contribution. Nurses must be enabled to make direct referrals to other professionals and agencies, and all barriers that prevent them from utilizing their full range of capacities and competencies must be removed.

11 Nurses’ and midwives’ contribution to health and wellbeing

Nurses and midwives must recognize their important role in improving health and wellbeing and reducing inequalities, and engage actively in the design, monitoring and delivery of services to achieve this. Commissioners of services must create incentives to encourage nurses and midwives to turn every interaction with service users into a health improvement opportunity.

12 A named midwife for every woman

The contribution of midwifery to delivering health and wellbeing and reducing health inequalities must be enhanced by organizing services so that every woman has a named midwife responsible for ensuring coordination of her care and providing support and guidance.

13 Staff health and wellbeing

Nurses and midwives must acknowledge that they are seen as role models for healthy living, and take personal responsibility for their own health. The recommendations of the NHS Health and Wellbeing Review (Boorman report) must be implemented in full, so that employers value and support staff health and wellbeing and thereby enable them to support service users.

14 Flexible roles and career structures

Commissioners and providers of education must ensure that nurses are competent to work across the full range of health and social care settings. Flexible career structures must be developed to enable them to move across settings within existing roles and when they change jobs.

15 Measuring progress and outcomes

The development of a framework of explicit, nationally agreed indicators for nursing must be accelerated, with the full engagement of front-line nurses. Further work must be done in midwifery to identify better indicators of outcomes, including service user satisfaction.

16 Educating to care

To ensure high quality, compassionate care, the move to degree-level registration for all newly qualified nurses from 2013 must be implemented in full. All currently registered nurses and midwives must be fully supported if they wish to obtain a relevant degree. A relevant degree must become a requirement for all nurses in leadership and specialist practice roles by 2020. The Midwifery 2020 programme should consider whether a relevant degree should become a requirement for all midwives in leadership and specialist practice roles. There must also be effective revalidation, and greater investment in continuing professional development.

17 Marketing nursing and midwifery

Strong national campaigns must be launched to tell new stories of nursing and midwifery that inform the public, inspire the current and returning workforce, and highlight career opportunities. They must position the professions as popular choices for school-leavers, and boost the recruitment of high calibre male and female candidates of all ages and backgrounds.

18 Fast-track leadership development

Regional schemes must be established to develop potential nursing and midwifery leaders, building on existing national work and learning from similar successful schemes in other sectors. They will identify talent, offer training and mentorship, and ensure that successful candidates who reflect the diversity of the workforce are fast-tracked to roles with significant impact on care delivery.

19 Integrating practice, education and research

An urgent review must be conducted on how to strengthen the integration of nursing and midwifery practice, education and research; develop and sustain the educational workforce; facilitate sustainable clinical academic career pathways between the NHS, other health providers and universities; and further develop nurses’ and midwives’ research skills.

20 Making best use of technology

A high-level group must be established to determine how to build nursing and midwifery capacity to understand and influence the development and use of new technologies. It must consider how pre- and post-registration education and development programmes could best deliver technological understanding and skills for information, communications and practice.

Have your say

You must sign in to make a comment.