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All staff should seize the opportunity to improve care

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Kuldip Bharj on why nurses should embrace change

Nursing and midwifery is firmly on the political agenda; the Commission on the Future of Nursing and Midwifery is set to advise the prime minister, Gordon Brown, on the role of nursing and midwifery in delivering High Quality Care for All.

Feedback from healthcare professionals, the public and wider stakeholders during the listening phase of the Commission’s work has expressed overwhelming support for the review of nursing and midwifery, welcoming its timeliness.

The organisation and context of nursing and midwifery has changed almost beyond recognition over the past 40 years. These transformations have been driven by demographic changes in age and ethnic profile, as well as scientific and technological advances. All these factors have had a major impact on the environment in which health and social care is provided and delivered, and in which nurses and midwives practise.

Social changes have resulted in an increase in demand for healthcare and social support, and also in more people taking an active and responsible attitude towards their own health.

‘Nurses and midwives should grasp the opportunity to transform their services, and be at the heart of shaping new pathways and experiences for all service users’

Following The NHS Plan and Maternity Matters, services are now, quite rightly, expected to work in partnership with service users, enabling people to take control and providing choice over the care they receive. However, achieving this is not easy - it requires different skills and also a change to how nurses and midwives see their roles.

Much of the evidence suggests that service users’ experiences in the NHS are variable - some good, some bad and some indifferent. Testimonies of service users highlight that experiences of compassion are sometimes compromised, perhaps victim to the greater emphasis on technical and clinical care. But almost all nurses and midwives have a desire to provide caring and compassionate care.

Practitioners need to develop their knowledge continually and compassionate care should complement this. In the delivery of high quality compassionate care, nurses and midwives need to utilise their head, coupled with their hands and heart.

In light of the above, maintaining the status quo is not the answer. The NHS is undergoing major reforms, harnessing the principles of client focused health services, empowering frontline staff, setting national standards and frameworks for accountability and inspection, and introducing innovative and flexible approaches to ways of working.

Nurses and midwives should seize this opportunity and transform their services, and be at the heart of shaping new pathways and experiences for all service users and their carers. Most professionals are ready for this challenge; however, some indicate they “need more resources” to bring about change. While there is sympathy for this view, such demands have to be realistic within the financial climate. Nurses and midwives need to harness the issues of productivity, efficiency and value for money, which may, in reality, prove to be the leverages that will unlock the resources needed to bring about improved care. Nurses and midwives must explore creative ways of working smartly and in diverse ways to bring about cost savings, as well as improving quality of care.

However, some staff have felt threatened within the changing operating environment. Increasing patient expectations, business like values, financial restraints and hierarchical systems have left some feeling disempowered. While others have harnessed these changes positively and introduced innovations, some have developed a sense of “learnt helplessness”, which has prevented them from working to improve the services in which they work.

It is clear that engagement of nurses and midwives at all levels of the NHS is vital to achieve the level of care proposed in High Quality Care for All. However, there is variation in the way policy is translated into practice and nurses and midwives need to do more to ensure rhetoric can move to reality. While many staff are inspired by the opportunities to deliver innovative, high quality services that improve client journeys and outcomes, they claim they are stifled by the more business oriented approach that is currently being adopted within the NHS.

During the listening phase of the Commission’s work, many nurses and midwives asserted that they are eager for the Commission to make recommendations to bring about change. It is questionable why they are waiting for someone else to give them permission to do what needs to be done. The Commission is looking forward to the publication of its report and vision early next year, which draws on some of the issues I have raised. However, I hope all nurses and midwives can grasp the opportunities that already exist and reassert themselves in their role to bring about positive change.

The forthcoming report intends to create a new scenario for nurses and midwives that will place them at the centre of care. It will seek to identify systems and processes to enable nurses and midwives to further improve care, as well as provide incentives for them to take leadership roles at all levels. This report should be a springboard to bring about positive change for the professions, professionals and, most importantly, for all service users and their carers.

Kuldip Bharj OBE is senior lecturer in midwifery and lead midwife for education at the University of Leeds

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