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Are the five new nurse career pathways the solution?

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A framework of post-registration career pathways could replace the existing nursing branches. Louise Tweddell gauges reactions to the consultation paper

THE DEPARTMENT of Health has launched a major consultation on post-registration nursing career development (NT News, 6 November, p2).

Towards a Framework for Post-Registration Nursing Careers, compiled by deputy chief nursing officer Janice Sigsworth, is currently confined to England but other UK health departments are said to be awaiting the outcome of the consultation ‘with interest’.

Under the new proposals, which are designed to take forward the Modernising Nursing Careers programme, qualified nurses would major in one of the following five pathways – moving from ‘novice to expert’ as they gain skills and experience:
- Children, family and public health;
- First contact, access and urgent care;
- Supporting long-term care;
- Acute and critical care;
- Mental health and psychosocial care.

Additionally, they could ‘minor’ in other pathways ‘so would acquire a portable portfolio of knowledge and skills that would support new directions at any step on the career framework,’ the report says.

Under the proposals nurses would therefore be able to change or move between pathways if they wished.

Few would probably disagree that nursing career development is in need of a major shake-up, given the existing maze of job titles within the profession and the plethora of courses available.

‘At the moment you do not really have career paths – it is about who you know and how you manage to get on with
it,’ said RCN policy adviser Jane Naish.

The proposals are made necessary by the rise in patients with long-term conditions such as diabetes and the government’s intention to move the majority of care from acute settings into the community. Both factors could lead to a more influential role, or at least a change in role, for much of the profession.

‘This [consultation] is geared up to what patients need and there is a band of patients with long-term conditions who are going to increase,’ Ms Naish said.

‘Nurses could do more of the work but we need to prepare them for that in the future. If you want to bring nursing to the forefront of healthcare you have to change it,’ she added.

Gail Adams, Unison’s head of nursing, also agrees that the proposals should help nurses make the transition to community settings.
‘The direction of travel is shifting the balance towards primary care and I don’t think we [currently] make that transition easy for nurses. It’s going to be a two-way street more and more, with hospital staff working between the community and secondary care.’

But, while nurses say change is needed, are the proposals on offer the best option? The document itself states that stakeholders recognised there were ‘many uncertainties and challenges’ inherent in the suggested pathway approach.

Cheryll Adams, Unite/CPHVA acting lead professional officer, has reservations.

‘There is a lot of emphasis on flexibility but I think that could be at the expense of quality and it is not specific enough. It makes the assumption that all strands of nursing within each pathway are the same but they all have unique characteristics,’ she said.

‘It is only by understanding that uniqueness that the highest level of service can be provided,’ she added.

Ms Adams said she was also concerned about who would carry out the necessary training. It would not be appropriate for more senior community nurses to be forced out of frontline work into managerial roles, she warned.

The document also covers advanced practitioners and refers to specialist nurses suggesting a standardisation of knowledge and skills, levels of competence and job titles across the country.

Sarah Cowey, professor of community practice development for King’s College London, said: ‘It was a very positive paper but the devil
will be in the detail and implementation. It’s trying to make things [specialist areas and advanced areas of practice] tidy when sometimes you need to have the courage to make things a little untidy. It is about trying to find a balance.

‘You could give specialist areas broad concepts that they would all sign up to but they would be so broad that an anyone could also sign up to them,’ she added.

The consultation closes on 15 February. It is essential for nurses to add their thoughts, according to chief nursing officer for England Chris Beasley.

‘This national consultation is a great opportunity to shape the nursing careers of the future,’ she said. ‘We want to gather as many views as possible on the options proposed.’

To take part in the consultation visit

A parallel consultation on pre-registration nurse training, run by the NMC, is available at until 8 February.

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