As we approach the general election, all three main parties will be putting forward their visions for the future of nursing. With over 500,000 nurses in England and Wales and many more ex-nurses, it is safe to say that nurses will play a major part in deciding who gets the keys to Number 10.
The Conservative nursing consultation on the future of nursing was advertised in Nursing Times last summer. I want to give you my view of the themes, controversial areas and some ideas that came out of it.
Targets were a common concern. “Central targets have been a distraction from quality improvement and capable of distorting the true needs of patients,” read one response. “Rigid targets have had an adverse effect on staff morale and patient care. Waiting lists have been reduced but a ‘hot bed’ policy has led to a rise in infection rates,” read another.
However, the point was also made that “it is vital to ensure that, if targets disappear, tight quality standards are in place and these will need enforcing”.
The question of influence and control over the patient environment had some varied responses. Stating that the ward sister/charge nurse/team leader/matron was the main person to maintain standards was common. The suggestion that nurses should be given “accountability and responsibility at ward or team level with direct access to executive directors at board level” is a very important part of achieving a ward to board approach. However, as one person pointed out, “the term ‘matron’ must not be a sop to public opinion”.
‘The concern that the voices of patients and nurses were being “lost at top level” was raised by many. Nurse representation at board level must not be tokenistic’
Whistleblowing was a popular topic. “Nurses must not feel penalised by management for speaking out”, “anonymity and confidentiality may prove challenging”, “nurses must act as whistleblowers with the same rights as others in industry have” and “employers should ensure all employees are fully aware of whistleblowing policies and procedures” were just some of the numerous responses. All agreed that “any policy in this area will have little effect unless we can ensure that action is taken after the whistle has been blown”. That clearly does not always happen at present.
Increasing representation and autonomy for nurses was a common theme. Director of nursing leadership varies, as does experience at board level. The concern that the voices of patients and nurses were being “lost at top level” was raised by many. Suggestions included measures such as ensuring “all planning of services includes contribution and active participation of nurses” and making sure that “the nursing profession plays a full and equal leadership role on trusts or PCT boards”. It was also mentioned that, if nurses were to be given more representation at board level, it must not be tokenistic.
Clinical care and responsibility were important issues. Most responses said the continued development of the nurse’s role was desirable, and that “nursing has worked hard to establish itself as a profession of equal value and esteem to other health profession roles”. It was also said that “where extended roles of nurses are largely protocol driven, clinical responsibility must be made clear and the clinical impact of the devolvement of tasks must not be ignored”.
Staff safety is hugely important, and there were many ideas on how to better protect nurses. Perhaps most consensus was reached on the opinion was that we must reaffirm “the commitment to zero tolerance of violence to NHS staff and increase the penalties for those consistent with aggravated assault”.
Needless to say, the move to a graduate nursing profession was much discussed. A number of representations argued that the “workforce must be educated to at least graduate level” to “equip nurses with the skills to plan, lead, manage and direct evidence based clinical nursing care”.
However, a number of nurses were unhappy that all new nurses in England should need a degree. There were worries from qualified nurses who do not have degrees that degree entry nursing would damage their career prospects unless they retrained. There were also those who believed that some people who would make great nurses would be put off by the academic requirements of a degree. Finally, there were those who thought that many areas of nursing care could be undertaken by those without nursing degrees. All of these are legitimate concerns, and we must make sure that any policy to make nursing a degree only profession deals with them.
Nurse education was written about extensively. People referred to the Royal College of Nursing student nurse study, which found 44 per cent of respondents had considered leaving their course. I thought the following was a good summary of what needs to be done: “We need to explore how high quality preceptorship, continuing professional development, clinical placements and mentorship can be made accessible to all students and qualified nurses, not just the few.”
The consultation gave me an invaluable insight into issues around nursing. I would like to thank all of you who contributed to it.
Conservative policy announcements on the future of nursing will be announced in the next few months and they will be directly influenced by many Nursing Times readers.
Anne Milton is shadow minister for health