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'It’s time for nursing to take charge of its own destiny'

Janice Sigsworth

Janice Sigsworth on why the profession needs to agree priorities for its future and deliver them

With more being expected of nursing care, a swine flu pandemic, a recession during which health budgets are likely to be hard pressed, and the imminent report of the Prime Minister’s Commission for the Future of Nursing and Midwifery, it could be said that we live in challenging times.

In recent years the profession has been hit by a stream of bad press - not always from the media. Nurses themselves have spoken out about declining standards in care, harking back to the days when matron patrolled the wards and Florence Nightingale’s words ruled. The most recent example is the Patients Association report, Patients… Not Numbers, People… Not Statistics, which includes stories from 16 people about the appalling treatment their relatives received from nurses.

What is to be done?

The history of nursing is littered with piecemeal announcements and developments that have amounted to very little. But the recent reports High Quality Care For All and Framing the Nursing and Midwifery Contribution have set out an ambitious framework for systematic change. Among the issues they discuss are training, recruitment and selection, and measuring the quality of nursing care. So, we know want we want to do - it’s time to put it into practice and make it happen.

We need to attract talented, rounded people and train them well. The integration of practice, education and research are paramount to this ambition, yet few understand how and what we need to change to achieve this.

‘We know that good quality care costs less - and that measuring what we do will help embed innovation and evidence based practice, prompting a culture of curiosity’

We need to raise the bar of ambition, through higher entry requirements into nurse training, coupled with more stringent selection of candidates. (A friend of mine had to undertake two weeks of unpaid school experience to demonstrate her commitment to teaching before her application would even be considered.) Let’s seek high quality students for training courses. Recruiting
for caring attitudes and training and communications skills should be our mantra.

To help things along, we need to get the government to end the funding disparity between diploma and degrees (which pushes degree-capable students down the diploma route) - doing away with the “too posh to wash” myth along the way. Degree trained professionals are not “too posh to wash”. Indeed, it’s more the case that others are “not posh enough to wash”. All the evidence tells us that better educated recruits not only last the course but also deliver better outcomes.

We all know that ward sisters and charge nurses are central to the quality of care - but they take up their posts in the certain knowledge that theirs is one of the few jobs in which you earn less for the privilege.

Sisters, charge nurses and matrons need time and power to fulfil their duties - which means that we need to paint a compelling and inspiring portrait of these roles in order to attract our best and most able nurses. Too many new arrivals, often promoted because they are outstanding clinical nurses, are ill prepared for their new duties.

How should we unlock the inspiration and ambition of these clinical leaders? The first step is to sort out their pay. The second to deliver a working environment that provides both the equipment and the human resources backup to let them set standards of care and challenge staff who do not meet them. The third is to organise care to meet not the needs of doctors but those of patients.

Such a transformation needs to be led by clinical nurses who can measure how well they are doing. High Quality Care for All pointed up the efforts of nurses to measure their performance across a range of indicators. It’s been said before, but we need to standardise and nationalise such indicators and their measurement.

We know that good quality care costs less - and that measuring what we do will help embed innovation and evidence based practice, prompting a culture of curiosity and enquiry. So let’s stop talking about what’s wrong with what we are doing and what we want to do and just do it instead - measuring what we do along the way. Let’s learn the lessons quickly and methodically, let’s spread good practice and invite everyone to share what works well. Let’s focus our efforts and energies on the “how” not the “what” and “why”. Let’s all sign up and move on - and deliver for our patients.

Making such a leap of faith has eluded a nursing profession perhaps frightened by its own reflection. But by agreeing priorities we will determine our own destiny and take charge of our future. This means developing partnership, building collaborations and implementing our objectives.

The PM’s Commission, of which I am a member, is central to pulling these strands of work together. Perhaps, more importantly, it will create an implementation plan that will deliver, deliver, deliver on what we know will work, thus making a real difference to patients and nurses alike. My goal is simple - to keep repeating my message and make it happen in practice.

So here’s to 2010 - a year of delivery or a year of yet more stories about what the future might hold?

Janice Sigsworth is director of nursing, Imperial College Healthcare Trust


Readers' comments (4)

  • Nursing will never change until nurses themselves stop bitching and fighting amongst themselves and start to get enough backbone to fight for better conditions/pay/recognition, and the tin pot hitlers in the NMC start to care more about the profession they pretend to regulate and less about their own precious job titles and fancy salaries.

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  • How many times have we heard this before?

    Why does nursing have poor conditions and pay?

    Nursing has poor leadership.

    We also have the 'vocation' mentality by many nurses...who are prepared to work for poor pay and conditions because they are nurses and their role is primarily about giving matter what.

    Bottom line though is that poor leadership leads to this. The RCN is the main union but nurses are in other unions the leadership we have is fragmented to start with. The RCN is a poor union when it comes to fighting for it's members and has a poor track record.

    Nursing will never change.... i can completely guarantee that.

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  • I couldn't agree more with the above comments. I agree even more with what Janice Sigsworth proposes, but these proposals will never materialise until the culture of bullying is addressed. I was targetted by the mob when I tried to integrate practice,education & research. The bullies included the Clinical Nurse Manager,Principle Nurse, & HR. Not to worry, I was represented by the RCN; or so I thought. The RCN Officer helped me with my employment application and provided me with an excellent solicitor. Imagine my shock, when 4 days before the hearing, my solicitor told me that he had been withdrawn. The RCN did not even contact me. When I contacted RCN I was told that it would not represent me, as my case had more chance of loosing than winning, eventhough nothing had changed since the ET application 6 months earlier. It was at that stage I realized that the officer who claimed to be working for me was in fact colluding with the mob(something that I had suspected all along). I decided to represent myself and the case was postponed for a further 6 months. The solicitor passed the correspondence over to me and my next shock was the 7 pages of a demonstrably false pregnognition statement by my RCN so called representative. Along with being false, this material had not been discussed with me.
    This was followed by a message from the Trust's solicitor to advise me that the Trust would press for costs when I lost my case. I replied that I had no intention of loosing and looked forward to meeting her at ET the following week. Suddenly there was a handsome financial settlement and ex'onerating statement on the table.
    I complained to the RCN who refused to meet because I had not met the time deadline.
    Some leadership!!
    Sadder still is the fact that nothing has been learned. Several colleagues have since been subjected to similar intimidation, with HR & unions more than willing to rubber stamp the decisions of their cronies ( done deals). With support from (CAUSE) bullied nurses are now defending themselves and supporting each other.
    So, here's to 2010, let's face up to what is really happening in the "profession". It's time to eradicate bullying and channel the energy into professional development and better health care. Turn the rhetoric into realty.
    Kathleen White (Edinburgh)

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  • This vision is either a Lucy in the Sky with Diamonds induced fantasy or a more extreme case of the sanctimonious rhetoric occasional espoused by senior nurses who are utterly out of touch with the reality of the work of nursing. It’s long on utopian vision and sort on the specifics of how to realise it.

    Setting aside the rubbish about whether diploma or degree nurses are better – it’s the relevance and the quality of the educational provision rather than the label on it that’s actually more important in determining patient outcomes. Whilst the selection process is important Janice should know that those with sufficient savvy actually prefer to purse careers in ‘clean’ caring professions like physiotherapy, occupational therapy and dietetics. The sad truth is nursing cannot afford to be as choosy as it once was, unless of course she is advocating a two tier nursing profession with graduate RNs supervising a workforce of healthcare assistants and support workers? I did wonder why the Prime Minister had chosen a nurse historian to chair his commission. Perhaps it wasn’t so much “it’s not what you know….” as it is a misguided belief that the answers are in the past, so Matrons’ today enrolment tomorrow?

    As for “painting a compelling and inspiring portrait of these roles [Sister & Charge Nurse] in order to attract our best and most able nurses” the issue isn’t one of presentation or marketing. Nor is it just about pay and meaningful preparation for the role, whilst both are important it is as much about refocusing the job on the delivery of high quality patient care. This requires people in roles like Janice to stand up for the staff they supposedly lead and review and challenge everyone of the mountian of adminstrative tasks dumped on nurses in order to make someone elses job easier, it means understanding the concept of variation and rather than simply rubber stamping every knee jurk response demanded by managers desperate to be seen to be doing something in the wake of every untoward incident, apply a bit of analytical rigour before introducing a new process or reporting requirement. It also means looking honestly at work load and establishment and supporting rather than supressing nurses who find the courage to raise concerns

    It’s both interesting and sad that some commentators on this piece look to the RCN for professional leadership, of course it should be people like Janice leading the profession. Perhaps she is a good leader who is seen and know by the nurses she is responsible for, perhaps someone will tell us.

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