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