The outdated image UK nursing presents to the world is one of the key problems for the profession in this country, according to an influential nursing leader and academic.
Despite the fact nurses are leading the way in many different fields, Professor Laura Serrant told Nursing Times the image of nursing was still far too “narrow”.
“The image of nursing hasn’t changed, it is quite old-fashioned and it is too narrow”
Nursing leaders needed to do more to explain the profession’s vital role in matters of global concern, such as tackling health inequality and helping ensure sustainable development, she said.
“What mainly worries me in nursing is the narrowness of how the profession is presented. The image of nursing hasn’t changed, it is quite old-fashioned and it is too narrow. I don’t mean that what nurses do is out of date but how we are presented is out of date – even the language we use as nurses to talk about our work is out of date,” said Professor Serrant.
She said: “There are nurses in everything from politics, education and research to innovation, business, private practice and practice in the home – all of those things – yet we still have the image of a nurse as someone who works in a hospital. That is in our gift to change, but I don’t know whether we as a profession are ready to speak differently about ourselves.”
She said the enduring stereotype of a nurse caring for patients on the wards was about as far removed as possible from where the profession was seeking to go with a drive to deliver integrated care in the community – and this stood in the way of change.
One of only six black nursing professors in the UK, she was recently named among the top 10 most influential people of African and Caribbean heritage in the country in the annual Powerlist published by Powerful Media. She told Nursing Times her place on the list was not just about personal recognition of her work to tackle inequality but also about recognising the importance of nursing in wider society.
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“There were people there [on the list] from the arts, sports, the media, entertainment, literature and it was good for nursing to be recognised alongside other professions,” she said. “Sometimes in nursing we only think about ourselves in relation to other health platforms and that’s what struck me most – it was about the profession standing alongside other professions.
“We can sometimes become too introspective in our conversations and who we talk to and network with – so nurses go to nursing conferences, nurses go to exhibitions about nursing or health. It’s not to say that is not important but it’s also important for us to talk about our profession outside the health sphere.”
She said she was struck by the fact many people at a dinner for those named in the Powerlist did not realise nurses could be academics or become professors.
“Lots of people said they did not realise there were such things as professors of nursing and many of them had members of their family who were or had been nurses,” she said. “Obviously there is quite a large proportion of BME people who work in healthcare and as nurses and midwives. Yet they didn’t realise there was variety in the profession beyond working in a hospital and didn’t realise there were any black professors of nursing.”
However, Professor Serrant, who started her nursing career working with vulnerable groups before moving into academia, admitted it was hard to tell a different story when nurses were struggling to do their jobs in an “over-loaded, time-bound, resource-restricted” environment.
As well as re-vitalising the image of nursing at home, she said it was also crucial for the UK nursing profession to position itself as a key player on the world stage.
Professor Serrant whose own research focuses on global issues and inequalities, said she was dismayed at the Royal College of Nursing’s decision to withdraw from the International Council of Nurses in 2014.
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Professor Serrant is currently professor of nursing at Sheffield Hallam University and chairs the chief nursing officer for England’s BME strategic advisory group.
She is also a member of the government’s independent advisory group on BME issues and an ambassador for the Equality Challenge Unit for Higher Education.
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She told Nursing Times she did not see herself as a pioneer but accepted she was regarded as such by others. “What I see myself as is a black nurse academic and I use those words exactly in that order because the order is important,” she said.
“I have never been in a cohort with a large number of other people who look like me whether that was my initial training or whether it is now,” she said. “It is important for me to be seen not just for other nurses coming through but other students working in the university. When I go to graduation students and their families come and talk to me, not just because they are nurses but also because they have never seen a black professor.”
She said there were ongoing challenges when it came to tackling inequality in nursing and ensuring people from different backgrounds had the same opportunities to progress in their careers.
“We definitely have issues and barriers, otherwise there would be a much more even spread – that goes without saying,” she said. “But we mustn’t beat ourselves up and say ‘everything’s as bad as it always was’, because some improvements have been made. It is never going to be an endgame – it will always be a work in progress to an extent. I’m in the role that I’m in but who is coming next?”
Professor Serrant said the key was to take a “whole systems” view of diversity and leadership.
“Leadership in nursing occurs from the bedside or classroom right through the levels,” she said. “It is about people being able to have an equal chance of success wherever they are and whichever level they are at.
She also noted that “not everybody wants to climb the ladder upwards”, and that some wanted to have different experiences by moving sideways. “Allowing people to have an equal chance and do the work they want to do is really what it is about,” she told Nursing Times.
While there have been high-profile national initiatives to boost diversity and bring on BME nursing leaders as well as raise the profile of nursing generally, Professor Serrant said achieving change was really about what happened day to day and called on leaders to consider their situation locally.
“If I am a director of nursing in a trust working in one area of the UK, then how diverse is my staff across the board? How does it reflect the population where my hospital is located – because they are the people that are going to be walking through our doors,” she said.
“If we are in education, then are we actually training and teaching nurses to be able to provide care for a diverse population – and that is not just about religion and food. Do they know how to look for skin integrity differences in different skin colours? We are talking about the everyday things and they are just as important as what our board looks like,” she said.
She said ensuring equality was also about going beyond trite mission statements about treating and respecting “everybody well”, and making a real effort to measure the impact of work to reach different communities.
“How do we know that within the populations we are looking after, people have an equal chance of good health? How culturally safe are the good practice pathways we are using? That is the work that needs to be done,” she said. “If there is no way of measuring, evidencing or showing we are making a difference then we fail.”
When it came to the future of nursing education, Professor Serrant said there was a need for it to evolve to meet the demands of future healthcare models. She said the switch from bursaries to loans would probably change the type of people applying for nursing degrees.
“People usually come into nursing because there is a personal drive for them to care and that’s not going to change,” she said. “But the likelihood is that over time we may see many less mature students coming into nursing because of the financial changes. We will probably have younger people.”
Meanwhile, course content and practice placements would need to change to reflect the move away from hospital-centred care, she suggested.
“Will we still need the same clinical competencies in 10 years’ time? That is probably the challenge for education moving forwards,” she said. “We need to be brave enough to have a conversation that doesn’t revolve around how we do more of the same with less money.”
Professor Serrant said nurses could also play a crucial role in re-designing services so they worked better for patients and communities. “That is about developing more entrepreneurial and innovative practice. However, at the moment, when we are all focused on performance targets and workloads – that is not an environment in which innovation and entrepreneurship can thrive,” she said.
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Biography: Laura Serrant
1986: One of the first nurses to qualify with a degree, graduating from Sheffield City Polytechnic
2011: Joined University of Wolverhampton as professor of community and public health nursing
2014: Awarded Queen’s nurse status by the Queens Nursing Institute
2014: Health Service Journal named her one of its inspirational women, top clinical leaders, and a BME pioneer
2015-16: On secondment as head of evidence and strategy in the nursing directorate at NHS England
2016: Appointed professor of nursing at Sheffield Hallam University
2017: Named in the Powerlist 2018 of the most influential British black people