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Exclusive: Work to start on new career framework for stroke nurses

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A group of experts is to develop a new career framework for stroke nurses, which aims to give nurses and employers a clear idea of the skills and competencies needed at different levels.

The concept is the brainchild of Ismalia de Sousa, a clinical nurse specialist in stroke, who said she has personally found it hard to pin down what she needed to do to progress her career.

“We know there are inconsistencies amongst nurses working in stroke care”

Ismalia de Sousa

She said: “If any nurse who started now as a band 5 asked me: How do I get to be like you or how do I get to be a nurse consultant? I would not be able to give a clear answer.”

She said her experience of being part of the Royal College of Nursing’s Neuroscience Forum and the Intercollegiate Stroke Working Party, which is responsible for national clinical guidelines for stroke and oversees the National Stroke Audit, revealed this was a common problem.

The ambitious year-long project to develop a clear career framework will be led by the RCN Neuroscience Forum, with input from key bodies including Health Education England (HEE), the Intercollegiate Stroke Working Party and stroke nursing groups.

Ms de Sousa said the framework would tie in with the existing Stroke-Specific Education Framework (SSEF) – which is hosted on behalf of the UK Stroke Forum by the University of Central Lancashire – and with HEE’s framework for advanced clinical practice and relevant RCN career frameworks.

It will also link in with the National Stroke Plan for England, which is due to be published imminently, but the aim is that it will be useful for nurses working in all four UK nations. Meanwhile, the existing SSEF will be used to underpin the workforce strategy element of the new stroke plan.

“People are finding it increasingly hard to recruit compounded by the reduction in validated specialist courses”

Amanda Cheesley

Currently there are wide variations in knowledge, skills, pay bands and job titles for stroke nurses, noted Ms de Sousa.

“We know there are inconsistencies amongst nurses working in stroke care around knowledge and skills, pay bands and titles,” she told Nursing Times.

“A nurse who works in stroke care in a London hospital may have the same title as a nurse who works in the south of England but have different knowledge and skills,” she said.

She hoped a career framework for stroke nurses would “give power to nurses” when it came to ensuring their skills were recognised and accessing training and development.

“Nurses can go to their managers and say: ‘Actually according to this framework I should be in this position and I should be recognised at this level’,” she said.

“If it states on the framework you have to know about coaching for health and have those skills, then it more likely the nurse can put that on their appraisal as an objective,” she noted.

She said having a clear career framework for stroke nursing could also encourage more nurses into the field and help improve patient care.

Ismalia de Sousa

Ismalia de Sousa

Ismalia de Sousa

“More now than ever, because of the changes in education and pre-registration training, you have a lot of nurses coming out of university who do want to develop,” she said.

She added: “I think we need something very concrete on paper that they can aspire to. At the end of the day there is a benefit for patients if we’re all performing at the level we’re supposed to.”

Amanda Cheesley, the RCN’s professional lead for long-term conditions and end of life care, said other fields of nursing such as diabetes, emergency care and pain management had seen the benefit of specific career frameworks.

“There are lots of highly skilled stroke nurses who have undertaken postgraduate training and qualifications but there isn’t a framework,” she said.

“Having a career framework will mean anybody thinking about going into stroke as a speciality can have a really clear understanding of the skills they need to be working at different levels right up to consultant nurse,” she said.

While there were shortages in all specialties, Ms Cheesley said there was a particular shortage of nurses with specialist neuro and stroke qualifications – especially in London.

“People are finding it increasingly hard to recruit compounded by the reduction in validated specialist courses,” she said.

“Courses have closed because not enough people are doing them and that’s partly due to cuts in education funding by many trusts,” she warned.

She added: “This is further compounded by trusts needing to make massive savings, so downbanding people or not supporting them to do specialist training – and also not understanding what it means to have somebody with those specialist skills.”

Ms Cheesley, who is also on the RCN Neuroscience Forum, said she hoped the framework would help organisations and employers with recruitment and also in developing existing staff.

Royal College of Nursing

Nurse-patient ratio found to be key to stroke survival

Amanda Cheesley

“It will demonstrate to organisations that if they want somebody with these skills, then these are the questions they should be asking or supporting members of staff who are interested to achieve those additional skills and qualifications,” she said.

“It is absolutely clear that when you have people with real expertise and skills in a particular speciality that it makes a massive difference to patients and their families and their outcomes are significantly better,” she stated.

She added: “If we can eventually have some kind of mechanism that means trusts shouldn’t be employing someone as a specialist nurse unless they have got these skills, then that would be helpful.”

The plan is to develop a draft document that will be shared with stroke nurses and other key stakeholders in the summer of next year.

Other organisations involved in the project, which is being overseen by a steering group of senior nurses and nurse researchers, include the National Stroke Nursing Forum, the Stroke Nurse and Allied Health Professional Consultants Group, the Welsh Stroke Nurses Forum, the Scottish Stroke Nurses Forum and the Northern Ireland Stroke Nurse Network.

The SSEF itself was set up in response to the 2007 National Stroke Strategy, with a steering group and task groups set up and co-ordinated by Professor Dame Caroline Watkins from the University of Central Lancashire.

The task groups, each chaired by a leading stroke expert, developed the SSEF, covering the whole of the stroke care pathway.

The framework consists of 16 elements of stroke care, which are based on the quality markers in the national stroke strategy and mapped to similar strategies in all four UK countries.

caroline watkins stroke association

caroline watkins stroke association

Caroline Watkins

The UK Stroke Forum also developed a training arm to support the continuation of the SSEF in recognition that it is applicable to all stroke-specialist and stroke-relevant staff across the stroke pathway, and is not profession-specific.

For example, role profiles have been developed to describe the stroke-specific knowledge and skills for different professions at different levels relevant to their role on the stroke pathway. The profiles allow staff to see how their stroke knowledge needs to increase to be in-keeping with higher pay and career bands.

The work of the RCN supported group, led by Ms de Sousa, will complement the SSEF. It will see an additional four elements, which relate to professional practice – such as research, audit, and leadership – developed to complement the stroke-specific elements.

The addition of these professional practice elements will assist in the description of career pathways, initially, for stroke nurses – using a format developed by the RCN for other disease specific career frameworks. 

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