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'More nurse involvement' wanted by public health commissioners

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A survey has revealed gaps between the contribution nurses make to public health services and the level of involvement commissioners believe they should actually have.

Research into the role of nurses in public health by the Royal College of Nursing found the gap was worst for services such as housing, employment, emergency responses and environment health hazards.

“There is a need to understand which practitioners best fulfil the needs of commissioners in these areas [such as homelessness]”

RCN report

In such areas, between 55% and 85% of commissioners believed nurses should be “always” or “frequently” involved in services, but in reality only 10% to 40% said nurses contributed “always” or “frequently”.

The survey of around 220 commissioners and designers of public health services across the UK also revealed that while nursing contribution was high in places – such as clinical effectiveness, governance, efficiency, service planning, and auditing – in all areas it should be increased.

Problems were also identified with the skills, knowledge and experience of nurses working in certain areas, according to public health commissioners.

Around 70% reported being “very satisfied” or “satisfied” that nurses working in family and community roles, in infectious diseases, and in areas of clinical effectiveness, had the required skills.

But between 25% and 40% said that in areas such as service planning, commissioning, and housing and homelessness, they were “dissatisfied” or “very dissatisfied” that nurses had the required abilities.

The top problems cited by commissioners as being a barrier to nurses becoming more involved in public health services included a shortage of nurses in commissioning, lack of understanding by commissioners of specialist roles, funding issues and challenges with nurse education.

”Nurses are often uniquely placed to respond to public health challenges as they understand the particular risks of individuals but also know the population”

RCN report

The report, called The Value and Contribution of Nursing to Public Health in the UK, noted that nurses ”often ideally suited and uniquely placed to respond to public health challenges, as they understand the particular risks of individuals but also know the population and the communities they work in”.

It noted that, while public health had traditionally been seen as being delivered by those in specialist community roles, such as health visitors or school nurses, there was now an increasing need for all nurses to promote public health.

The RCN concluded that nurses’ roles in clinical governance and clinical effectiveness featured strongly in the research and that nursing input into improving services was valued.

It also said it was “encouraging” that commissioners believed nursing should be involved in these areas.

However, it noted the low ratings for nurse involvement in areas such as employment, housing and homelessness, and commissioning despite a desire by commissioners for a stronger contribution.

“[This suggests] either a gap in demand and supply, or an unrealistic expectation for nurses to be involved in areas outside their traditional preparation and scope,” it said.

“We know that nurses are in fact working in many of these areas so there is a need for further debate and discussion to understand the needs more and which practitioners best fulfil the needs of commissioners in these areas,” said the report.

Meanwhile, in interviews carried out as part of the research public health nurses said parts of their work – such as giving advice or information – were often invisible.

They also spoke of concerns around a lack of local nurse leadership and fears that the move to local authority commissioning of public health could result in cuts to health and wellbeing budgets without nursing contribution being understood.

The RCN recommended a series of actions to improve the contribution nurses make to public health services.

Public health should become more of a focus across all nurse education programmes, it said, and there should be more opportunities for nurses to be “skilled up” to work with commissioners.

It also called for nurses to better articulate their role and the hidden aspects to their work, and for more local champions of nursing.

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