So what is nursing? It seems to me that no one can really decide whether nurses should diagnose, prescribe and treat, or observe, provide personal care and assistance to patients and service users.
This week former Royal College of Nursing president Dame June Clark demanded that the college and nurses define nursing urgently.
Her calls for action came in the wake of a court case in Wales, which showed misunderstandings between the local authority and the NHS about the tasks that should be carried out by a nurse.
In order to save money, the NHS health boards were trying to pass some fundamental nursing and personal care duties to cheaper staff, reducing the need for registered nurses.
Dame June, quite rightly, was up in arms. She believes that by allowing others to determine what the profession is and should do, nursing is losing control of its own destiny. I would tend to agree.
She complained that the judge in charge of the case repeatedly asked for a definition of nursing, was told there wasn’t one, and suggested the health boards and local councils sort it out between them.
“Nurses’ more advanced clinical skills and deeper knowledge mean they do far more than task itself.”
Dame June’s belief is that it is the job of the profession, not health boards or local authorities, to define nursing. This has become even more important with the introduction of new roles – such as the nursing associate – which have the potential to confuse the public, and encroach on the domain of the registered nurse.
Concerns have been raised – and compounded by this court case – that such new nursing roles could remove the need for registered nurses to provide fundamental care, such as helping patients with washing, dressing, eating and drinking.
While these may seem ‘easy’or ‘basic’ jobs that could be done by anyone, nurses’ more advanced clinical skills and deeper knowledge mean they do far more than task itself.
These interventions give nurses an opportunity to observe their patients and assess their health and wellbeing. For example, when washing their patients can check the condition of their skin and ensure they are not at risk of pressure damage.
When helping them to dress, they can chat and assess patients’ mental state. And experienced nurses often recognise subtle signs a patient is deteriorating before that patient’s vital signs are altered.
“Washing a patient requires skill and patience… it’s not just giving someone a rub with a flannel.”
The care provided by nurses is not a set of tasks done in isolation, to be ticked off and handed out to any pair of hands. This is a role that takes a holistic view of a complex situation, and nurses can make a huge contribution with every interaction they have with their patients.
I fear that, by trying to make nurses work ‘to the top of licence’, as I have heard many times during the nursing associate debate, we will put patients at risk by denying them access to a crucial set of skills and knowledge.
Nursing care can be provided by a relative or an unregistered healthcare support worker, as well as a nurse.
But what differentiates the care provided by a registered nurse from the care they can provide is the clinical judgement and expertise that will inform decision making about that care. Washing a patient requires skill, patience, an ability to assess, communicate, evaluate and treat – it is not just giving someone a rub with a flannel.
So we should be clear that nursing is a skilled profession, and not a series of tasks that can be offloaded to a cheaper substitute.