The meltdown of the Royal College of Nursing last year was “traumatising” but has opened the door for a “rebirth” of the organisation, its new president has told Nursing Times.
Anne Marie Rafferty admitted the “implosion” that culminated in members passing a no-confidence vote in the leadership had made her question whether she still wanted the job.
“There is an opportunity to rebirth the RCN and actually deal with some of the issues that have been identified”
Anne Marie Rafferty
But as the daughter of a coal miner who went on to become the first nurse to receive a doctorate from Oxford University, Professor Rafferty has never been one to shy away from a challenge.
Currently professor of nursing policy at King’s College London, she said she was a believer in turning crisis into opportunity and she saw the RCN’s present situation as a chance to “rebirth” the college.
“I had put my hat in the ring [for the presidency] before the implosion of the organisation, which did make me think ‘do I really want to be associated with this at all’,” said Professor Rafferty.
“It was very serious and very damaging. It was very traumatising,” she said. “It’s a crisis… from that there is also an opportunity to rebirth the RCN and actually deal with some of the issues that have been identified as being in need of some remedy.”
The row erupted after members did not receive pay rises when they were expecting them after voting in favour of the 2018 NHS Pay Deal last summer. They said they had been “misled” over what they would receive and when, a claim that was backed up by an independent inquiry.
High-profile resignations, including the then chief executive Janet Davies, followed, and during an extraordinary general meeting in September members voted for the ruling council to stand down.
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As the things settled down, nurses then made it clear they wanted the RCN to be taken in a new direction in the future and to become more transparent and member-led.
Professor Rafferty, originally from the Scottish town of Kirkcaldy, said she had purposefully not got herself “chapter and verse” on the pay deal debacle, because the independent inquiry had been held. She, instead, wanted to focus her energy on the future and creating positive change.
Running for RCN presidency had been on her wish list for some time, but she said she now had the opportunity to make a real difference. Having carried out extensive research in safe nurse staffing, she hoped to use her specialist knowledge to bolster the college’s campaign for safe staffing legislation for England.
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She told Nursing Times: “It seemed to be playing to my day job in a sense in that I’ve been involved in trying to build evidence as part of a huge international effort over many years.”
However, Professor Rafferty said the success of the campaign would depend on the availability of political airtime, noting that the debate had previously been sucked of oxygen by Brexit. Safe staffing legislation has been passed in Wales and is currently being considered in Scotland.
Meanwhile, Professor Rafferty said there was a “big problem” with nurse leadership right now – “not because the leaders that we have are not excellent and there are many, I think we just have too few”. She described the current workforce structure as currently looking like the Chrysler Building in New York, with very few nurses making it to the top.
“We have more players being introduced into the skill mix in any given any environment”
Anne Marie Rafferty
There needed to be clearer career structures in place to help nurses understand what they needed to do to progress to consultant level from day one, she said, while also highlighting the importance of reversing cuts to continuous professional development (CPD).
“We need to make sure that we’ve got the kind of engine of robust and resilient career structures, so that it’s quite clear to people when they come in as a student how to get to become a consultant, that the stages and steps are really clear and predictable and that there will be support along the way to help people do that,” she told Nursing Times.
In addition, Professor Rafferty said it was her personal view that advanced practice nursing should be regulated. “Those are some of our high yield net worth practitioners, we should be really valuing that and making sure that that is a really clearly defined structure and scope of practice,” she said.
As revealed in the latest Workplace Racial Equality Standard (WRES) report, nurses from black and minority ethic backgrounds face even greater struggles getting to the top of the career ladder than their white counterparts.
Improving diversity in nursing is a key priority for Professor Rafferty, an ambition she said will be strengthened with the support of new RCN deputy president Yvonne Coghill, who was elected at the same time and is also director of WRES Implementation at NHS England.
Professor Rafferty identified workforce as one of the key challenges facing the nursing profession and said the removal of bursaries, cuts to CPD, and Brexit had aligned to create a “perfect storm”.
This month the Nursing and Midwifery Council opened its register to nursing associates for the first time. However, Professor Rafferty expressed scepticism over the value of the role, noting that it “complicates the divisions of labour”.
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“We have more players being introduced into the skill mix in any given any environment, and rather than streamlining and simplifying things, we are adding complications to it. There are more people to contend with and provide supervision for, and that supervision is reliant on the same workforce that’s been there, so it’s taxing that workforce more,” she said.
Professor Rafferty acknowledged that the former bursary for people studying nursing did not actually deliver the level of financial support that many students required. She said there needed to be research carried out in a “much more data driven way”, to work out what a suitable student nurse funding package might look like.
She suggested this piece of work needed to “drill” into the “nature and the costs and consequences of student hardship”. “From that there could be a case for reformulating what an ask for student support might actually look like,” she said.
The recently released 10-year plan for the NHS outlined ambitions to steam forward with the “digital revolution” of the health service in England and to bring “digitally-enabled care” into the mainstream.
Professor Rafferty said nurses needed to take a leading role in this movement and ensure that technologies were adapted with nursing functions embedded from the start, rather than as an afterthought.
“Rather than playing catch up we actually need to be in the decision making while these things are being developed and the nursing piece designed into it,” she said. “We need to be at those top tables actually getting into that policy dialogue now and ceasing the opportunity.
“From that, lots of other things are going to grow and develop and we will see what the opportunities are, and our students and other parts of the workforce are going to become really excited and that kind of energy is going to have a positive, contagious affect and I think it will really show nursing at its best,” she said. “We are all going to be really surprised at how nursing will actually really fly.”
In the NHS Long Term Plan, it was stated that funding for CPD would be increased year-on-year in the wake of cuts that saw the budget for this area reduced by 60% between 2015 and 2017. Professor Rafferty said this was a positive step but added that the RCN would stay “vigilant and keep a watching brief on that one”.
Details of how the staffing initiatives in the long-term plan will actually be delivered are still being put together by a “workforce implementation group”, which involves new chief nursing officer Dr Ruth May. Professor Rafferty said she felt assured by Dr May’s presence on the panel that the promises to refuel CPD would be fulfilled because she the CNO was “really hot” on this agenda.
“One can move forward with confidence that she has that within her sights and, therefore, I think drawing the RCN into that dialogue as well and adding strength and amplifying that voice at policy level will be very important,” she added.
Professor Rafferty said as part of her tenure she wanted to encourage more RCN members to use their vote, acknowledging that there was a “huge democratic deficit within the organisation”.
“A tiny proportion of people turn out to vote, a tiny proportion of people voted for me, and that under engagement I think is a serious worry, because it means that decisions that are taken impact on everybody are taken by a very small minority of people,” she told Nursing Times.
“If other people don’t pitch up and step up to the plate, then that is always going to perpetuated, so I think [the RCN] will only be taken in a different direction if different voices come into the organisation and express themselves,” she said.
Biography: Anne Marie Rafferty
Anne Marie Rafferty is professor of nursing policy and former dean at the Florence Nightingale Faculty of Nursing and Midwifery, King’s College London.
Anne Marie Rafferty
A member of the Nursing Times advisory board, she is currently president of the Royal College of Nursing after being elected to the post in November 2018.
She is a historian, health workforce and policy researcher, and was the first nurse to gain a doctorate from Oxford University.
She was seconded to the Department of Health to work with Lord Ara Darzi on the Next Stage Review of the NHS and awarded a CBE for services to healthcare in 2008.
She served on the Prime Minister’s Commission on the Future of Nursing and Midwifery 2009-10 and been recipient of various awards; Nursing Times Leadership Award in 2014 and was inducted onto the Sigma Theta Tau International Hall of Fame in 2016.