There must be a “fundamental change” in the level of respect given to the Royal College of Nursing, its new chief executive has urged, claiming the current crisis facing the profession could have been avoided if its previous warnings had been heeded.
Dame Donna Kinnair said the college had been raising alarm bells about the sustainability of the nursing workforce for the best part of a decade but no-one in power had taken notice. The shortfall of nurses in England’s NHS is predicted to rise from 40,000 now to 70,000 in the next five years.
“What we are seeing now is that we are at breaking point”
She stated that decisions to push through with policies against the advice of the RCN had “led to the devastation of the nursing profession”, highlighting the axing of student bursaries as an example.
In her first interview with Nursing Times since being confirmed at the end of April as the new chief executive and general secretary, Dame Donna said the RCN “ought” to be taken more seriously rather than viewing the college as simply “agitating” on issues that it deemed important.
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Dame Donna, who has been acting in the role since August 2018, said: “We weren’t just agitating, we were issuing warnings that if people had listened to could have averted the crisis that we are in now.
“I want there to be a fundamental change and a level of respect to this college that should be there anyway,” she said. “We shouldn’t have to be battling for that.”
The RCN leader – who was made a dame for services to nursing in 2008 – said under her leadership she wanted the college to be the first port of call for government and heads of the NHS on key matters affecting the nursing profession.
“We’ve got a huge amount of knowledge in this college about the science and art of nursing and, therefore, I want to see it as the place to go,” she said. “I don’t want people to [ride] roughshod over nursing, as though it is there to be done to.”
“We were issuing warnings that if people had listened to could have averted the crisis that we are in now”
She named workforce as the most pressing challenge facing the nursing profession right now and, as a result, one of her top priorities as RCN leader. The sheer number of nurse vacancies meant those on the wards were under increasing strain, she noted.
“Workforce, workforce, workforce is the number one issue,” she said. “The system is dependent on the goodwill of nurses to keep it going at the moment, but actually that’s not a satisfactory position to be in,” she said, highlighting that registered nurse vacancy levels were at around 40,000 in the NHS in England.
“That creates a cycle where actually it’s quite hard to go to work, if every day you can’t do a satisfactory job, if every single day you are thinking there’s not enough of us to do the basics and to deliver decent care to patients, and if you are having to constantly leave some aspects of care undone.”
The RCN is currently campaigning for legislation for safe and effective staffing across the UK, which would hold ministers ultimately accountable for ensuring there were enough nurses to meet patients’ needs.
Dame Donna said it was not about absolving frontline nurses of responsibility for their actions, but rather seeking accountability for those who created conditions that made it “impossible” for them to do their job well.
Meanwhile, according to new research, productively in England’s NHS has improved dramatically since 2004-05, with staff providing 16.5% more care pound for pound in 2016-17. This is compared with a growth of only 6.7% in the economy as a whole over the same period.
Dame Donna noted that this had been possible through “radical” changes in care resulting in patients being discharged from hospital much faster.
However, she feared that nurses were being pushed to their limits holding together the cracks in services and warned that without action to put more staff on the ground the NHS was at risk of collapse.
“Workforce, workforce, workforce is the number one issue”
She said: “The system has become much more productive because actually when you are at rock bottom you find better ways to delivering care, but even that comes to a point where there is not much more to be done.
“What we are seeing now is we are at that breaking point, where actually if we don’t do something about staffing in the NHS – and that’s not just nursing – that actually we are not going to be able to deliver the health service as we know it.”
Dame Donna took up the reigns of the RCN in an acting capacity at a turbulent time following the sudden resignation of her predecessor Janet Davies, which was sparked by outrage among members over the way it communicated details of the new NHS pay deal.
Members claimed RCN leaders had become disconnected from them and later passed a vote of no confidence in the ruling council.
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While admitting that stepping up to the plate in these circumstances was “quite scary”, Dame Donna said she had heard the concerns of members loud and clear and that she was under no doubt that it was her role as the leader of the college to reflect the voices of those she represented and not that of the government or the NHS.
She said it had previously been her intention to eventually retire from her previous role of director of RCN nursing, policy and practice, but that she did not hesitate when asked to take the helm because she knew had the skillset for the job.
But Dame Donna is set to face questions over her position at this year’s RCN Congress, which will take place in Liverpool this month.
The RCN congress agenda contains a resolution to be debated on whether the current joint role of chief executive and general secretary should in future be split, with the latter becoming an elected post.
Dame Donna said she personally saw “huge benefit” from the roles being joint but stated that if members disagreed, the college would respect that and make it happen.
However, she highlighted that having an elected general secretary carried “dangers”, because it could result in someone not fully equipped for the role being voted in by a small minority of people who took part in the ballot.
The RCN has in the past struggled to get members engaged – the turn-out for the no-confidence vote last year was just 3% – and Dame Donna said it was one of her ambitions to change that.
Another issue up for debate at congress is whether the RCN should re-join the International Council of Nurses, which represents over 130 national nurse associations around the world. Members voted to leave the ICN in 2013 due to concerns about high fees.
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Dame Donna said she could see “some real benefits” of reconnecting with the ICN, if the previous issues that made it depart in the first place were resolved and if members supported the move.
“It is hugely important for us to work with nurses across the globe and making sure that we are mutually supportive, because actually nursing is one of those professions that transcends boundaries,” she said.
“It’s a real sadness for me, actually, when I think about the unintended consequences”
Meanwhile, Dame Donna said the RCN would be releasing a joint report at congress with the Queen’s Nursing Institute about the importance of maintaining dedicated community nurse training and qualifications amid fears about the use of advanced nurse practitioners in these roles.
“We are publishing this report because actually we recognise that there are many people in policy positions that have never entered a family’s home as a district nurse and had to deliver care to the whole family when something drastic has happened within that home,” she added.
“You are not just caring often for the individual that may be elderly, they may have a husband who is also suffering from some phycological illness,” she said. “Those nurses aren’t just advanced nurse practitioners that deliver a high level of care, but they have to be trained in social development and social issues as well.”
Dame Donna previously served as a nurse advisor to Lord Laming during his high profile inquiry into the 2000 murder of eight-year-old Victoria Climbié, who suffered horrific abuse.
Having heard how health professionals and social workers had missed a series of chances to intervene before the child’s death, Dame Donna went on to campaign for nurses to take a greater responsibility for child protection.
But she told Nursing Times that, as an “unintended consequence” of this work, some areas of the country were now using health visitors primarily for child protection purposes.
She said it made her “grieve” to learn that parents were going to psychologists for support with issues that had previously been the “bread and butter” of health visitors, such as potty training.
“It’s a real sadness for me, actually, when I think about the unintended consequences of some of the campaigning we did,” she said. “To put child protection as a component part of health visiting [was] never meant to erode everything else.
“When we come out and say something, it’s not so you can just ignore us”
She added: ”It’s a great source of sadness for me when I see boroughs stipulating that only children that are on the child protection register, or who have concerns, are visited by health visitors, as there is so much more they can do for the normal family.”
Asked what she wanted her legacy to be after her tenure at the RCN, Dame Donna said she wanted people to think of the college as a “really strong place”, that was listened to when it challenged on issues.
“We often speak on behalf of our members so actually if we are going to deliver good, safe care, then you need to listen to the people delivering it, and nurses deliver most of the care,” she said.
She added: “When we come out and say something, it’s not so you can just ignore us, [it’s] because we’ve got something to say about a subject matter and it’s quite important.”
Biography: Dame Donna Kinnair
Dame Donna Kinnair has been acting RCN chief executive and general secretary since August 2018 and was permanently appointed to the role in April.
She joined the RCN as head of nursing in 2015 and was then promoted to become director of nursing, policy and practice in 2016.
Prior to joining the RCN, she held various leadership and commissioning roles, including clinical director of emergency medicine at Barking, Havering and Redbridge University Hospitals Trust and strategic commissioner for Lambeth, Southwark and Lewisham Health Authority’s Children’s Services.
She also advised the Prime Minister’s Commission on the Future of Nursing and Midwifery in 2010 and served as nurse/child health assessor to the Victoria Climbié Inquiry.