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'If nursing does not stand up for itself and its worth, who will?'


It is hardly surprising to hear from the Royal College of Nursing that nine out of 10 of the 50 largest NHS hospital trusts have a number of nurses that is below what their management planned.

This latest report from the RCN, released over the weekend, backs up what the college, ourselves and many nurses have been saying for a while. There aren’t enough nurses to provide care – and patient safety is at risk as a result.

What the college warns is that, left with no alternative, those in charge of rosters and decisions about staffing are often being forced to use unregistered healthcare support workers to provide care.

I don’t blame directors of nursing and their senior teams for using healthcare assistants in this way. They have nowhere else to turn, having been let down by poor workforce planning. Add to that the erosion of the nursing register as the government refuse to look after the nurses that are currently on it by paying them fairly and treating them respectfully, and you have a challenge to keep your wards or units safely staffed. It is not a time for principles, but pragmatism.

But I worry that we are now beginning to normalise substitution of registered nurses for healthcare assistants. Could we get used to having fewer registered nurses providing care, and suddenly find ourselves in a position where finance directors and other members of the board think it entirely feasible to staff a ward or unit with fewer RNs? Maybe even no RNs?

Of course, substitution is a moot point while there are no nurses to take the jobs. And what’s better – a healthcare assistant who is familiar with the patients, the team and the ward environment, or an agency nurse who, in some cases, might not have set foot in the trust before?

“It could be very difficult to argue for more budget for registered staff”

But, when other members of the senior team see the care that is usually the domain of nursing staff being delivered by less qualified and less expensive staff, it may well drive down the perceived value of registered nurses.

Now more than ever, chief nurses and directors of nursing need to be superb at articulating the value of registrants in their nursing teams to hold onto their establishments. It could be very difficult to argue for more budget for registered staff, especially if the government’s plan to boost numbers with nursing associates and apprentices is successful.

Don’t get me wrong – healthcare support workers play a very valuable part in the care of patients, and we need them. I am supportive of routes into nursing that support those staff who cannot gain a conventional degree.

However, I am also in favour of ensuring nursing is a graduate profession that has the status of other graduate professions, and commands the same respect.

When we reduce nursing to a series of tasks that can be performed by anyone, we fail to demonstrate the skill and expertise of a nurse. And I worry that more than ever, we need to articulate just what nursing is and what it can do. If nursing does not stand up for itself and its worth, who will?



Readers' comments (4)

  • The answer is no-one. As far as having the same status as other graduate professions and commanding the same respect, forget it. All nursing will ever get is lip service to the idea. Nursing has very little political influence, and people only respect strength.

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  • Nurses get very little respect is because no one knows what you do.
    People only see nurses only for a short time and while they are patients and they are ill.
    You need to tell the world how complicated being a nurse is. Yes, its complex: Combines science, learning, compassion and intuition.
    You need to explain to the public what you actually do.
    I have been saying this here for months!
    You need to publicise what you do. You need to go into Hyde Park and demonstrate what you do. Advertise on boards:

    So being a nurse is easy?
    Can you get someone to walk again?

    So being a nurse is easy?
    Can you calm a child for an operation?

    So being a nurse is easy?
    Can you be in theatre during an operation?

    Nursing is hard, difficult and tough.

    I love you all

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  • You are "Spot On!" The value of a nurse becomes evident when there is a medical or surgical crisis, when there is healing or comforting to be done. Otherwise we are forgotten. Remember the poem "Tommy? Kipling articulates the forgotten soldier theme when he wrote: "While it's Tommy this, an' Tommy that, an ``Tommy, fall be'ind,''
    But it's ``Please to walk in front, sir,'' when there's trouble in the wind." Can we as nurses fall behind? I don't think so: It is not in our nature to be timid when there are lives to save and suffering to be tended to!. When I hear nurses being blasted by politicians and administrators who have forgotten how to lead or care, I am very angry. I see what they're doing, but I don't get it. I have been a nurse for 40 years, including several deployments in the US Army. And I get like Tommy, and recall the famous closing to Kipling's poem: Yes it's Tommy this, an' Tommy that, an' anything you please;
    But Tommy ain't a bloomin' fool--you bet that Tommy sees! If I can see the mess in the UK nursing situation from Brooke Army Medical Center, Texas, why can't those leaders right there see the problem? Perplexing, isn't it!? JB Warren LTC (retired) US Army Nurse Corps

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  • It is good to get thanks for our work & for everyone to recognise us for our skills.
    However, we are our own worst enemies. We moan, whinge & say blah, blah, blah but when push come to shove, what do we do? Nowt! By the time we get to the boss's desk, if you are lucky you might get one nurse but mostly everyone has dissappeared.
    We are not political enough. We let managers, who if they are trained nurses, haven't been on the "shop floor" for years & they make the decisions for us & criticise us when we dare object. Lots are not even nurses & still make decisions for us. Just look at the articles in the nursing press like this one, you do not have to have the brains of an archbishop to know (common sense maybe!!) that trained nurses
    have a direct impact on outcomes; infection control rates, discharge dates, readmission rates, etc etc. There are piles of research articles on staffing levels, impact of RN to recovery rates but senior manager do not want to listen as this might impact on their annual bonus or the promotion rates & lets face it, they only want to make an impression for the short term.
    42 years I have been doing this job & never until the last 10 max have I heard so many nurses counting the days to their retirement. Sad reflection.
    We must start saying no, demanding change, we should be proud of our years of training & not hand it over to very capable people I am sure that are not. They are there to support us not usurp us. The job is CARING & it takes skill, stuff other folk DO NOT KNOW but we do. Lets not let it slip away but I fear for our profession.
    I have allowed my name which I feel is the first step, l want to stand up & be counted. Will anyone else join me & stick with it right up to the desk?

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