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Is anyone standing up for nursing?

  • 19 Comments

3012945 jenni index

There appears to be a conspiracy of silence around the enormous changes happening in nursing right now, with few of its most senior leaders having any opinions on crucial issues facing the profession.

Spend a short teabreak on Twitter and you’ll find people debating short staffing, the nursing associate role, scrapping of the bursary, closure of the Department of Health’s nursing and midwifery policy advisory unit, and comments from NHS Improvement’s chief executive Jim Mackey that nurse to staff ratios above 1:8 are “unaffordable”.

Royal College of Nursing chief executive Janet Davies has made her voice heard, most notably at last month’s RCN Congress. But who else is standing up and saying what these changes will mean for the profession and how it will survive their aftermath?

Every time a big nursing issue arises, I expect a rousing response from a senior figure, galvanising the profession and explaining the impact of that change, but instead we get silence.

Nurses could be forgiven for being unaware of these issues, as so little is being said at the top of the profession. And I think that’s what the government is relying on – a wall of silence, no campaign and for everyone to sit back, shut up and do nothing. Move along, there’s nothing to see here.

But there is something to see. These are big changes and whatever the profession may feel, it looks like they will happen – the scrapping of the bursary was confirmed last week. The government will get what it wants, because no one is putting up a strong resistance. So if the rest of these changes are also to happen, surely we need someone to lead us through this sea of uncertainty?

Where will the workforce come from if EU nurses feel unwelcome? What will happen if the removal of the bursary does deter people from entering nurse training? The health service can’t even fill rosters now so how will it cope when these things take effect? Will we be filling empty nursing posts with nursing associates? And what will that look like? Will the public be confused? Will the nursing profession be threatened? Will it no longer mean as much to be a registered nurse? Or will it mean more?

I ask these questions, and I expect a deafening silence. Because everyone who should be speaking out is keeping silent.

Everyone, that is, except the House of Lords. Yesterday, its latest nurse representative Baroness Mary Watkins got the issue of how nursing will cope post-Brexit on to the agenda.

In her speech, she raised many of the above issues, and I felt like shouting “at last”. Because someone needs to stand up and say that enough is enough. That the axe has been wielded over nursing too many times, and the government cannot keep taking swings at the profession, without nurses and their patients sustaining some serious wounds.

This was the point made by fellow Baroness Audrey Emerton, also a nurse by background. She raised concerns about the nursing associate name, which she thought would confuse the public, and said that if the government could not afford enough registered nurses to provide safe care, it was time to consider changing its services – and even charging for them.

Baroness Emerton warned that another care scandal could be imminent, Baroness Watkins said that the future generation of nurses could be deterred by the removal of the bursary and wished a pilot had been tried first to gauge the effect. She also asked the government to consider protected training to preserve specialist careers in the service, and to reconsider closing the DH nursing and midwifery policy advisory unit. All wise words. Thank goodness Baroness Watkins and Baroness Emerton are asking the questions and raising concerns with ministers. Because very few others are.

  • 19 Comments

Readers' comments (19)

  • michael stone

    'with few of its most senior leaders having any opinions on crucial issues facing the profession'

    I'm sure they HAVE opinions - I think you mean

    'with few of its most senior leaders expressing any opinions on crucial issues facing the profession'

    A few people in the HoLs won't cut it - I'm not sure what the answer to this problem is, but I would invite you to ponder as to why so many nurses who post here on NT, post as 'Anonymous' ?

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  • It's very sad looking forward that any government would consider getting Nursing students to pay their way through a Nursing Degree which in my opinion. I would have personally chosen a different career pathway if not the option of undertaking this strenuous course as a diploma (tuition and bursary paid) and then topping up with a degree which I had to pay out of pocket due to changes in requirement.
    Considering that training to become a nurse is a full intensive 3 years with as little as 2-5 weeks holiday and the expectation of fulfilling 24hour patient care. Which if I had a family then would not be as lucrative as it is made to look at the moment.
    People who come into nursing know they can make a difference to the lives of others hence a choice of committing time and resources to undertake this profession. With a high rate of people feeling disillusioned post brexit, I wonder where this country would be in the next 3 years with regards to nursing care. NHS hospitals unable to provide professional nursing care to clients due to the current lack of nurses and then choosing to axe bursaries of course on a political wimp.
    As we in the profession are feeling the pressure of undertaking more and more work in an attempt to meet stringent requirements of documentation. Ha! Most nurses do not have enough day light hours at the moment and then we considering making the course self-funded. (47,000-51,000 after 3 years).
    I guess its only a disillusioned out of touch elite who would perceive a head on collision and choose to actively do nothing about it and like the ostrich stick your head in the ground and hope for the best. As shortages goes at the moment United Kingdom would have to start recruiting nurses from foreign countries that is if the home office has nothing to say about immigration. (sigh)

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  • Thank you for a most thought provoking piece regarding the apparent silence from our nursing leaders on crucial issues facing our profession. As an Ex Chief Nurse of many years, I can recall that in the past we had brave outspoken leaders who were always prepared to publicly challenge the government of the day in the interests of the profession, but more in the interests of their patients. Politicians listened because these leaders were passionate but not shroud wavers, critical but with a sense of reality, patient focussed, charismatic and extraordinarlly well networked within and outwith the profession. The leaders of yesterday always had creative options to propose rather than just criticise. Today of course you get the sense of if you raise your head above the trenches publicly you are likely to come unstuck - career limiting or ending you might say. The truth is that some of our leaders fail to speak up in their own organisation for fear of reprisals from senior colleagues. Recent scandals are clear evidence of this. There is however another possibility of course. Perhaps our nursing leaders work in different ways in 2016. Rather than confront publicly, perhaps they are working creatively behind the scenes in order to influence the major issues threatening our profession, influencing key players and decision makers quietly, in dark corners, in order to survive another day.I I am reminded of something I learned on the Kings Fund Leadership Programme 10 years ago which was that to be successful and to achieve your goals it is the quality and the strength of Relationships that matter, Relationships up, down, sideways as well as across. Relationships within the organisation as well as out of it. Relationships lead to Possibilities - which in turn lead to Plans which will lead to ACTION. Relationship building is the most important critical skill for leaders in 2016 in my opinion. I am hopeful that our leaders are building the right relationships with the decision makers at all levels, from Government downwards. If they are not building and fostering the right Relationships, don't expect alternative Possibilities for the profession to emerge to address our current challenges, never mind the Plans and Action that follow. I live in hope.

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  • michael stone

    I found Anthony Plamer's well-written piece interesting.

    He explains that as a former Chief Nurse, he thinks 'nursing leaders' are perhaps different from nursing leaders of the past, and I get the sense he sees 'nursing leaders' as being above 'Chief Nurse' positions.

    Surely Chief Nurses within organisations need to be speaking up - perhaps the problem, from bottom to top within nursing, is Anthlony's:

    'Today of course you get the sense of if you raise your head above the trenches publicly you are likely to come unstuck - career limiting or ending you might say'

    Extended perhaps to 'or even in private - if your view clashes with the CE's position and objectives' ?

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  • When people are raising these issues but appear not to be heard / ignored by policy makers and do not feel widely supported by other stakeholders, then how long would you feel motivated to continue.

    It is widely reported that lack of safe staffing levels, skills, training, etc all lead to poorer quality care of patients. Its on the news all too regularly that we hear about poor care and feels like the nursing profession is under constant attack. This if anything will not aid recruitment + retention.

    With baby boomers + generation x retiring and more people needing ongoing care the NHS will struggle. More nurses leaving than entering profession. Fewer home grown nurses, and some will leave abroad while others may leave nursing. Some EU + overseas nurses will move on to where they feel more welcome / treated better.

    Only when those who have been silent for so long need the care of nurses + the NHS, but are not going to receive it, then the penny might drop about how poorly treated carers + nurses leads to poorer quality care not due to staff dedication but due to being stretched so thin to the point of being transparent and where people burn out.

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  • I agree with Sandy Beech . General apathy among those to be led(and who can blame them?) and failure to inspire by the 'leaders' mean the situation will continue. Bear in mind that striking by the junior doctors didn't get them very far. Any hope of a General Election?

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  • FROM PENNY NIBBS 01/08/2016
    When Mr Edwards wrote about the NHS and bullying etc, I started this email to him. Tonight I thought I haven't finished it but I had better send it just to get rid of it...Did he ever respond to you guys?
    Mr E CEO for Nuffield Trust
    You are right that staff shortages, disputes with government and bullying are a "toxic mix” but neither the Govt, DOH nor anyone else are prepared to do anything effective about it. Bullying in many cases underpins much of this grief and loss. In the NHS bullying, has been getting worse year on year for decades now. It is endemic and it seeps through from top to bottom of the NHS. Directors can be as much bullies as their underlings are. Who cares about the way it devastates lives, and who puts a stop to it? No one. The bullying policies aren’t worth the paper they are written on and there are no stringent consequences for bullies even when they are proved to be bullying.(I believe these people need to be made to face what their behaviour does to other people, rather than either terminating their employment or just letting them continue to work in the same way with no more than a flea in their ear, which only stores up revenge further down the track, in my experience. Promoting the bully seems to be another favoured line of approach, which is also unhelpful to the whole workforce.) The NHS loses staff who become incapacitated to work because of the trauma they are put through via the bullying. I have worked in departments where there have been persistantly 60% sickness rates because of 2 bullying Managers. But to add insult to injury, the Nurse Managers then report perfectly good and safe staff to the NMC. Just to make sure they will never nurse again. This too is bullying, in fact it is almost as good as murder, except the nurse doesn’t die she just can’t nurse any more.
    Lets put the individual Nurse aside for a moment, because its functional staff you want in the NHS. The Nursing stock is depleted at the rate of 4000 nurses reported to the NMC every year( and yes, some justly) but many completely unjustly - you only have to read through the NMC’s hearing charges to see how petty and silly some of the charges are. These charges are published for public scrutiny on their website before even the case has been heard; thus kicking everyone’s right to any confidentiality out of the window - I believe. Of the 4000 nurses reported, the NMC arbitrarily selects 2000 to go free( the NMC say “ no case to answer”) at some point in their ponderous proceedings, though it might take them 6 months or more to make this ruling, and the other 2000 nurses to go to a hearing.. which might be 2 or more years later, from date of report. Once a Nurse has been reported to the NMC( guilty or not) its almost impossible to get another nursing job, they get black listed from NHS jobs and agencies or private employers are not always willing employ the individual either. So these people have to seek employment away from the health service. Bang goes all those(useful) nurses who have been trained, often multiply qualified, are skilled, knowledgable and experienced - on the whim of a Nurse manager who is exerting their will or a Management who don’t like the flaws in their systems being pointed out to them - they prefer the “ignorance is bliss” approach, until too many people have died or come to harm to be able to ignore it anymore..Do you wonder there just isn’t enough staff? The NM C are a curious very expensive Organisation too, run by Lawyers who don’t know diddly squat about medical decisions yet stand in judgement over nurses, and invariably find them guilty of what the NMC minions know next to nothing about! This isn’t sound or healthy practice either. The PSA say "not fit for purpose", but exactly how "not fit” do you have to be, before anything effective is done about them?
    Honestly I don’t think anyone cares a toss - its an”I’m alright Jack, who cares about you" mentality.
    I will send this in the knowledge that you have a lot to read and may not bother to read it anyway. I would have said more, but whats the point?
    I am glad to have retired, glad to be shot of the last nurse manager who really didn’t like the truth and did her best to pervert it at every turn…as did all the other levels of Management in the Organisation. My nursing career though an interesting one had, some pit-like moments, I was one of your many whistle blowers whose work life was cut short by malicious Management. There you are, the NHS hates Whistle blowers too and that is seriously bad for the Health of the Nation. All the policies, Czars and Champions will never make any difference to that situation until honesty is valued again.How ever accountability will one day come home to roost for all those who have bullied and abused staff, so we just have to wait for that day to come.

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  • I totally agree. There ia na almoat deafening silence publicly. Perhaps there is behind the scens influence but it does n ot seem very apparent and if it is too hidden how can the nurses out there know and feel supported and able also to make their views known. To me there seems to be a conspiracy to downplay the need for Registered Nurses. A let's try all sort of other ideas like an Associate Nurse. Even the consultation didn't allow for a straight disagreement with the whole concept.

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  • michael stone

    More-or-less on a similar theme to this one, Margaret McCartney has just written an interesting piece asking if it safe for junior doctors to blow the whistle at:

    http://www.bmj.com/content/354/bmj.i4215

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  • It concerns me greatly that so many of my colleagues are not planning to renew their 2016 NMC under the revalidation process, and most have already left nursing. I do feel the revalidation in principle, however (!) a colleague's signature of endorsement would have been sufficient. To ask nurses (already swamped with work and little spare time) to write accounts and network in their spare time etc, IT IS ALL A STEP TOO FAR...Not only a step too far but highly insulting. My leaving colleagues are highly skilled, many in community work (already a short staffed sector), and the patients will undoubtedly suffer.

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