In the 1960s, the RCN and other senior nurses were concerned about the lack of influence the nursing profession had with doctors, politicians and the public in negotiating improvements in the organisation and practice of nursing. They explored organisational alternatives and also envisaged career pathways that would include degree-level education, while allowing continuing involvement with patient care, in a similar way to doctors’ training.
I became involved with the deliberations through participation in the RCN Study of Nursing Care Project, which was intended to be a first step for change. It was very informative, but did not lead directly to changes.
Since that time there have been the major changes following the implementation of Project 2000 in the late 1990s. This saw pre-registration nurse education move from hospital-based schools of nursing to universities, and students being supernumerary. Sadly, this has not in any way implemented the early hopes.
While evidence-based practice is the mantra for improving modern nursing, the profession is being denied the tools to make this a reality at the frontline.
There has been an increasing fissure between those working in research and the main body of professionals working in wards, and the community and other settings - when in fact they should be brought closer together.
The divergence has not come from nowhere. The implementation of Project 2000 marked the beginning of this divide and more recently the move to degree-nursing has exacerbated the problem
Those who show academic prowess are creamed off early-on in their nursing careers to work in universities – many of whom would be the ones to become nursing leaders and more likely to instil research for practice and organisation if they had stayed at the front line.
Meanwhile, pre-registration nurse training is delivered in a way that separates academic tuition from teaching skills. Half of student nurses’ three years is spent in university lectures and half is spent on placements, where they are taught by ward staff with little, or no training in how to teach.
These splits mean that not only is research not informing good nursing practice but, along with other factors, standards of care appear to be falling in some situations.
What is needed are strategies to facilitate better communication between academia and practitioners, both during nurse’s education and their ensuing careers.
The intention behind Project 2000 was not for everyone to decamp into universities – it was to ensure training included higher academic content. Essentially, nurses wanted to have theory and practice running along side by side.
But we have now ended up in a situation where the practice and academic spheres of nursing are so separated – including geographically and in terms of pay and conditions – that it is difficult for research to make its way to the frontline.
Action research, which occurs alongside practice, is what is needed to ensure a useful and relevant evidence base which can be created and used to progress care. While recent increases in numbers of clinical ‘professional’ research nurses has been a welcome move to address this problem, more can be done.
Findings from my own study looking into how difficult patients with mental health problems could be treated less favourably than others – The Unpopular Patient, published in 1972 – have had a difficult journey making their way to the profession.
Upon publication the study was rubbished and only after many years later was it used to inform practice.
This distance between appreciation of research findings – no matter how controversial – and the profession should not still exist. But has anything changed since then? Who is monitoring whether any of the research is improving practice anywhere?
The most imperative change for the profession right now is for a convened group of nurse leaders, from theory and practice, to establish a career pathway for nurse educators/teachers alongside the established academic, practitioner and management career pathways, all of whom should have equal status in terms of pay and conditions of service.
Only by doing this – and by creating a new body of people who can have a career teaching within clinical settings - will the profession be able to draw together academic learning and practical experience to deliver a relevant, informed evidence base for maintaining high standards and striving for progress.
Felicity Stockwell, mental health nurse by background and author of The Unpopular Patient