Deborah Sturdy argues the case in favour of a re-evalution of our perceptions of care home nursing, too often dismissed although crucial in an ageing society
Nurses working in care homes are skilled in caring for people with complex needs. The profession and clinical commissioners needs to value this specialty and enable care homes to help meet the challenges facing healthcare providers. As the NHS struggles to make sure it has safe-staffing levels to meet increasing needs across every service, we face unprecedented demand to recruit and retain nurses throughout the profession. However far less attention is paid to social care, which faces the same challenges.
Around 426,000 people receive social care, and many will have countless interactions with nurses both in social care and NHS specialist services. Nursing in social care is complex – these nurses play a crucial role in managing comorbidities and coordinating specialist services, and care homes are a vital part of the care system.
Care homes are truly nurse-led services in which nurses work autonomously to prescribe and deliver care, often with little professional support. Many of these nurses have no access to a multidisciplinary team or senior colleagues with whom to debate and discuss care strategies. They bear huge responsibilities, yet care home nursing is often dismissed as a backwater in which those with less skill and experience go to hide from hard work.
Care home nurses deliver in excess of £2.5bn of NHS-funded care, yet their contribution is dismissed by many of their peers. Often they are excluded from fair and equal access to Health Education England funding for continuing professional development, and from local forums debating commissioning. In this time of fiscal restraint, we need to find solutions to perennial problems and make the health and social care systems efficient and effective – so why are nurses working in social care not involved? If they were included in the discussions, they could share their solutions to many common problems.
In our ageing society all nurses need to develop the skills required to care for older people, and enabling them to do so in preregistration nurse education is fundamental to the preparation of a workforce that is fit for purpose. There also needs to be investment in generating a body of evidence to underpin practice, which can then be built on. If we are to achieve this, it is time to create a new role: a chair of care home nursing. This could build on the current and growing work and academic interest in the field to create an academic base, and nurture an increased capacity and appetite for research.
We need to improve understanding of the specialty in order to galvanise the wider profession to take care home nursing seriously. It must be at the heart of undergraduate learning and taught in such a way as to enthuse students about this fulfilling career option.
Care home nursing needs a stronger voice, a place at many tables and a recognition of the specialist skills it requires. Recognising the specialty as a partner could help to address many of the challenges the NHS is facing.
A machine that goes beep will give you information, but the art of nursing is far more complex than that. Care home nurses manage complexity, frailty, family relationships, and many complex multiprofessional and multi-agency inputs. This field of nursing really is not for the fainthearted.
There needs to be a fundamental change in general perceptions about the value of social care and in the relationship of the NHS with the nurses working in this crucial sector.
Deborah Sturdy is honorary nurse adviser at Care England
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