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Professional boundaries hindering nurses, say managers


Nurses’ lack of confidence to challenge other professionals is hindering their progress, NHS managers have told the prime minister’s commission.

NHS Employers’ consultation response also says there is a lack of clarity over the duties that supporting roles can undertake, creating a perception that nurses and midwifes are unwilling to delegate.

The response says: “Much work has been undertaken to encourage multi-disciplinary team working but the traditional professional boundaries still hinder parts of the nursing or midwifery profession from realising its full potential.

“Some of this is can be attributed to organisational or professional culture.”

NHS Employers recommends more support for nurses in leadership roles and those providing clinical placement supervision and preceptorship programmes.

The emergence of different types of organisations, which nurses may be leading, means they must be given the opportunity to build their entrepreneurial skills and knowledge of different organisational forms and charity laws.

The response also calls for a national framework for assistant practitioners, with a minimum set of competences and possibly educational attainment, while still allowing for local flexibility.


Readers' comments (2)

  • "emergence of different types of organisations, which nurses may be leading, means they must be given the opportunity to build their entrepreneurial skills and knowledge of different organisational forms and charity laws"

    If I may make so bold as to suggest we learn lessons from an organisation that diversified away from its core function and dramatically failed; Marks & Spencer have some valuable lessons to teach the nursing profession. We have seen today patients and families tell us their is something fundamentally wrong with some nursing areas.

    We appear to have strayed from the core foundation of what nursing and nurses are about; providing patient care and fighting for the right to have the right amount of time, the right number of nurses and the right skill mix to do it!

    If we were GP's we would be funded to employ staff to support us to manage these changes not learn it ourselves!

    While we are away learning to be entrepreneurs who is looking after our patients?

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  • Nursing has to move forward, and it is no use trying to regress nursing back a hundred years. We cannot use one example of Marks and Spencer as one failed attempt in diversification.

    Nursing needs all levels of skills and interests with everyone starting at the bottom and learning the bedside care and those interested in taking what they learn from that to higher levels of power to maintain and enhance that good care.

    It is my experience as an ex State Enrolled Nurse that many nurses I worked with scoffed at my interest in information technology in the 90s and how this could enhance patient care, often stating that I could not be a 'real nurse' if I took my interests away from the bedside.

    Now I work in general practice as a senior practice nurse, sat at a computer most of the day, but this involves care of the patient as well, but now my care is often blocked by my employer who is a GP. GPs may be as the above commenter stated 'funded to employ staff to support us manage these changes not learn it ourselves!' but in my experience, GPs want to keep as much of the global sum they can, and now I am a senior nurse with 8 years experience as a practice nurse doing what my health care assistant used to do for me over 5 years ago as the GP employer will not employ staff to manage these changes.

    My GP employer/manager is definately preventing me from crossing boundaries in areas I feel competent and able to do so, not just for my own professional satisfaction but also to enhance the care of the patients I see that are not receiving evidence-based care in my opinion now. I have spent time and money doing accredited modules in some areas ahead of GP apparrent knowledge but cannot apply it because I have no power to make my own professional choices. My proffesional boundaries are most defininately hindered and I need some form of central training, such as nurse prescribing and clinical assessment where I am not dependent on medical support.

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