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Nurses should be recruited on 'caring' values


Nurses of the future need to recognise they are more likely to “care” rather than “cure”, a senior NHS figure has told Nursing Times ahead of a major speech to the Royal College of Nursing.

The values of nursing recruits needs to reflect the increasingly palliative nature of the job in order to drive up workforce standards and bring down student attrition rates, according to the man appointed to oversee nurse education under the reformed NHS and who has just completed a major review of patient dignity.

Ward managers must also be handed greater control over staffing levels on their wards and be given more respect by senior managers in order to deliver safer care.

Sir Keith Pearson, currently chair of the NHS Confederation, is due to take up his new role as chair of Health Education England next month.

In September 2011 he set up and chaired the Commission on Dignity in Care for Older People, which aimed to examining the underlying causes for growing numbers of reports of poor care.

Speaking to Nursing Times ahead of his keynote speech tomorrow at the RCN’s annual congress in Harrogate, Sir Keith said clinical professions were no longer primarily about curing patients, but instead were about caring for patients with long term conditions.

“We must ensure that the workforce of tomorrow is trained to recognise the shift from curative to palliative care. Many people who go into medicine and nursing perhaps go in with real hope that they will be for the majority of their time involved in both caring and curing.

“With older people dominating much of what we do, cure is not what we will be doing [a lot of the time],” he said. “We need to make sure the students coming out of training understand the world they’re coming into.”

Sir Keith warned that such a misunderstanding of what much of nursing involved could be one of the reasons behind persistently high attrition rates among nursing students.

In 2006-07, the latest intake for which full figures are available, the dropout rate was 26%.

This is the kind of issue Health Education England will look at under the organisation’s brief for ensuring the healthcare workforce has the right skills, behaviours and training to support the delivery of healthcare and health improvement.

Sir Keith suggested one solution to the problem could be to ask nursing recruits for evidence they have been involved in providing care when they applied to university.

“We need to put much more effort into recruiting people for their values and then training them for the skills they need,” he said.

The dignity commission was set up in partnership with Age UK and the Local Government Association. It spent eight months gathering and reviewing evidence from around 40 organisations and held three days of public hearings last year.

Sir Keith said staffing levels had emerged as a key issue but the commission had not recommended minimum nurse-to-patient ratios due to the variation seen in the needs of patients on the same ward on a “week to week” basis.

The topic of mandatory ratios remains controversial, with some in the profession sharing Sir Keith’s view that differing patient acuity levels make it too complex to set them and the government do so far opposing them.

However, ratios are increasingly supported by academics who say staffing levels are linked to care standards, while a recent survey of frontline staff by the union Unison found 91% of respondents backed their introduction.

Instead of ratios, Sir Keith said the commission was in favour of empowering ward mangers to be “very much in charge and driving what the staffing ratios should be” according to the care needs of the patients on the ward at any one particular time.

He said this should include being able to ask for and get extra bank or agency support when needed.

“Ward sisters and charge nurses [should be able] to translate what they see as the dependency levels on their wards into what they think are the right staffing levels,” he said.

He accepted that in a lot of places this would mean improving relationships between ward managers and senior management.

“Boards need to understand that their primary role is to deliver patient centred, dignified care. There needs to be a dialogue between those who have ultimate responsibility for resources and those who have frontline responsibility for delivering care.”

The commission published a draft report earlier this year and is due to publish the final version next month.

Sir Keith, who is also former chair of the East of England strategic health authority, said he hoped the health sector and the nursing profession would use the recommendations to drive improvements in care.


Readers' comments (4)

  • "Care" and "cure" go hand-in-hand.

    Medical and nursing students "perhaps go in with real hope that they will be for the majority of their time involved in both caring and curing"; only the majority? What should they be doing with the rest of their time? In any case, whilst caring cannot cure directly, nevertheless it is an integral component of patient amelioration.

    As for ward managers being given greater control over staffing levels, presumably greater levels; this would be a great improvement - but has Pearson thought about the resistance such managers are likely to receive from their seniors when more money for this is required - especially if bank and agency staff are involved?

    With regard to student attrition, surely this is largely due to a combination of INEFFECTIVE student selection and course quality.

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  • what? not enough staff so we just offer palliative care to anybody over a certain age? even if they have a curable problem and could, once cured, continue to live a productive life? assisted euthanasia? eugenics?

    as for the title, not very complimentary to those already in the profession!

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  • Wasn't this how we approached elderly care years ago?....nothing can be done!! Wash and feed, do for......this may be envisaged as 'caring' but takes away dignity and independence. I can see the private sector making a great living out of opening more Nursing/Care homes, if this attitude to caring for people with long-term conditions ensues. I suspect it's in preparation for the inability for community care to cope with the increased elderly population. Why do we preach healthy living to produce longevity, when the aim is to make those extra years miserable.
    A new notion of patient dependency needs to be taken on board, e.g. time taken to use facilitation to promote independence and not the 'do for' notion. There is more than curing and caring, there is adapting and finding new ways of coping too.

    If wards are competing for staffing levels on a shift (which is what happens when patient dependency is taken into account), it is open to abuse by stating some patients require higher levels of 'care' than they actually do.... and I repeat facilitation is not usually acknowledged. It is not helpful to patients to be made more dependent when fighting for adequate staffing levels on the shift. If patient dependency is introduced again (yes it has been done before), it needs to be monitored very closely and honestly.

    Recruiting nurses that care is essential, but that has a different meaning to the comparison between 'curing and caring' in this article. I find the notion of instilling into nurses minds that patients will need more 'caring for than curing' is rather negative at the onset.

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  • Recruitment methods should be looked at and standardised for universities in my opinion. I applied to 3 universities for my course. One required an 8 hour assessment day with prepared essays, a presentation, group and individual interview; second an individual interview and the third university only asked for a group interview. Guess which university has the higher attrition rate?!

    The value of previous care experience should not be overlooked either.

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