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.