We have many problems and they all need to be addressed if we want to get nursing back on track. I don’t claim to be an expert but I have pulled together my top 10 suggestions. Please change, adapt, disagree as you see fit - I can take it. But let’s have a clinically focused conversation about what really matters to nurses and their patients. So, with a deep breath and in no particular order:
My top 10
- Wards should have staffing levels and skill mix based on patient dependency, not on numbers of beds. Nurses need time to provide the care their patients need.
- We need strong clinical leadership on wards. Free ward sisters from management tasks and allow them to lead clinical care by giving them clerical and housekeeping support. They become ward sisters because of their clinical and leadership skills, but do not have the time to use them or share them.
- Nurses should be managed by nurses, not by general managers. Trust chief nurses should manage their nursing workforce directly.
- We need nursing degree courses that ensure graduates feel confident to practise. Clever people can make good nurses!
- We need to reintroduce second-level nurses (SENs). HCSWs give nursing care, so why not put nursing into the title, standardise training and regulate the role?
- All newly qualified nurses must have a compulsory preceptorship programme to help them adapt to their new role. Qualifying is only the beginning of becoming a nurse.
- All nurses must have protected time for training to ensure they stay up to date.
- We need a robust system of re-registration that ensures nurses are competent to continue in practice. There needs to be a fair and effective way of dealing with those who do not meet professional standards.
- Nurses need a work environment that is well equipped and promotes patient dignity. Patient care should never be compromised by a lack of resources.
- We need nurse leaders with influence and real power on trust and commissioning boards - and in the Department of Health. The nursing voice must be heard at a local and national level.
Too often the direction of the profession has been dictated not by patient need but by the demands of health services, and these are not always compatible. We need the building blocks that allow nurses to feel confident and able to deliver safe and effective care to every patient, every day, on every ward, on every shift in every hospital.
It’s not rocket science, but I think we are going to need a 21st-century Florence Nightingale to take on the establishment. Any volunteers?