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'My top 10 suggestions for improving nursing'

  • Comments (9)

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

  1. 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.
  2. 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.
  3. Nurses should be managed by nurses, not by general managers. Trust chief nurses should manage their nursing workforce directly.
  4. We need nursing degree courses that ensure graduates feel confident to practise. Clever people can make good nurses!
  5. 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?
  6. 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.
  7. All nurses must have protected time for training to ensure they stay up to date.
  8. 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.
  9. Nurses need a work environment that is well equipped and promotes patient dignity. Patient care should never be compromised by a lack of resources.
  10. 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?

 

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  • Comments (9)

Readers' comments (9)

  • Hmm, some of those I agree with, some I don't, not entirely anyway.

    1. Agree, but I would add 1 staff Nurse and at least 1 HCA should legally have to look after more than 6 patients. The government should also ensure that there are enough roles available at all bands so that no staff Nurse in this country is struggling to find a job as they are now!

    2. Absolutely agree.

    3. Absolutely agree.

    4. Absolutely agree, this could be achieved by making the course much more clinically dominant.

    5. No. Absolutely not. The term NURSE should remain a specific protected title reserved only for those who have undergone FULL training. The blurring of lines and patient confusion is high enough as it is. As for senior health care assistants, that is a different matter, I agree with that, as long as their roles are limited to specific and basic clinical tasks and very clearly defined, and they are fully regulated.

    6. Absolutely agree, and trusts/work places (primary, secondary, private or public) should have a LEGAL order to make sure we get it too. It's no good saying we should have it if workplaces just don't bother.

    7. Absolutely agree, and this protected time should be part of our working hours, we should not be expected to put in a full working week, and THEN do extra training.

    8. Kind of agree. I would go further and say that we need to scrap the current NMC and put in place a professional body that is there to regulate, but also SUPPORT Nurses. On top of this we need to scrap the RCN and have a specific union that is robust, strong and supportive of our profession

    9. Absolutely agree. I would add with enough beds to actually accommodate all the patients too!

    10. Absolutely agree.

    I would also add however...

    11. We need clear and robust clinical career paths for Nurses to follow right up to Nurse practitioner level and even beyond. At the moment, we are all over the place with no clear pathway for career progression. It seems once we hit band six and above, we are doomed to be stuck behind a desk! Not everyone wants that.

    12. We need an instant upgrade in pay to reflect our professional status as key public sector workers. You cannot expect degree trained, highly skilled professionals to earn barely more than jobs that require no training or quals, the same as a bin man or less than a tube worker! It isn't on! A minimum of £25,000 should be the STARTING salary upon qualifying. If anyone disagrees, just look at the stories of temp management on £1000 a DAY!!!!!!!

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  • Anonymous

    5. I do wish people would stop confusing the SEN with HCSWs with NVQs. There is no comparison with the level of training/knowledge/education they receive(d). I know as I started off my nursing career as an SEN before converting to RN in 1989. SENs were often in charge of shifts and did a damn good job. Is that what we expect of HCSWs, I don't think so. I work with 2 Band 5 experienced SENs who are as competent, and more-so, in some instances, as any RN. They keep up to date too. If no-one told you, you would never know. Please no comments about the person who posed as a Nurse Practioner, that was a one off.

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  • Anonymous

    I agree with the top 10 but would add nurses should nurse- the word used to mean nourish. Lets do our job and let others do theirs. How many times do we undertake the role of cleaners-clerks- porters- medical staff.

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  • Anonymous

    How about scrapping archaic terms such as sister and matron. Ward manager and senior nurse titles are more modern and inclusive of male colleagues.

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  • Anonymous

    Aside from the measures above, the image of nursing would also improve, I believe, if we more robustly challenged the portrayal of nurses in UK TV medical dramas. Shows, such as Casualty and Holby City are often insulting in the way they portray nurses. A class action brought against the BBC would help.

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  • Anonymous

    I would broadly agree with this top ten despite my not being a ward based nurse.
    No. 5:
    I would add that I have no objection to the re-introduction of the SEN but as someone has mentioned equilibration of skill and regulation needs to happen. I also have no objection to the NA being re-introduced as a defined and trained role.

    No 2+3
    I would add that part of the reason for the lack of strong leadership comes from the positions of the potential leaders being wholly compromised not only by non-clinical management but by lack of support from an effective nursing body and a separate union with teeth. I would argue that part of the urge to commission services, and thus staff, is to dilute the unity and strength of the workforce to be able to challenge the current moves and rationalisation of care. Working for a private firm is a very different ball game.

    In terms of education, I've been saying for ages that we need a mandatory preceptorship period for the newly qualified, a robust CPD and clinical/ education career pathway, protected and funded, as well as a robust education in college about learning a confidence and standing your ground within the MDT/management system regarding nursing issues or decisions and politics awareness.

    I'm sure I'll think of some more later.....

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  • Anonymous

    Government and local management can call me whatever they like as long as they give me the tools and resources to do the job and then leave me alone to get on with it !

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  • We need competent pay, that is part of the problem. that is why others prefer to work as agency staff hence staff shortage.

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  • Anonymous

    I agree with the last comment that better pay for nurses to compensate for the skills and experience they provide.
    It helps to keep staff retention if they improve the staffing level. And lastly, to guide and support those in their career path for their progression thus produce more competent nurses that deserve to be in the higher post.

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