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Specialist posts add to the squeeze

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VOL: 98, ISSUE: 04, PAGE NO: 33

Alex Mathieson, RGN, RNMH

I am not naturally sympathetic to nurse managers. While I was working in the NHS, I found they tended to be reactionary forces hell-bent on stifling innovation.

I am not naturally sympathetic to nurse managers. While I was working in the NHS, I found they tended to be reactionary forces hell-bent on stifling innovation.

But I have to say that, as 2002 dawns, my heart goes out to them. Nurse managers in Scotland are under pressure, perhaps more so than at any other time. They are being squeezed between health boards determined to prevent another winter crisis and nurses keen to develop their careers.

Health boards are concentrating on developing specialist nurse roles in the fight to prevent a winter crisis like the one reported in the press (and denied by the government) in 1999/2000. Specialist nurses are being employed in investigation and treatment units, working with people with chronic illnesses to prevent hospital admissions. They are liaising and coordinating like mad to get people home from hospital quickly, running nurse-led clinics, and diagnosing and treating patients according to protocols.

Experienced nurses from acute wards are enthusiastically filling many of these (admittedly) innovative and (hopefully) productive roles. They seem visibly less stressed than they were in their original clinical areas. They have more control over their workloads and feel valued by their medical colleagues.

But while this 'revolution' in care delivery is presenting nurses with great career development opportunities, it is giving managers a headache.

A director of nursing I know was recently drawing up a list of nurses who could be called in to staff inpatient areas during a crisis. She tried to sign the specialist nurses up to her contingency plan, but was rebuffed. When she stressed that they would be called on only during a dire emergency, the doctors entered the argument to defend 'their nurses' against having to do 'general nursing'. Specialty status, it appears, is not compatible with washing and feeding patients.

We know that direct patient care in our hospitals is largely in the hands of unqualified staff. Once it was students, now it is auxiliaries. But the creation of specialist nursing roles, whatever benefits they may bring further up the food chain, has depleted the core nursing staff of inpatient clinical areas. Nurse managers are struggling to fill the gaps - getting nurses at short notice is feasible, but getting them up to the speed on an understaffed acute ward at the busiest time of the year is almost impossible.

I'm pretty sure that if I had been offered a specialist post while a senior staff nurse, I would have jumped at it. And I would have labelled any manager who stood in my way a 'reactionary force hell-bent on stifling innovation'.

But I like to think I have grown up since then and that I would now be able to look at things from the manager's perspective. And when you are being squeezed at both ends, being reactionary is, at least, understandable.

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