Demanding that a nurse makes a permanent move from their chosen field to plug staffing gaps compromises professional practice and patient safety, says Tina Donnelly
It infuriates me when I hear people saying that nurses can work anywhere once they have qualified.
Redeployment policies in the NHS mean that nurses are moved from pillar to post. I wonder what would happen if we were to apply this to other professional groups, such as accountants. I do not know of any accountant who would say that once qualified they can work anywhere. Like nurses, they have discrete areas of practice that share a common foundation and have specialisms.
But all of us in the nursing family, regardless of our area of clinical practice, share the common bond of caring. We became nurses because we wanted to care and help people and make a difference. Some of us have always known that we wanted to become nurses while others have come to nursing much later in life.
Caring is at the heart of nursing and everything we do. No matter how sophisticated the equipment or treatment, or how technically proficient or intellectually challenging the practice – without caring, nursing fails to deliver excellence in patient care.
“We all have reasons why we became nurses and why we chose our fields of practice”
Our professional competence and caring should not be compromised because some people believe that anyone can provide basic nursing care. I don’t understand that term. There is nothing basic about assessing vulnerable patients and planning their care to ensure the correct treatment then evaluating their progress.
The delivery of high-quality patient care depends on the skills and experience of nurses, but there are simply not enough skilled nurses in the workforce. We should not enable the powerful individuals who make decisions to redeploy nurses to use our profession to compromise patient safety and our professional practice because they do not have sufficient staff.
I agree that a nurse can choose to work in many different specialities within the community or in hospitals or clinics. A nurse’s initial training provides for transferable nursing skills, such as communication, respect and dignity in care, nutrition and hydration and compassion. These are essential in preparing a newly registered nurse for care delivery, no matter which area of nursing the nurse chooses to practice.
To put it simply, the Royal College of Nursing’s Principles of Nursing Practice describe what everyone can expect from nursing. Moreover, the principles tell us what patients, colleagues, families and carers can expect.
The RCN is closely monitoring the effects of measures being taken across the health service to help make the efficiency savings required in the economic situation we face. Identifying trends that directly affect the quality of care being delivered is important to nurses at every level. The long-term improvement and stability of the NHS across the UK should not be sacrificed in the drive to secure short-term delivery efficiency savings.
Local health boards and NHS trusts have taken to redeploying nurses to balance shortages within clinical specialties that are finding recruitment a problem.
Redeploying nurses outside their clinical fields of practice is not a quick fix to this problem of understaffing. Nurses are anxious when they are redeployed to a new clinical area to plug gaps. They worry about their competency in an unfamiliar area of practice. This leaves nurses feeling devalued.
Yet they are often placed in the position of having to move at short notice “just to help out”.
Nursing care often reaches beyond fundamental care. For example, many nurses undertake specialist study at higher education. Specialist nurses work in a defined area of practice – they may work at advanced levels in a specialist role for example, be nurse prescribers or simply focus their practice in one area, becoming experienced in that field. When these nurses are redeployed to areas outside their specialty, their efforts can be counterproductive, which may prove detrimental to patient care and to themselves.
Without orientation and training in a new area, an experienced nurse may feel inept. This may lead to feeling a lack of worth and satisfaction with the role. There is an increase in the workload of permanent staff, who have to answer questions and act as buddies for nurses new to the area. This relationship may be difficult if the incoming nurse has different ways of working.
Furthermore, selecting a field of practice is a very personal issue for a nurse. We all have reasons why we became nurses and why we chose our fields of practice.
Nurses have often chosen a specific area of practice because they feel a passion for those groups of people. Caring for children or people who are mentally ill, disabled, critically ill, older or at the end of life are all unique areas of practice.
Requesting and even in some cases demanding that a nurse makes a permanent move from her or his chosen field is unfair and can be difficult for the nurse to see that this is for the benefit for the organisation.
Tina Donnelly is director of the Royal College of Nursing in Wales