VOL: 97, ISSUE: 33, PAGE NO: 40
Elaine Ryder, MSc, BA, RGN, DN, CPT, CertEd, RNT, DNT, senior lecturer in primary and community health at Oxford Brookes University
Sula Wiltshire, BA, PGDip(ed), RGN, RM, senior lecturer in primary and community health at Oxford Brookes UniversityElaine Ryder, MSc, BA, RGN, DN, CPT, CertEd, RNT, DNT, senior lecturer in primary and community health at Oxford Brookes University
These days, many of the activities once carried out by community nurses are being delegated to other workers as employers downgrade posts to save money (O'Dowd, 2000). Is such delegation appropriate? And if there are to be fewer qualified, skilled practitioners in the future, who will ensure the quality of supervision necessary to safeguard standards?
The challenge for community nurses is to engage in this debate and ensure that appropriate care is provided for those who need it, rather than those who simply demand it. Williams et al (1997) stated that nursing is shaped by external factors such as the role of doctors and the economics of care. But practice has expanded into patients' homes, while new roles and services are emerging and new competencies, such as nurse prescribing and acute care at home, have had to be learned.
Where does this leave those patients who have been sidelined from nursing care? What happens, for example, to chronically ill people with complex needs who require knowledgeable, skilled practitioners to deliver effective care?
Professional nursing is a complex activity involving practical tasks, the gathering of data, planning, analysis and review. It serves to inform and enhance other medical interventions, as well as physiotherapy, occupational therapy, social care and welfare. It is imperative, therefore, that nurses are given recognition for the responsibility attached to such an important role.
Failing to do so risks reducing nursing to a series of tasks that can be done with little training or understanding. There are situations in which it is unwise to devolve that responsibility to someone who is not trained to make complex choices about management and care (Chambers, 2000).
Integrated nursing teams were introduced into community nursing services to enhance the contribution of nursing in the community. However, Goodman (2000) suggests that this development has been driven mainly by managerial and medical agendas rather than the nursing needs of the community. It would be interesting to hear from other community nurses how this is manifesting itself in practice.
In a society that values technology and rewards those who can perform technical tasks with money and status, it is not surprising that nurses have come to value the technical aspects of their work disproportionately. Could this lead to the essence of nursing being lost? All too often the media alerts us to incidents where basic nursing care is missing or has been devolved to untrained staff. The consequence is often an absence of care.
However, as Carper (1978) highlighted, basic care is integral to the art of nursing. Over the years nursing has failed to articulate this key aspect of the job, and because this element is often identified only through its absence it is often not considered a central tenet of nursing. Perhaps this stems from valuing nursing financially. It is possible to cost the medical element of health, such as a hip replacement, but the nursing contribution is more nebulous and therefore, perhaps, considered less important.
Could it be that the reason competence has become such a problem for nursing is that the purpose of nursing has become indistinct? Bradshaw (2000) raises the question of whether the pendulum has been allowed to swing too far towards professional freedom and too far away from service needs and requirements. If this is so, urgent restoration is needed.
- Next week: How can the NHS form effective partnerships with local services?
- The authors would like to hear from readers involved in primary care trusts who have views on the issues raised in this article. Send your comments to Mary Ward at Nursing Times, Greater London House, Hampstead Road, London NW1 7EJ, or email: firstname.lastname@example.org