Analysis

Professionals offer their opinions about the forthcoming nursing and midwifery strategy

Over the next few weeks, chief nursing officer for England Jane Cummings and her team will draw up the first draft of a new nursing and midwifery strategy. The draft strategy is set to be presented to around 500 senior nurses attending the chief nurse’s annual two-day summit in Birmingham, to be held next month and entitled Leading Change and Creating Value

Over the next few weeks, chief nursing officer for England Jane Cummings (pictured) and her team will draw up the first draft of a new nursing and midwifery strategy. The draft strategy is set to be presented to around 500 senior nurses attending the chief nurse’s annual two-day summit in Birmingham, to be held next month and entitled Leading Change and Creating Value.

Picture credit: Barney Newman

The nurses, from hospitals, clinical commissioning groups and non-governmental governing bodies, as well as academics and patient representatives, will be asked for their feedback on the draft strategy. Before then, those wanting to influence the development of the draft can respond to six questions set out by NHS England (see panel below). The final strategy is expected to be launched in March next year.

The engagement phase is a continuing process. Nurses who wish to take part can respond to these six questions:

  • What has worked well in Compassion in Practice?
  • What are the issues you feel we are facing?
  • What do we need to do more of to create care that is truly person centred?
  • What is your vision for care for the next 20 years?
  • What matters to you?
  • How do you see your role in supporting delivery of this vision?
Exploratory discussions

According to Ms Cummings, a former emergency nurse and national lead for emergency care, several themes that clinicians would like included in the new strategy have already emerged from exploratory discussions which started in May this year.

These include developing and sustaining the workforce, safety and staffing, the personalisation agenda, productivity, population health, service transformation and innovation and improvement. Conversations among a range of clinicians also indicate that any new strategy should go beyond nursing and midwifery, according to Ms Cummings.

Agency staff

Jane Naish, deputy chief nurse and head of quality at Milton Keynes University Hospital NHS Foundation Trust, Buckinghamshire, which has 400 inpatient beds and treats more than 200,000 outpatients a year, says that addressing the shortage of nursing staff and agency spend is top of every senior nurse’s agenda and is a must for any new nursing strategy.

The trust, which employs around 900 registered nurses, recently doubled the number of pre-registration nursing students for whom it provides practice placements, but Ms Naish says: ‘Insufficient numbers of nursing students are being trained nationally. Senior nurses are constantly balancing risk, quality and budgets. There are clearly not enough nurses to go around.’

She points out that in some cases, acute and community providers have ‘abdicated themselves’ of responsibility for training nursing students, a topic she would also like to see covered in any initiative. She also says the role of specialist nurses should be covered. ‘We are still some way from having a clear vision of the role of these nurses.’

Nurse numbers

Debbie Mazhindu, a reader in clinical nursing practice and innovation at Buckinghamshire New University and Imperial College Healthcare NHS Trust, London, agrees that the emphasis of any new strategy should be on nurse numbers.

The former intensive care nurse argues that unrewarding working conditions, such as ‘lack of attention’ to staff wellbeing and ‘taking advantage’ of goodwill to fill gaps in staffing levels, need to be addressed in any strategy.

‘We need to protect nurses and professions allied to medicine by changing the culture of the NHS to be compassionate towards staff and to look after them better. They cost a huge amount of public money to train and we need to change our working environments to keep them there,’ she says.

Workplace

Mental health nurse Niall McCrae, a lecturer at King’s College London’s Florence Nightingale School of Nursing and Midwifery, agrees and says any new strategy should focus on recruiting and retaining good nurses. ‘Making the workplace such that good nurses want to stay and develop their practice is vital. We get great nurses who find themselves in the wrong environment and who leave the profession.

'The new strategy needs to be one which motivates and improves morale and makes people feel good, rather than one which creates a more bureaucratic burden.’

Clinical careers

Senior therapist Donna Swinden, a former modern matron on an acute mental health ward, says any strategy should look at bolstering clinical careers. ‘Far more nurse consultant posts are needed. Those of us who want to succeed often find ourselves having to take managerial posts when we would rather progress working clinically if the opportunity existed.

'We had an exodus of nurses on the ward because they could see better opportunities to go from a band 6 to band 7 by training as a psychological therapist and the strategy could address this.’

She says that the current three-year nursing and midwifery strategy, Compassion in Practice (CiP), launched by Ms Cummings in December 2012, was hospital focused and NHS England should consider how any new strategy can be adopted easily by both acute and out-of-hospital settings.

The 6Cs

The CiP strategy set out six areas of action for nursing teams to focus on, known as the 6Cs: care, compassion, competence, communication, courage and commitment. Like many nurses, Gwen Moulster, clinical director and consultant nurse at the mental health and learning disability provider South Staffordshire and Shropshire Healthcare NHS Foundation Trust, questions the impact of the 6Cs policy at the level of service provision.

‘The 6Cs could have been written as a description of the way learning disability nurses work, so for me there is nothing in that strategy,’ she says.

Ms Moulster points out, however, that the learning disability health-equality framework included in the CiP strategy has, where adopted, improved practice.

With a few weeks to go until the draft nursing and midwifery strategy is unveiled, NHS England points out that a November 2014 report, Compassion in Practice, Two Years On, has shown that the strategy can deliver tangible improvements. And NHS England expects the new strategy to do the same.

What urgent care professionals want Jane Cummings’ strategy to include

Mike Paynter, consultant nurse, Somerset Partnership NHS Foundation Trust

‘There needs to be a degree of rationing within emergency care. Emergency nurses are constantly juggling multiple and often conflicting demands, such as which priority patient requires attention first.

Priority setting and risk management is something nurses are very familiar with. Any new nursing strategy must link in with other major pieces of work, such as the substantial review of urgent and emergency care by Sir Bruce Keogh. The chief nursing officer must acknowledge the significant demands on health care; not least the impact caused by the reduction in social care funding. Without an appreciation of these aspects, a revision of the strategy might risk losing the support of dedicated and compassionate nurses.’

Amanda Burston, major trauma co-ordinator, University Hospitals of North Midlands NHS Trust

‘The ageing population is stretching resources to the limit. A free and equal NHS is what we all signed up for; however, the reality is that it is not free, and it is unequal. We need a reliable service, 24 hours a day, seven days a week.

There remains inequity of services across the seven-day period; investment is required to secure the personnel structure and adequate financial backing across all sectors, including our mental health partners and community teams who engage with patient care in order to meet the seven-day demand. Complex comorbidity patients require a new area of specialist care, designed and co-ordinated from the GP sector, pharmacy monitoring and expert involvement from community and the family.’

Mike Parker, lecturer in acute and critical care nursing, University of York

‘The thing that concerns me and that I find frustrating is that strategies and protocols are made in an idealistic way, detached from the reality of budgets and staffing. We can agree to see patients within four hours, but what happens when we don’t have somewhere to put them or when a major accident happens? Unless there are resources, such as training and funding, to support new protocols, position statements or strategies such as a new nursing strategy, they just become rhetoric. They can reduce morale among staff unable to meet them or put pressure on a service already stretched beyond belief.’

Janet Youd, chair, RCN Emergency Care Association

‘Any future nursing strategy needs to cover post-registration education in specialties such as emergency care. The strategy should focus on building the required skills among nurses, rather than just focus on nurse numbers.

We need nurses in the right place with the right skill set. A huge number of experienced nurses will leave the health service over the next few years, so it is vital that newly qualified nurses coming through are trained to fill the gaps that will be left. We also need more clinical academic posts so research and evidence-based practice is embedded into clinical practice. We have a lot of universities doing research, but this can often be divorced from the front line. Research needs to be better integrated into practice.’

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