Analysis

New model of nursing across national boundaries

Ireland's intellectual disability nurses are joining forces with the UK’s learning disability nurses by signing up to the Strengthening the Commitment policy for the future of the profession

Ireland's intellectual disability nurses are joining forces with the UK’s learning disability nurses by signing up to the Strengthening the Commitment (Scottish Government 2012) policy for the future of the profession.

The person behind the move is Ireland’s chief nursing officer (CNO) Siobhan O’Halloran, (pictured) who is committed to getting nurses to work together wherever possible.

Picture credit: Crispin Rodwell

‘One of the things I was keen on when I was appointed as chief nursing officer was joining nurses together, across the north and south of Ireland, and in other ways.

‘When I started engaging with nurses in the UK I realised there are some policies that have already been developed there. So, rather than trying to scope our own policy, I asked the other CNOs if we could engage with the UK policy. It may have to be adapted slightly, but the values base is the same, and the situation here is similar to that in the UK. Also, thinking and analysis has gone into the policy, and there has been sophisticated decision making.

‘I went to a steering group meeting in Wales and I may just as well have been here. The meeting had the right feel and it made sense to piggy back on to the UK policy. So we are bringing the Strengthening the Commitment steering group over to Ireland this month to present it to our ministers, academics and nursing leaders.’

Purest form

Dr O’Halloran, who is an intellectual disability nurse by background, says that the profession – or learning disability nursing as it is called in the UK – is nursing in its purest form.

But, she says people generally do not recognise the importance and the contribution of intellectual disability nurses because their title includes the word ‘nurse’. She suggests rebranding them as ‘specialists’ rather than nurses could solve this problem.

Re-brand

‘The title “nurse” is a block and I think we are going to have to re-brand the profession in some way. If I said tomorrow that intellectual disability nurses in Ireland are no longer going to be called nurses, but “intellectual disability specialists”, the whole country would want them.

Dr O’Halloran says: ‘I would not take the construct of being a nurse away because, in my mind, intellectual disability nursing is the purest form of nursing.

‘It exists in its own right; it did not grow up under medicine. It’s nursing, just nursing. To me, it is the purest form of caring.

Challenging

‘But I think having “nursing” in the title is problematic. If you think of the different models we have had over the years, from the medical model to an education model to a rehabilitative model to a social model, all have challenged the title of nursing, but none has challenged what nurses do.

‘These models reflect how our understanding of disabilities has improved at [different] points in time. So, for example, I would relate the social model to the 1960s, when there was generally a social revolution. But the core of nursing is still caring, and the essence of caring and nursing does not change.’

Dr O’Halloran says that if intellectual disability nurses were recognised as the experts, or specialists, that they are, people’s lives could be transformed.

First point of contact

‘I would like every mother who delivers a baby with Down’s syndrome in Ireland tomorrow to have an intellectual disability nurse as one of their first points of contact. Intellectual disability nurses should be there providing care and connecting up all the services.’

One of the things that Dr O’Halloran is working on at the moment is the closure of its ‘congregated living’ services, which are institutional settings that people have lived in for many years.

‘There have been changes here in terms of closing down some of the major campuses,’ Dr O’Halloran says. ‘There is a plan called Congregated Settings to take people out of these places and into their own homes or in community-based houses. We have a lot of legacy issues here still’.

Abuse

Ireland, like the UK, has had its problems with abuse of people with learning disabilities, and Dr O’Halloran is addressing this by speaking directly to nurses about their responsibilities to the people for whom they care.

‘We have had some difficult issues here in some of our services, not unlike those at Winterbourne View, and this has been really challenging.

‘Our regulator has made recommendations about some services and a number of them will need capital investment to bring them up to a satisfactory standard.

Fundamental problem

‘When I saw our version of “Winterbourne” on TV and read about it in the papers, what struck me was that there was a fundamental problem around care. It was a real wake-up call.

‘Some of our facilities in our big institutions are not great, as you can imagine, but to see this problem with care is absolutely horrifying.

‘This year we have decided to do a values exercise with nurses all around the country, starting with our intellectual disability nurses. I will ask them to recommit to the three core values that underpin Irish nursing: critical thinking, critical acting and critical caring.

Contract with society

‘I want to explain to nurses that the social contract between ourselves and society supersedes every other form of contract that we have. The core of nursing is us being in service to society and regardless of what goes on around us, we cannot lose [this contract].

‘If we did, we would not be nurses and would not be doing what society wants us to do. This is about values: no amount of structural rearrangement will change that.’

Like other countries in the European Union, Ireland has suffered in the recession, with more than 5,000 of its 34,000 nurses losing their jobs as a result of essential cuts to public spending.

Recruitment

As the Irish economy recovers, Dr O’Halloran is concentrating on recruiting nurses to the system, rather than relying on more expensive agency staff who were recruited in the short term to fill gaps in services.

‘The system recalibrated itself. While we took people out of the services, we replaced their nursing hours with agency hours, which is problematic because of the higher cost base.

‘We have a problem at the moment in relation to recruitment and we will be going to the UK to recruit. The economy is turning around.

Global profession

‘The recession has taken nurses out of the system, but that is only part of the story. Nursing is a global profession and there are huge opportunities for travel.

‘Nursing skills are portable, there is an expectation among young people that they will travel before they settle and I think that young nurses will develop portfolios of experiences. In my day, it was about getting a permanent job as soon as possible, but these days it’s a different experience.’

Dr O’Halloran says the biggest job in her in tray is the development of a framework for nurse staffing and skill mix.

‘I want it to put a safe staffing range across all areas, so that it’s not simply a matter of who shouts loudest gets the most nurses. There is a science behind how many nurses are needed and an evidence base world-wide that we are going to apply in Ireland.’

Ireland's plans for community-based services

In 2011, the Irish Health Service Executive published a report setting out a national policy for residential support in the mainstream community.

The plan involves moving people who currently live in ‘congregated settings’ to ordinary housing in the community, with services being provided in the normal way by GPs, home helps and other primary care services.

Congregated settings are those in which ten or more people with disabilities are accommodated in single living units or are placed in campus-based accommodation. Most people in these settings live isolated lives, apart from their communities and families, and many of them experience institutional living conditions where they lack basic privacy and dignity.

In 2011 there were 4,000 people residing in congregated settings in Ireland. Under the new plans these service users should be able to choose where and with whom they live, and receive personal support plans to facilitate their choices of community location.

The overall objective of the policy is for people with learning disabilities in Ireland to live ‘inclusive lives at the heart of the family, community and society’.

Over its seven year lifetime, 2013 and 2019, the strategy for inclusion will see residents who are currently in communal settings offered alternative housing while remaining institutions and residential campuses for ten or more people will close.

Read the Time to Move on from Congregated Settings report

Background

Siobhan O’Halloran trained as an intellectual disabilities and general nurse.

She worked in nursing and nurse education, including a stint as head of the school of nursing at the Dundalk Institute of Technology.

Since 1999 Dr O’Halloran has worked in the Irish Department of Health and Health Service Executive, for example as a nursing adviser and as the executive director of the committee responsible for transferring undergraduate nurse training from the hospital to the University sector. She was appointed Ireland’s chief nursing office in October 2013.

Reference

The Scottish Government (2012) Strengthening the Commitment. The Scottish Government, Edinburgh.

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