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Make better use of nurses' skills says leading nurse academic

Nurses are working below the scope of their practice, says leading UK nursing academic speaking at international conference

Nursing needs to go through a ‘radical upgrade’ if the increasingly complex needs of patients around the world are to be met, according to a global authority on nurse education.

Too many nurses are working well below the scope of their practice, there are not enough advanced nurse practitioners and there is a lack of investment in nurses’ postgraduate career pathways, said Anne Marie Rafferty, professor of nursing and dean of the Florence Nightingale school of nursing at King's College London.

Opening the sixth International Nurse Education Conference in Brisbane, Australia, she criticised UK governments for failing to train enough nurses in recent years, at a time when countries with similar resources have been expanding the workforce.

‘Most countries have increased their nursing student intakes because of the demands on the system,’ Professor Rafferty said.

‘Increasing complexity and comorbidity, an ageing population and higher volumes are creating the perfect storm for a threat to quality. Governments have realised that they will need more sophisticated practitioners.

‘It is not just the size of the workforce that’s important, it’s how we use nurses’ skills and how we deploy them. There is a significant skills mismatch between the level of education that nurses are receiving and what they are being asked to do. We are not using nurses’ skills well enough.’

She likened nurses’ career structure in the UK to a Christmas tree, with ‘clumping’ at the bottom, fewer roles in the middle and hardly any at the top. Investment is needed to push more nurses from the lower branches and so make best use of their knowledge and skills, she said.

Professor Rafferty added: ‘The future of nursing lies in developing more advanced roles that meet the needs of patients with more complex needs and so enable nurses to work at the top of the scope of practice.

'That will require imagination, strong managerial support and leadership from nurses themselves.

‘We need to scale up education and training to fill the skills gap in the UK. We have got a huge shortage of general practitioners and patients are being denied access to primary care.

'We need to take some money used to train doctors and invest it in producing more advanced nurse practitioners. That’s a “must-do” over the next five to ten years. 

‘However, there are question marks about how many nurse practitioners we have in the workforce, so that’s an area that we have to concentrate on.’

Professor Rafferty added: ‘We need to invest in the current workforce. I am advocating a radical upgrade of the profession, moving from a policy of all-graduate entry to investing in postgraduate career pathways.

‘We need to look not just at the shape and size of the workforce, but at the scope and skill mix of the profession. We need to upskill the current workforce and fill the gaps in primary care training to ensure access to services.’

Professor Rafferty warned that the UK government’s plan to scrap bursaries for nursing and midwifery students was likely to have unintended consequences.

In particular, fewer people are likely to join the professions as a second or third career, and those from disadvantaged backgrounds could be put off.

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