Analysis

Mixed views on plans for the profession

England's chief nursing officer Jane Cummings and her team are busy drawing up the first draft of a new nursing and midwifery strategy, to be presented to about 500 senior nurses attending the chief nurse’s annual two-day summit in Birmingham on December 1-2

England's chief nursing officer Jane Cummings and her team are busy drawing up the first draft of a new nursing and midwifery strategy, to be presented to about 500 senior nurses attending the chief nurse’s annual two-day summit in Birmingham on December 1-2.

Nurses will be asked for feedback and those who want to add their views can do so by responding to six questions set out by NHS England before the strategy is finalised ahead of its expected launch in March next year.

The new strategy’s engagement phase is ongoing. There are 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

Ms Cummings says that exploratory discussions started last May have brought to light several themes that clinicians would like to see included in the new strategy.

These include developing and sustaining the workforce, safety and staffing, the personalisation agenda, productivity, population health, service transformation, and innovation and improvement. Clinicians indicate that the strategy should go beyond nursing and midwifery.

Training more children’s nurses is a must, according to nursing and clinical operations director at Sheffield Children’s NHS Foundation Trust director John Reid. The trust employs more than 3,000 staff and treats about 30,000 inpatients and day cases, and 161,000 outpatients a year.

Mr Reid says: ‘Prematurity and congenital abnormalities are increasingly able to be treated, but lifelong disability can result. Many of these children go home with highly complex technical interventions including home IVs, ventilation and enteral feeding. Families need to be trained in this care and require access to 24-hour assessment and support.

Vital role

‘Nursing has a vital role in supplying experienced children’s clinicians to fill this burgeoning demand and the service gap left by inadequate numbers of junior medical staff.

‘The real risk is that we fail to live up to this role. Insufficient numbers of registered nurse (child) training places, absence of dedicated paediatric advanced nurse practitioner courses, and discussions underway to skew all registered nurse training towards generic and largely adult nursing experience, potentially leave a generation vulnerable.’

Mr Reid, who is also the Association of Chief Children’s Nurses (ACCN) treasurer, adds that many schemes such as the patient feedback NHS Friends and Family Test are primarily aimed at adult services, with children’s needs only ‘shoe-horned’ in.

Needs of children

‘The ACCN would urge any review of nursing strategy to address the needs of children and set out a separate and detailed plan for this in primary, secondary and tertiary care,’ he says. ‘Children should be the focus of a society, not an afterthought.’

Divisional head of governance and nursing (children’s and women’s division) at Oxford University Hospitals NHS Foundation Trust Annette Dearmun agrees. She calls for greater recognition in any new nursing strategy of the skills required by children’s nurses.

‘Disease pathways for children are very different to those among adults, with many, such as genetic conditions, starting at birth. Children’s nurses require a special understanding of the disease process as it relates to the age and stage of the child.’

Staffing levels

Dr Dearmun, who oversees around 400 nurses and is responsible for maintaining safety and standards across four trust sites as well as overseeing safeguarding, also wants to see mandated staffing levels for children, separate to those for adults.

Senior lecturer in nursing and midwifery at De Montfort University, Leicester, Doreen Crawford thinks that mandated staffing levels, ratios and a skill mix specific to children’s nursing are needed to stop cuts to frontline staff. Like many others, she sees post-registration training as ‘ad hoc’ and ‘variable’. A national postgraduate scheme should be part of any new nursing strategy, she says.

‘We need a national initiative so that intensive care nurses in Newcastle have the same programme of preparation as those who work in Newquay.

Different education

At present, postgraduate provision is variable, so a neonatal nurse attending one university may have a vastly different education and experience from a postgraduate of another. This may not reflect the needs of the service.’

A new nursing strategy should bolster the role of nurses in research, argues clinical nurse specialist in paediatric diabetes at Nottingham University Hospitals NHS Trust Ann Brown.

Fellowships

‘Clinical nurse fellowships need to be more readily available and nurse researchers, particularly in children’s nursing, given higher credence.’

She says the existing three-year nursing and midwifery strategy Compassion in Practice, launched by Jane Cummings in December 2012, was used by the Nottingham trust to review and increase registered nurse numbers.

‘It had a big impact here and helped in conversations with finance managers, who often had a very different idea to us on what to do with money for nursing staff. It gave nurses more power,’ says Ms Brown.

Service gaps

But she hopes any new strategy will fit the community children’s nursing agenda: ‘Many primary care staff don’t want to treat under-18s as they say they are adult-trained nurses. This leaves service gaps.’

Some scepticism exists in the profession about the impact of yet another nursing strategy. Programme lead for the Bsc (Hons) Integrated Children and Young People’s Practice course at Edge Hill University in Lancashire Toni Bewley comments: ‘Nursing strategies are “best practice” documents. They have no legal backing and, like all good guidance, they are just that.’

‘Children should be the focus of a society, not an afterthought’

Given the NHS’s financial problems and the growing range of workers in health care, Ms Bewley questions whether any new strategy will be implemented, and wonders if each workforce group will receive one. ‘If so, will anyone take any notice of them?’

But NHS England points out that a 2014 report, Compassion in Practice, Two Years On, shows that the 2012 strategy delivered tangible improvements. With only a few weeks to go until the unveiling of the plans, many are counting on the new strategy to do the same.

What nurses want

Ros Godson, professional officer, health sector, Unite

‘The 6Cs have been on the whole fairly patronising to nurses, so my main recommendation is that it should support nurses, not criticise them. The government needs to lead on this and value their professionalism. We would like the new nursing strategy to have a public health approach. It is incredible that during 12 years of compulsory education, children aren’t leaving school with the knowledge base to keep themselves well. Local targets are often unrealistic and don’t take into account the facts of looking after children in the context of their family and social area.’

Ray McMorrow, RCN children and young people’s staying healthy forum chair

‘For me any strategy needs to focus on greater government commitment to providing student nurse placements. It was of note that the recent objections from health leaders to government proposed restrictions on immigration focused on our dependency on overseas nurses. At a time when youth unemployment is high, it seems a no-brainer that we should be investing in homegrown future nursing; we must build a coherent workforce of nurses with shared values that are required for the demands of 21st century health and social care. The strategy must also be both generic but also protect and enhance specialism in children and other branches.’

Joanna Smith, lecturer in children’s nursing at the University of Leeds

‘For children’s nursing, the themes identified by NHS England, such as population health, needs to focus on what this means in the context of children and young people. Often, general themes become adult focused. Safety and staffing, particularly qualified nurses with the right skill set and patient ratios, are explicitly linked and this needs much greater recognition.’

 

 

 

 

 

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