A chance to shape the future of children’s nursing
The NMC consultation on new proficiency standards, which closes on 12 September, is an opportunity to equip childrens nurses properly for the future, says Doreen Crawford
The education and training of childrens nurses is changing at a speed that has worried many nurse academics. Two changes that have been rapidly imposed are the removal of the bursary and the introduction of a range of new training and educational models including nurse apprentices and nursing associates.
These new roles have the potential to complement the workforce of registrants, healthcare assistants and maternity support workers, as well as improving the health outcomes for children, but what is worrying some in the RCNs children and young peoples (CYP) community is what has been perceived as a lack of...
The NMC consultation on new proficiency standards, which closes on 12 September, is an opportunity to equip children’s nurses properly for the future, says Doreen Crawford
The education and training of children’s nurses is changing at a speed that has worried many nurse academics. Two changes that have been rapidly imposed are the removal of the bursary and the introduction of a range of new training and educational models including nurse apprentices and nursing associates.
These new roles have the potential to complement the workforce of registrants, healthcare assistants and maternity support workers, as well as improving the health outcomes for children, but what is worrying some in the RCN’s children and young people’s (CYP) community is what has been perceived as a lack of meaningful consultation, transparency and an apparent drive towards generic/core standards (Carter et al 2015).
Change for the right reasons
The CYP community is not against change but it wants change for the right reasons. There is a need for the continuation of a child health workforce. The child health nurse who is fit for the future will have a background in mental health problems, learning disabilities and public health. A curriculum encompassing these aspects and more would benefit all children and their families – and improve child health outcomes.
The situation in post-registration children’s nursing is also of concern. There has been a piecemeal approach to post-registration educational provision and, in most areas, there is a lack of national standards.
In neonatal nursing, for example, there are only a small number of specialist training places commissioned from the higher education providers (HEIs) and the provision of some of these programmes was not profitable for some HEIs. This resulted in many programmes being cancelled.
The lack of nationally agreed standards for education, training and assessment of competence in neonatal care has resulted in variable standards between providers. Some institutions will have an eye on attainment, attrition and student satisfaction data, but will be providing a curriculum and assessment schedule that may not equip neonatal specialist nurses to be completely competent when caring for the most challenging preterm and newborn infant.
The pre-registration education and training for the child specialty is a three-year course. The programme of preparation is graduate level and mirrors the mental health, learning disability and adult nursing programmes. The programmes are provided by Nursing and Midwifery Council (NMC)-approved HEIs that have been through a validation approval process.
Scotland, Wales and Northern Ireland are not planning changes to nurse education and training at the moment, however in England the training places commissioned by Health Education England (HEE) had the cap on numbers lifted. The HEE workforce plan for England 2016-17 indicated that this was to avoid future workforce shortages (HEE 2016).
The plan considered mental health and adult nursing but did not consider the shortages in child health, including neonatal care. It was predicted that there would be an increased demand for children’s nurses (creating a 42,000 shortfall by 2020), but it also stated that there was no consensus on the future demand for nursing and midwifery across the NHS.
The removal of the bursary has affected the recruitment of nursing students, as the most recent UCAS figures have demonstrated, but it is unclear if the child health field has been as affected as adult, learning disability and mental health.
Post-registration education and training includes NMC-recognised programmes for school nurses, health visitors and district nurses, but also includes qualified in specialty (QIS) and programmes not recognised by the NMC, such as neonatal and children’s intensive care programmes. As ratios of QISs can be built into service standards this is, perhaps, an oversight.
A need for change
As society and populations change, healthcare also needs to change. The NMC consultation would appear to be more generic with a core of proposed skills and these may have been proposed with a desire to set registrants apart from nursing associates or apprentices. These standards include cannulation and intravenous medicine management and they may be relevant and desirable for adult generalists. However, these skills could be considered questionable for newly qualified children’s nurses when the difficulties and risks in cannulating small infants and young children are considered.
Perhaps the biggest driver for change is to improve health outcomes for children. The UK, despite being a wealthy nation and having an accessible healthcare system, has compared unfavourably in some areas with other developed nations (Children and Young People’s Outcomes Forum (CYPOF) 2015). The Royal College of Paediatrics and Child Health (RCPCH) (2017) review of public health indicated there had been some improvement but stated that more needed to be done.
Child health workforce
The healthcare needs of children, young people and families are evolving and maintaining the status quo is not an option. Progress is needed. New technologies and medical advances mean that children and young people with serious illnesses or long-term conditions are living longer.
Many people are presenting with different health needs, reflecting changes in the environment and in society. Different care pathways, treatment, support options and new approaches to care challenges are needed. The expectations of care and advances in communication present threats, opportunities and challenges to children and families. The children’s workforce needs to respond to this.
The workforce education and training theme group (CYPOF 2015) recommended a system that was adaptable and able to work across professional boundaries to develop and maintain a flexible, responsive and integrated children’s workforce. It considered a life-course approach to planning the healthcare workforce. This would align the education and training of other professional groups, social care, youth justice, education, wider NHS services and public health to ensure the development of an integrated children’s and young people’s workforce.
Dynamic approach to education
Critically, the workforce group did not want a service set in stone – they wanted a dynamic process. To create a CYP nursing workforce that is sufficiently flexible to meet modern and emerging needs, the process preparing them should also be flexible and responsive. The NMC’s standards for education (2010) are seven years old. By the time the new standards are released they could be obsolete.
The RCN forums proposed a model of the child health nurse of the future (RCN 2007), an integrated programme of preparation that was family-focused and child-centred. This model was never piloted nor trialled, which was a missed opportunity. As a theoretical model it has stood the test of time, so rather than reinvent the wheel it might be a good starting point to build on.
The NMC consultation closes on September 12. For more information click here
About the author
Doreen Crawford is nurse adviser with consultancy Crawford McKenzie and consultant editor, Nursing Children and Young People
Find out more
- Carter B, Clarke D, Crawford D et al (2015) Generic training will not prepare nurses of the right calibre to care for children and families. Nursing Children and Young People. 27, 6, 8-9.
- Children and Young People’s Outcomes Forum (2015) Report of the Children and Young People’s Health Outcomes Forum 2014/2015
- Health Education England (2016) Raising the Bar: Shape of Caring; Health Education England’s Response
- Nursing and Midwifery Council (2010) NMC Standards for Pre-Registration Nursing Education
- Royal College of Nursing (2007) Preparing the Child Health Nurse - Fit for the Future
- Royal College of Paediatrics and Child Health (2017) State of Child Health
- Willis P (2015) Raising the Bar
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