Children's nursing: why diluting skill sets would be a mistake
History tells us that a return to 'general' nurses and a generic preregistration qualification would be to the detriment of children's care and nursing skills
In their article Children’s nursing: is it time to rethink field-specific training? Edward Purssell and Rohit Sagoo ask if child field-specific undergraduate education should be abandoned in favour of a more generic programme.
Children’s nursing was recognised to be different from general nursing as long ago as 1919, and there have been attempts to remove it from the nursing register.
The current system was established when the UK Central Council for Nursing Midwifery and Health Visiting abolished general nursing and introduced the four branches.
Preregistration children’s nursing programmes are often oversubscribed
Following consultation to reflect modernising nursing careers, in 2007-08, the Nursing and Midwifery Council (NMC) continued to recognise children’s nursing as a discrete field of practice.
Training in children’s nursing has been popular but the number of places limited. Preregistration programmes are oversubscribed in most UK higher education institutions, although recruitment to adult, mental health and learning disability fields appear to be facing challenges.
The NMC’s field-specific competence standards set out the context in which each programme practices. For children’s nurses these include: issues related to consent; understanding developmental stages; advocacy, and working in partnership with children, young people and families to deliver care and support.
Potential to dilute children’s nursing workforce’s skill set
Arguments defending children’s nursing tend to focus on the unique needs of children and their place in society, but there is some difficulty in articulating why a primary child registration is important.
There have been repeated calls to reintroduce a generic preregistration qualification with specialisation in children’s nursing available only as a post-registration option. The danger of such a proposal would be to dilute the skill set of the children’s nursing workforce and significantly extend the time required to achieve it.
Replacing the principle that nurses who work with children should be educated as children’s nurses and the reintroduction of ‘general' nurses as the mainstay of the children’s nursing workforce would involve considerable risk.
Inquiries into child deaths in hospital – the Clothier report and the Bristol Children’s Heart Surgery reviews – cite the lack of paediatric competence as important factors.
One reason for appreciating history is it provides us with the opportunity to prevent such mistakes. Achieving a consensus might be difficult but the end point of a safe, sustainable service for children would be a start.
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Statement by members of the editorial advisory board of Nursing Children and Young People
- Department of Health (2006) Learning From Bristol: The Department of Health’s Response to the Report of the Public Inquiry into Children’s Heart Surgery at Bristol Royal Infirmary 1984-1995
- Glasper EA, Charles-Edwards I (2002) The Child First and Always: The Registered Children’s Nurse Over 150 years. Part Two
- NMC (2014) Standards for Competence for Registered Nurses
- Nursing Ethics (1994) Implications of the Clothier Report: the Beverly Allitt case