A workforce for the future

RCN Wales director Tina Donnelly reflects on the decade since the country pioneered an all-graduate profession in the UK

RCN Wales director Tina Donnelly reflects on the decade since the country pioneered an all-graduate profession in the UK.

Nurse education is a dynamic phenomenon. Since the 1980s, it has ceased to be solely hospital based and become a core component of university education complemented by clinical practice across a range of healthcare settings.

This education and training is demanding, however. Nursing students in Wales commence a challenging degree programme involving the completion of 4,600 hours of theoretical and clinical practice-based learning. Students who achieve this go on to the professional Nursing and Midwifery Council register as nurses, and can draw on their knowledge and skills to care for people in the NHS, as well as in the independent, voluntary, military and business sectors.

In 2002, Wales became the first country in the UK to introduce an all-graduate profession and there is now high demand across the UK for nurses from Wales because highly qualified nurses make for better patient care.

The RCN is clear that an all-graduate profession is an essential foundation of a nursing career and that the entry gates must remain as wide as possible to enable maximum uptake. There must also be opportunities for nurses to step on and off their career paths to enable life outside the profession to continue.

Health needs

There has never been a time when health care has undergone more change. As health needs become more complex and public expectations increase, nursing requires skilled researchers and strong leaders to provide the evidence on which to base practice.

The health service is grappling with socio-demographic changes as well as advances in technology and medicine. As people live longer and require access to services 24 hours a day, 365 days a year, the profession must become more responsive to help keep the population as healthy as possible.

All health service users have a right to receive care from competent, caring staff who are up to date with the most contemporary treatments available.

RCN Wales estimates that the country needs 1,000 nurses in acute care, including emergency departments and short-term surgical care units, to resolve the current problems in urgent and acute care. More generally, Wales needs more than 2,500 extra nurses across all healthcare systems.

A shortage of student nurses coming through the system, along with an increase in sickness absence and numbers of staff leaving the profession prematurely, contributes to a staffing shortfall.

Wales is especially vulnerable to this shortfall because its ageing population and growing chronic disease rates increase demand for health care.

Two years ago, RCN Wales welcomed an increase in student numbers, especially in children’s nursing places. Pre-registration nurse training places rose from 919 in 2012 to 1,011 in 2013. Yet this total remains lower than that before 2011.

In 2011, there was a 35% cut in the number of children’s nursing places so the RCN was delighted that the Welsh Government increased training places for children’s nursing in 2013.

RCN Wales gave its views as part of the commissioning process and were pleased that its concerns have been reflected in the final figures.

Investment review

RCN Wales also responded to the Health Professional Education Investment Review. The purpose of this review, which was commissioned by health and social services minister Mark Drakeford, was to establish whether the existing arrangements represented the best value for Wales or whether changes were required.

The panel proposed a single body for Wales to bring together a number of functions including strategic workforce planning, education commissioning and organisational role design.

The RCN doubts whether a single body can deliver the required workforce without adequate funding and a strategy for health and social services over the next 15 years. Experience shows that commissioning figures are based on what is affordable rather than an absolute requirement.

RCN Wales has also hosted two health education summits for nurse leaders in health care and nurse education from across Wales.

The summits focused on developing an RCN Wales strategy on the future of nurse education in Wales, including pre- and post-registration nurse, advanced practice and healthcare support worker education.

Healthcare professionals must clearly express what they want from professional education in the future, and what should be delivered in Wales. These kinds of questions are too important to be left up to the politicians alone. Healthcare professionals want a clear vision of nursing education, expressing their views on what they want for the health service and how it should look.

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