A vision for nursing in Scotland
Scotland’s new strategy for nursing emphasises personalised care and a shift towards nursing in the community. But there is also a new focus on nurse well-being – a topic close to the heart of chief nursing officer Fiona McQueen.
Scotland’s new strategy for nursing emphasises personalised care and a shift towards nursing in the community. But there is also a new focus on nurse well-being – a topic close to the heart of chief nursing officer Fiona McQueen
When Scotland’s chief nursing officer Fiona McQueen travelled the country to talk to people about what was important for nursing now and in the future, several messages came through.
Nurses and nursing students agreed that what they wanted to do was provide compassionate, rights-based care. They wanted respect for their profession across all care settings, and they wanted decent and dynamic career pathways, with the proper support and education at every stage.
But there was something else as well. ‘One of the things that surprised me was nurses talking about their own health and well-being,’ says Professor McQueen. ‘We’ve always been committed to the health and well-being of nurses, but the feedback really affirmed that nurses care about the health and well-being of patients, of course, but that they also recognise that their own health and well-being is important. So that was something we really wanted to emphasise.’ (See box.)
Professor McQueen’s Nursing 2030 Vision, published in July, is a strategy for the future of nursing in Scotland. Based on the views of more than 3,000 nurses, students and other stakeholders, it is a relatively short document which will be backed up by a detailed action plan, due to be published later this year, informed by an expert group.
The Vision’s overriding themes are clear: personalising care, preparing nurses for future needs and roles, and supporting nursing.
But what does this actually mean, and will the resources exist to make it happen? Scotland’s health service is facing the same problems as the rest of the UK – nurse recruitment and retention is an issue, and even the greatest optimist would admit that the financial environment is challenging. So will the Vision’s ambition to make clinical supervision available to all nurses, for example, actually be achievable?
‘I know what nursing is like – it’s busy, it’s rewarding, it can be stressful, it can lead to people burning out’
Professor McQueen acknowledges the challenges, but has confidence it will happen. ‘I know what nursing is like – it’s busy, it’s rewarding, it can be stressful, it can lead to people burning out. Lifting your head up and looking at the art of the possible can seem a step too far. Clinical supervision benefits practitioners and the safety of the public. It’s effective and it should be built in.’
Safe staffing legislation, due to be brought in for the Scottish NHS, plus the workforce tools that already exist, should help, she says.
On recruitment, she says nursing student intake is increasing, and there are also efforts to widen access to nursing, some targeting areas where there are specific issues, such as an initiative to encourage healthcare assistants in more rural issues to be trained as nurses.
More community nurses
The Vision was launched in Aberdeen, where Professor McQueen attended the graduation of nurses at Robert Gordon University, then visited Aberdeen Royal Infirmary. She was hugely impressed by the care being given to older people. ‘The quality of the professional leadership was palpable,’ she says. ‘What they call Welcome Wards had open visiting, and the care from the multidisciplinary team was breathtakingly impressive.’
She was struck in particular by the policy of encouraging patients to use the nurse call button. ‘The message was “please call” rather than the harrumphing you sometimes hear about,’ she says. ‘Patients were in their own clothes, encouraged to sit up for meals – you could see and feel the compassion and personalised care.’
It is clear that Professor McQueen wants to see this approach replicated across Scotland and all settings, not just in hospitals. Indeed, the Vision makes it clear that by 2030 it is likely that the balance will have shifted so there are considerably more nurses working in community settings than at present – something that brings its own challenges and requires a change in mindset. ‘There will be more care at home, more people working in the community,’ she says.
‘We need to stop thinking that the only good nurse is a nurse who has hospital experience’
‘We need to stop thinking that the only good nurse is a nurse who has hospital experience, and that you shouldn’t recruit someone (as a community nurse) unless they have worked in a hospital for two years. Across the voluntary sector, there are nurses getting great experience in care homes, for example, and we should recognise the value of this experience. We need to break down the barriers between different roles in the community, and we should be employing new graduates directly into the community.’
Professor McQueen wants the Vision to be a realistic document that shapes change – and one that talks not just to nurses but to the wider healthcare community, and to the public. Perhaps that’s why it specifically says: ‘This is not about promoting the profession of nursing: it is about preparing a nursing workforce that will be ready and able to meet people’s needs as we move towards 2030.’
Surely it’s possible to do both? ‘Of course I want to promote nursing as a profession,’ she responds. ‘But this Vision isn’t about grandiosing nursing, or “bigging up” the profession – it’s about meeting the needs of the people of Scotland. I don’t want people to look at it and say “so what?”. I want them to recognise that this is about developing a sustainable nurse workforce for the future.’
To read Nursing 2030 Vision click here
CNO leads by example: 'I've lost over seven stone'
Fiona McQueen knows from first-hand experience just how physically and emotionally challenging nursing can be, and how it can take a toll on nurses’ own health and well-being.
That’s why she was so keen that the Vision should stress the importance of protecting and promoting nurses’ physical and mental health – and she is leading by example, changing her own lifestyle and improving her own health.
‘I’ve lost over seven stone,’ she says. ‘I’ve got normal blood sugar, a healthy BMI, healthy waist size – all the measures you can think of. I feel transformed.
‘I had been a yo-yo dieter: it’s the challenge of being a working mum, or indeed any nurse. It’s finding the time to do the right amount of physical activity and to eat the right sort of diet. After a 12-hour shift, it can feel much easier to phone for a pizza than to shop for and cook a healthy meal.’
Now aged 56, Professor McQueen says she decided last October that ‘enough is enough’ and that she was going to change her lifestyle.
Leading by example
‘I’ve been eating healthily – brackets less,’ she laughs. ‘And I’ve increased my physical activity. It’s not rocket science.’
She wears a fitness tracker and does a minimum of 15,000 steps per day (around six and a half miles), and is a member of a gym where, to her surprise, she enjoys classes such as body pump, RPM (indoor cycling) and body balance.
‘Most of the walking is built into my day,’ she says, explaining that she gets off the train a stop early and walks around while she talks on the phone.
Her diet has involved ‘cutting out the rubbish’, by which she means most refined foods, and eating ‘real’ foods, including full-fat dairy.
She is happy to talk about her own lifestyle change, partly because she sees it as empowering to be able to lead by example, but also because she is obviously delighted with the results. ‘I don’t want to be evangelical about it, but it’s great. I’ve got so much more energy and I feel so much better.’
Jennifer Trueland is a freelance health journalist.