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‘I want nurses to flourish in all areas’

Nursing is a great career, declares newly-appointed chief nursing officer for Scotland Fiona McQueen. She also reveals that the reassuring care she received from nurses as a child was influential in her decision to follow in their footsteps.

At the age of seven, Fiona McQueen had the first inkling of what her future career might hold.

In hospital to have her tonsils and adenoids removed, nursing staff made her feel safe and cared for. She had a similar reaction four years later when a slipped epiphysis landed her in hospital for weeks.

‘I didn’t make a decision to become a nurse at the time but it was the influence of nurses that stayed with me,’ she says. ‘It was that sense of being reassured.’

Much might have changed since then – including the likely length of hospital stay for such conditions – but Professor McQueen’s belief in the function of nurses has stayed the same.

It is a belief that she brings to her latest role as Scotland’s chief nursing officer (CNO). She took the job on an interim basis last December and was confirmed in the post in the summer.

‘It’s important to have a connection with, and understanding of, what’s going on,’ says Scotland’s chief nursing officer Fiona McQueen

It is a challenging time for health services in Scotland; budgets are tight, demand is growing, and the ageing population means that care is getting more complex. There is also a problem in attracting enough nurses.

Workforce figures released in September, for example, show that the number of nursing and midwifery staff in Scotland is rising but, as RCN Scotland director Theresa Fyffe has pointed out (see story below), so too is the vacancy rate.

What’s in store…

The NHS in Scotland, and the nurses working there, are facing similar challenges to the rest of the UK, says RCN Scotland director Theresa Fyffe.

Providing nursing care in Scotland’s remote settings adds to the challenges facing the CNO

Picture credit: Leila Angus

Workforce (or the lack of it), an ageing population, financial constraints and the role of senior charge nurses are only a few of the issues that she lists. Add to that, Scotland’s acute geographical challenge with large rural areas, as well as pressing health inequalities, and some policy demands (for example, around children’s services) and it is clear that the new CNO’s role will be no sinecure.

So what does she think should be in Ms McQueen’s inbox? ‘Workforce figures for nursing,’ says Ms Fyffe, without hesitation. ‘I know that Fiona is all too aware that however you look at it, there aren’t enough nurses.’ She adds that there have been problems with student planning – nursing and midwifery student numbers were cut in Scotland by more than 20% between 2009 and 2012 – and says: ‘That has led us to a more difficult place. There has been some improvement but there’s a lot still to do.’

She says that although the NHS in Scotland can boast that the number of nurses is increasing, vacancy rates are also on the rise. In addition, she casts doubt on whether workforce modelling based on health boards’ own estimates of numbers of nurses needed will truly meet service needs.

‘Modelling has been informed by what the boards will employ, rather than full service needs,’ she adds.

Ms Fyffe points out that Scottish Government policy on children has meant that more health visitors have had to be employed to help meet the conditions of the Children and Young People (Scotland) Act 2014, which says that each child has to have a ‘named person’ responsible for their care and wellbeing. In pre-school children, this will often be the health visitor. Sourcing the new health visitors can help to drain away nurses from other parts of the healthcare system.

One of the overall workforce issues, she says, is that while the modelling might work for a city like Glasgow, it is less applicable to rural settings. She would like to see more emphasis on imaginative solutions such as encouraging nurses from rural areas to maintain links with their communities and return after training. Steps such as having placements away from the central belt of Scotland can help.

Ms Fyffe would also like to see more focus on the nurse practitioner role, pointing out that these senior nurses can be important, particularly in out-of-hours services and rural areas.

‘The senior charge nurse role is also something we are concerned about,’ she adds. ‘They’re still not freed to lead – in too many places, they’re still in the clinical numbers. There’s also the issue that, for some nurses, taking on these roles would mean a pay cut. For example, a band 6 nurse who is doing some evening shifts might look at the role and look at the money and decide they don’t want the hassle.’

Ms Fyffe would like to see a clinical care assurance framework – similar to Scotland’s patient safety programme – that would tackle issues such as those raised in the recent inquiry into Clostridium difficile outbreaks in the Vale of Leven Hospital.

Money is also a challenge, in Scotland as in the rest of the UK. ‘Nursing is the biggest workforce in the health service so can be a target when cuts are needed. We would argue that this is a bad plan.’

There are big issues, she adds, but RCN Scotland is already working with the new CNO to tackle them.

Similar demands

Add to that the latest staff survey, which shows that only one quarter of nurses and midwives think there are enough of them to do the job – plus the usual challenges of increasing demand and complexity – and it is clear that it is no bed of roses.

‘The challenges we face in Scotland are similar to the rest of the UK,’ Professor McQueen says. ‘How do we continue to provide high-quality care against a background of fiscal challenge?’

Brought up in Greenock on the west coast of Scotland, she is honorary professor at the University of the West of Scotland and graduated with a degree in nursing in 1982 – a time when graduate unemployment was at its height. ‘I was lucky and got a job in neurosurgery in the Southern General in Glasgow. It was a fascinating journey of discovery,’ she says.

She intended to follow a path in nursing education but moved up the ranks quickly, getting her first appointment as a nursing officer at the age of just 25. ‘It was the impatience of youth,’ she smiles. ‘I wanted to do things like implement named nurses, and much of that was resisted by management. So I decided if I couldn’t beat them, I’d join them.’

She learned much from senior colleagues, she says, but adds: ‘I felt I was the cream in the sandwich, neither fish nor fowl. I realise I had to become a clinical practitioner or get a more senior job.’

Around that time Project 2000 came along, and she was employed translating this revolution in nursing education in her local area. It was also her first real taste of workforce issues. ‘We called it “manpower planning” in those days,’ she says, slightly grimly.

In 1999, Professor McQueen became executive nurse director in NHS Ayrshire and Arran, a job she held until becoming CNO. She also took on national roles, including one as chair of the Scottish Executive Nurse Directors group.

Such varied experience garnered in a career that has spanned more than three decades is standing her in good stead. ‘I think it’s important to have a connection with, and understanding of, what’s going on. How can I give policy advice to the cabinet secretary for health if I don’t understand what’s happening at a practical level?

‘From the nursing assistant to the cabinet secretary, there should be a golden thread that supports the way that policy is put into practice and informs how that policy is made.’

Since devolution, health services in Scotland have diverged from those in England with one of the key differences being a rejection of England’s more market-led approach. However, many of the policy drivers and philosophies of care are similar. For example, Scotland is now on the way to integrating health and social care, particularly for older people, with new legislation on this due to be implemented by next April.

All of this requires a flexible and skilled nursing workforce – and the fear is that the numbers simply are not there. The new landscape means a change in thinking, says Professor McQueen.

‘There’s some fantastic nursing practice in communities and many more nurses are based in communities. But we do need to look at how we shift the balance of care against a background of the public’s continuing love affair with hospitals,’ she says.

The increase in vacancies is more complex than it looks, says Professor McQueen, adding that the decision to take on 500 more health visitors meant that health boards are in a transition period as they replace those who want to fill the new vacancies.

She acknowledges that the decision to cut nurse training numbers temporarily has had an effect on numbers of nurses coming through, but says this has since been rectified. Universities are working hard to come up with ways of reducing student attrition and ensuring that students with the right values are being recruited and supported, she adds. Imaginative ways of bringing in committed nurses are also being explored, including support for healthcare assistants wishing to train as registered nurses.

‘We can have an impact on making services sustainable, and we are making a difference’

Throughout her career, she has remained connected to patients and the difference that nursing can make to them. ‘I remember in my first staff nurse job; there was a young man from the Highlands who had head injuries and died. His family – who hadn’t been able to get there in time – were incredibly grateful that I had stayed with him.’

She has also witnessed significant developments in care. ‘Look at stroke,’ she says. ‘We’ve moved from the point where there was basically no treatment to now, where patients have CT scans and thrombolysis. It’s a transformation.’

Despite – or perhaps because of – the many current challenges, Professor McQueen thinks nursing remains a great career, especially in Scotland.

‘There are opportunities, and I want to support nurses to flourish in all areas,’ she says.

‘There’s great stuff happening, in learning disability nursing, in prisons – everywhere. Nursing is the biggest workforce in the NHS – it’s the biggest occupational group. We can have an impact on making services sustainable, and we are making a difference’.

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