Is the green uniform set for a return?

Editor's Editorial

Deborah Glover - Editor PCNR

BSc (Joint Hons), Dip. Care Policy & Management, RGN

You know what it’s like –

- you have every intention of putting those loose photos into an album* but once you start looking through them, you suddenly drift back to your 13-years-old self, when your only stress was wondering why David Essex didn’t wait to marry you, or you stare at a person who looks like an axe murderer, but is in fact your great aunt Alice, which you only remember at 3am several days later.

And so it was when I started writing this editorial. I thought I would revisit some opinion pieces I had written back in 1998-1999, so was clicking away and getting completely distracted by the content. I was interested to see what had changed and what hadn’t; in one piece, written after the publication of the White Paper, ‘Making a Difference’ [1], I postulated that:

 ‘…continuing professional development is somewhat of a lottery for most nurses. Unless trusts ensure it happens for all nurses, whether through funding courses or allowing study leave, and unless there are national standards for all post registration courses, then standards will neither be national nor clear’.

And, as evidenced in the ‘Education and Societies’ section, the RCN report that 16 years later, it is still a lottery.

Four legs good, two legs bad?

Which then brought me on to State Enrolled Nurses – I know I said I wouldn’t mention the E word, but UKIP have baldly stated that they would bring them back

because we believe nursing starts and ends on the ward, we will bring back the State Enrolled Nurse, and put care and compassion back at the heart of nursing [2].

Aside from the fact that they’ve dismissed all the community, primary care, theatre, outpatient, outreach and specialist nurses, is this a good concept? Well, the Lib-Dem Care Minister Norman Lamb, believes there should be something akin to the SEN to facilitate better career progression for HCA’s post achievement of their ‘care certificate’, and a recent #NurChat and associated comments seemed to favour this [3].

Enrolled nurse courses are still up and running in Australia, and in New Zealand, the Ministry of Health is actively encouraging organisations to recruit enrolled nurse [4]. They state:

Enrolled nurses can work in a team of health care professionals under the direction of registered nurses to deliver nursing care and health education in home, community, residential care and hospital settings. Their competencies require enrolled nurses to comply with professional standards and codes to safely provide quality care.

Enrolled nurses are regulated health professionals with the knowledge and skills to:

  • contribute to nursing assessments and patient care planning
  • provide nursing care and evaluate the outcomes of care for patients and their families
  • coordinate teams of health care assistants (in some settings) under the supervision of a registered nurse
  • undertake other nursing responsibilities (eg, observe changes in patients’ conditions and report to the registered nurse; administer medicines and assist patients with activities of daily living

I have to admit, I’m inclined to agree. While undertaking a degree course to become a Registered Nurse (and btw, what was wrong with being a State Registered Nurse – title to be proud of…), is great for some, the alternative for those of a less-academic inclination or ability, is a ‘care certificate’ with little prospect for career progression. Is this because it is a task-focused training and ‘real’ nurses don’t do tasks, rather merely direct others?

Of course, the content of the course would need to be updated somewhat and practical task such as administration of IV drugs etc should be inherent in the course rather than being done after training (come to think of it, that could equally apply to current pre-reg training). And I don’t believe that anyone who fails their RGN training three times should automatically become an EN as they did when I trained.

Naturally, arguments exist for both sides; in our Comment and Opinion section, Ian Peate, Head of School, School of Health Studies in Gibraltar shares his thoughts about undertaken SEN training and how it has enhanced his career. On the other hand, one university educated nurse is particularly vehement [5], although she is slightly off point in thinking that SENs only had ward-based training. But we have to consider patient and carer feedback. In the Willis Report on the future of nurse education [6], it is stated that patients want nurses who will:

  • deliver high quality, safe, essential care to everyone and more complex care in their own field of practice
  • practise in a compassionate, respectful way, maintaining dignity and wellbeing, and communicating effectively
  • protect their safety and promote their wellbeing
  • be responsible and accountable for safe, person-centred, evidence-based practice
  • act with professionalism and integrity, and work within agreed professional, ethical and legal frameworks and processes to maintain and improve standards;

I cannot see any reason why Enrolled nurses cannot do that.

NMC Code

The Code is now with us. In this issue you'll see a critique, albeit personal rather than academic. This is not to be negative, rather pose the question why such prescriptiveness is required for a profession? Yes, of course, there have been some ugly examples of where care has failed recently, but it seems rather than going to the root of the problem and preventing this happening in the first place, everyone is hurridly coming up with words that will prove, going forward, that they've done some fire-fighting.

We all want to avoid the 'oops' situations, but with recent figures suggesting that never events are increasing, this document seems only a watering can against the Towering Inferno.




* For anyone under 20, photos used to be printed onto paper and mounted in files. I know, how primitive!