I could crush a grape...
Deborah Glover, MBE - Editor PCNR
BSc (Joint Hons), Dip. Care Policy & Management, RGN
Rarely have I been so cross...
I don't mean the cross where you seeth quietly while drinking a large glass of wine, or the cross where your frown lines are so deep that you think Botox may not be such a bad idea after all, or the cross when you have a week's worth of holiday washing to do and the machine packs up.
No, I am really, really angry. Angry that our profession is being undermined on an almost daily basis, angry at this government, responsible for a catalogue of decisions that are destroying our profession, and angy at those who are letting it happen.
Let me explain how this particular game of Buckaroo has played out. The last three objects placed on the saddle were:
- The nurse associate role
- Scrapping the nursing bursary
- The Nuffield Trust’s proposal that nurses do a Masters (failing that, some quick and dirty training) so that they can do the clinical work of junior doctors
I have to admit, I do not necessarily agree that the first two are a Bad Thing; they apparently are tenets of the ‘creation of a modern workforce’. The principle of the nurse associate role, as outlined by Health Minister Ben Gummer, is laudable:
…widening participation and social mobility in the NHS… a new nursing associate role to provide greater support for nurses and help bridge the gap between healthcare support workers and nurses.
…the nursing associate trained through the apprenticeship route… will work alongside healthcare support workers to deliver hands on care, freeing up time for existing nurses so they can use their specialist training to focus on clinical duties and take more of a lead in decisions round patient care.
This exciting new role will open up a career in the NHS and a route in to nursing for thousands of people and will help us to get the right mix of skills on our wards that patients need.
Those in this role will able to progress to becoming a registered nurse either through a further – degree level – apprenticeship or via a nursing degree, shortened to take account of the apprenticeship already done.
…there is now a clear route to becoming a nurse without having to leave to take a degree. For all aspirant nurses, there will be a dual route to a nursing degree and registration – via university or through a two-stage degree-level apprenticeship, or a mixture of the two.
Those of us of a certain age will think this sounds rather familiar. State Enrolled Nurse (SEN) anyone? These nurses were one of the NHS’s biggest assets, but sadly were thrown out with the ‘all nurses should really have degrees, you know’ bathwater. Yes some were working above their pay grade, but the majority were highly experienced, skilled and knowledgeable practitioners. As a student nurse, they were always my first port of call for information about ward routine, Sister’s foibles and where everything was kept. Medical staff, on the whole, were as happy to talk to them about patients as they were to staff nurses because they knew they spent the most time with them.
So, if the nurse associate role brings in those passionate, intelligent and practical people into nursing, with an option to further develop if one so desires, I am all for it. What I am concerned about is that as registered nurses are decimated, the associates will be landed with the roles and responsibilities (and associated accountability issues) of the RN, but without the full range of knowledge and skills required.
The scrapping of the nursing bursary will remove the ceiling on the number of nurses that can be trained in a year. Yes, I know the situation we are in is a result of scrapping the apprentice style training coupled with a glut of nurses; but managers didn’t mine the numbers enough – if they had, they would have realised that the majority of that glut would be retiring within 10-15 years - and gaily cut the number of students to bare bone levels.
Today, even with migrant staff few organisations have enough nurses to provide safe care let alone excellent and compassionate care. But according to the Department of Health, in 2014 37,000 potential nurses could not access a training place because there only a certain amount of bursaries were available. This figure may have to be taken with a large pinch of salt, but the principle holds true - more people want to be nurses than the current number of training places available.
And let’s not forget attrition rates – very hard to come by, but I have heard as much as 60% in some organisations, or those who get themselves a cheap degree then never nurse…
Student loans are probably the obvious answer; there will be no cap on the number of places available, and if one appraises the figures, repayment figures per month are negligible, particularly on a nurse’s salary! According to the DH:
…trainees will receive around 25% more funding support at university, an increase that will make a real difference to students …in addition… students studying to become a nurse, midwife or allied health professional through a second degree will be able to access student loans.
I do however, appreciate that many of you do not agree, and that you feel that scrapping of the bursary is a retrograde step. We may have to agree to disagree, but fundamentally, I believe it will go ahead and we have to find ways to make it work for the new breed of students.
Unless of course, someone comes up with a 'half-way house' alternative.
I’m not going to say anything about the third item on the saddle, the penultimate straw - the Nuffield Trust's suggestion, leapt upon by the DH, that nurses should do more of the work of junior doctors (JDs). I am old school enough to think that during an endoscopy, nurses should be at the top end reassuring the patient, not at the 'bottom' end doing it. Not saying nurses shouldn’t be innovative when it comes to patient care, just saying that they shouldn’t be doing the job of a JD – there should be an adequate number of JDs.
My definition of nursing is on the 'being with the patient doing nursing things' end of the continuum rather than the 'nursing is doing vein grafts, invasive procedures and other 'sexy' jobs' end…
So now to the item that made the mule buck…
- The closing of the DH Nursing, Midwifery and Allied Health Professionals unit
To me, this is a blatant undermining of all the professions represented. Given that the Francis report (2013) suggested that nursing had a 'weak voice', and that profession’s voice to be strengthened, this move is counterintuitive.
I have seen first hand the work that members of this unit do. Not only do they support projects that would otherwise not be recognised (for example, visiting/working with winners of the Mölnylcke Wound Academy Scholarship and Awards programme. amongst other things), they provide impartial advice to the Government about nursing because they are civil servants - they do not have a personal or political agenda.
According to the government, advice will be given by Jane Cummings, chief nursing officer based in NHS England, with further 'specialist' advice from various ‘experts’ dotted hither and thither. Have a read of Brian Booth’s article (Comment and Opinion) for an ex-insider’s view on the use of such ‘independents’.
Call to action
So, with this perfect storm of activities which surely are designed to erase nursing as a profession altogether, instead of spitting tacks and generally being Moany McMoanFace, I have started a petition to get the government to reconsider this decision. When my partner asked why I had to start this rather than the RCN, NMC or other nursing body, I didn't really have an answer, except to tell him that after being honoured with an MBE for services to nursing and nursing journalism, it behooves me to speak up for nursing whether or not the more official bodies do so. I may be opening myself to a Chuck Connors 'Branded' type stripping of this gong here (Google it if you are under 50!), but I don't have a choice.
I appreciate that unfortunately, the whole country has a lot of other things to worry about at the moment, but I urge you, and your friends, and your friend’s friends to sign this (but only if they live in the UK). Even if you are Scottish or Welsh and don’t really like us anymore, remember it may be your turn next….
The petition can be found here. Please sign; after all, it’s your future and your profession we are fighting for!