Extract from 2020health’s report ‘Too Posh to Wash? Reflections on the Future of Nursing’
Is this nursing’s watershed? The current media battering and public disquiet about the profession of nursing appears to have hit an all time low. The Prime Minister’s statement at the start of 2012 which appears to tell the profession how to behave and what to do should make us all sit up and question why that has happened and stir us to feel ashamed.
Nursing has changed and will continue to do so as we face increasing demands of a population which has reached seven billion globally and a demographic shift which means we are seeing a much sicker, frailer and older population in our daily practice. The demographic impact has been underestimated by the profession and we have not done enough to prepare the workforce with the requisite skills and knowledge to deal with it. Do nurses today really understand that they will be working with older patients across all clinical specialties of adult nursing? Cancer, surgery, intensive care and community services? I think not. Has this impacted on the attrition rates of nurses in training? Have we been honest about what the 21st century nursing agenda is?
The Cinderella ‘geri’ services of the 1980’s and the ‘geriatric wards’ were places where the nurses who were perceived not to be able to hack it in acute services were banished. The
underestimation of the skills and values needed to work with this complex older cohort of patients with multiple comorbidities, functional deficits, mental health needs in addition to their cancer, fracture, vascular surgery or myocardial infarction is palpable across services today. Nurses have failed to grasp the full opportunity around the older patient. Nursing has created a plethora of new roles and ‘specialisms’ which should be applauded, but the generalist is needed too. This is evident in the older patients we see. The nurse in the Care Home who is seen as the ‘lowest of the low” is far from it. The dependency of residents entering a care home in 2012 is much higher, they are much frailer and will have a multiplicity of nursing needs. A complex drug regimes and clinical interventions will be required. Long gone are the days of the residential home where relatively fit and independent people live and everyone played skittles in the afternoon. The 24,000 Care Homes in the UK employ many registered nurses who are the forgotten workforce by their
nursing family. The Care Home does not have machines that go bleep or the junior doctor who can be called from the ward next door. The dependency on out of hours services, GP locums and long waits for a visit mean that the nurse in the Care Home has to know what they are doing and there is often no other registered nurse in the building to even discuss a resident with. That is where nursing has retained its place as a profession with autonomy and huge responsibility.
Bring on the new roles, clinical skills development which enhance the nurse’s ability to improve outcomes for patients or residents but we need to remember that nursing has its place at the table in equal measure to that of any other professional. It has to act in the professions best interest and not respond to the fiscal challenges without sound reason and good clinical judgement.
Extending our roles can only stretch so far. Nursing leadership has to be visible and it has to be vocal, we have lost that nationally, at board level and at the bedside in some places. The profession needs to hear what the public are saying, they need to take action to ensure the best for patients. Nursing has to be its own advocate, sharing the good, ensuring every day we challenge what is going on in our communities, hospitals and care homes.
Not to challenge is to condone, it means we have failed in our duty. Nursing is, and should be, a profession of which we are proud and of which we really want to be associated with. How many of us can truly say we feel that every day?
We are at a tipping point and we have a chance to stop this toppling over into a great abyss. We have an ageing population, we need to prepare the workforce to meet the challenges of today but also of tomorrow. We will see considerable numbers of people with dementia coming into our care, and all the additional skills that will be needed to support that are grossly underestimated. We need to stand up and be counted, speak up and stand together. We can learn a lot from medics who seem to execute the maxim ‘united we stand, divided we fall” with aplomb. Older people make up the majority of the NHS workload, the nurses banished to the ‘geriatric wards’ need to be unleashed and we all have much to learn from them if we are going to have the best for and by our patients. Cinderella has arrived at the ball.