Contribution to 2020health’s report ‘Too posh to wash? Reflections on the future of nursing’
By Professor David Sines CBE, Pro Vice Chancellor, Buckinghamshire New University
In 1959 Isabel Menzies Lyth produced her classic paper “The functioning of social systems as a defence against anxiety”. This paper examined reasons for the poor retention rates of student nurses in a London hospital. It laid the foundation for work which attempts to look at the unconscious life of an organisation. Her work remains as significant today as it did fifty years ago and reminds us of the need to co-create dynamic learning environments that transcend clinical practice and academic preparation that takes place in UK universities.
If we are to instil a genuine passion for excellence amongst our student nurses then our aim must be to connect students with the reality of patient experience, aligned to the very best models and systems of evidence-based care and clinical interventions that combine the delivery of intelligent care with compassion. This journey must commence with early exposure to care ‘in vivo’, enabling patients and carers to share their ‘lived’ experience with novitiate student nurses who are welcomed into the clinical care team as valued colleagues, who will represent the next generation of professional care providers.
Such exposure from an early stage of a student’s career can be challenging to all concerned but providing the opportunity to enable students to experience different care perspectives and treatment modalities in a safe environment will lead to the earlier acquisition of key interactional and clinical skills, confidence and capability. It is also essential that as individuals responsible for the safety and wellbeing of patients/clients and others in the healthcare environment, that our students understand and comply with the standards and values of their future profession. They will be required to demonstrate the achievement of practice and theoretical learning outcomes, but also provide evidence that they are professionally suitable for their chosen career through their conduct, behaviour and human interaction with patients, carers and members of the healthcare team.
As clinical leaders and clinical academics our mutual aim must therefore be to prepare the next generation of nurses who are capable and confident to provide high quality
care for all and to ensure that our nurses are innovative, dynamic, capable and proficient in all that they do. They will need to maximise the nursing contribution to promote positive health and wellbeing to diverse and wide-ranging groups within their local populations, including those who
present with longer term conditions. Above all they must provide intelligent care, underpinned by research evidence and compassion, at all times promoting the welfare and safety of their patients without compromise to clinical standards. They must also demonstrate willingness to challenge unacceptable variations in care standards and to enhance their skills and knowledge. This must be part of a commitment to ‘future proof ’ the sustainability of the health service they assist to provide.
If nursing as a profession is to step up to these challenges then we will need to:
• prepare the future nursing workforce for the demands that will be imposed upon it for transition to a 21st Century patient group, employer and commissioner;
• build employability into our curricula from the outset to enable our students to be associated with their future employers as valued and integral members of the future workforce and in so doing expose them and socialise them to the realities of practice and the tenets of professionalism;
• ensure that our students are ‘future-proofed’ at the point of entry to the workforce, confident, competent and capable to take up their place immediately as qualified nurses and able to adapt their skills and practice as the employing organization changes and responds to external demands;
• produce autonomous, expert, evidence-based adult nursing practitioners who are capable of assisting our commissioners to design and co-deliver world class clinical services, in accordance with the vision, aims and objectives of the new NHS;
• instill a quest for non-aversive practice that develops practitioners who are fit to practice and capable of assessing and managing calculated risks in accordance with our NMC and provider Trust’s requisite standards;
• embed research, critical thinking and innovation both within the theory and practice components of our learning experience, supported by the production of effective metrics to measure success and effectiveness;
• develop dynamic placement opportunities for students that expose and challenge them to confront the complexity of health and social care, within, between and across clinical care pathways, supported by a curriculum that is ‘wrapped around the patient’s/user’s real experience and journey’;
• develop robust, enhanced and effective mentorship and preceptorship partnerships with our Trusts;
• celebrate diversity and promote equality of opportunity, responding always in an appropriate and adaptable manner to meet the diverse needs of our local patient populations; as such our nurses should be equipped to demonstrate cultural competence and cultural awareness.
Above all our next generation workforce requires access to expert mentorship and role models to nurture and inculcate excellence in practice and resilience in attitude to deliver optimal standards of care at all times, turning each patient encounter into a learning opportunity that leads to sustainable excellence. This approach will provide our nursing students with an insight into the dynamics of health care delivery and will encourage them to acquire an aptitude for creativity and innovation, always placing the patient at the heart of their agenda.