What future for Nursing and Nurses?

Contribution to 2020health’s recent report ‘Too posh to wash? Reflections on the future of nursing?’ 

By Kay Fawcett, Chief Nurse, University Hospitals, Birmingham NHS Foundation Trust

Nursing is based in a complex healthcare system where compassion and dignity are an expectation. Constantly discussed in the media, the suggestion that nurses are “too posh to wash” or “too clever to care” is never far away. So why is it that nurses have become the fallen angels of the care world?

Numerous high profile reports have cited cases of poor nursing care within the last 5 years and without exception they focus upon the inability of nurses to provide compassionate care.

Progress in health care has seen patient length of stay shorten, meaning that the need for effective communication has never been greater. The patient/ nurse relationship is vital to ensure that care is individualised, appropriate and timely. As the operational tempo of care has increased, the relationship between nurse and patient has become more difficult to achieve, nurses work less days and longer shifts, making continuity harder to maintain. However, nurses remain the 24 hour workforce and through rectification of their roles in delivering continuity of care, nurses will be re-energized in the public psyche.

Compassionate care comes from a variety of sources, an individual’s values to provide care to others, education and role models during a student nurse’s three years of training and vision and values of the leaders of the organisation and wards and departments in which nurses practice. Should any one of these things be missing, then the delivery of such care is almost impossible. In the future nursing must focus upon the selection of the right people at the right time with the right skills. A graduate nurse who does not recognise the importance of an individual’s dignity is worthless in a society that will see an unprecedented rise in the older population and many people living, debilitated and dependent upon care, well into their 90s.

Once registered, nurses must recognise their responsibilities to continue to deliver hands on care, act as role models and assure themselves that the tasks they have delegated are delivered to the high standard they expect for their own loved ones. Finally at Board level, there needs to be a recognition that the focus for nursing should be on providing the best care. Educational institutions which select nurses need to do so focused not only on their academic qualifications or ability to critically analyse care, but on the ability to communicate and recognise discomfort in another human being. More must be done to expose students to patients with communication problems and to the so called “challenging patient” who requires careful communication and sensitive care delivery.

Student nurses should feel part of care from the beginning of their education, and the ability to deliver the physical and psychological elements of care should be deciding factors in allowing them to become registrants. They should feel that they belong within an institution, be that

an acute hospital or a primary care setting. Moreover these institutions should feel an ownership and sense of responsibility for teaching students the right skills. In order to achieve this Nursing should be a truly integrated professional training and educational experience and should be jointly owned by health care and academic institutions.

Care is complex, and the recognition of this is often limited to things that can be measured in dashboards and via formulae. These are reflections of the technical nature of care and can be taught, audited and reported on, but these interventions are not the only key to the delivery of care in 2020. Care in the future must utilise these valuable and increasingly complex tools to support thoughtful care, care which is delivered with humanity and not by rote. To do this nurses need to see the people that they care for, not as complex diagnoses, but as the people they once were and therefore still are.

When care rounds were introduced within this organisation in 2011, it was not just because the environment, designed with a public that has space and privacy in mind, prevented

the observation of increasingly dependent patients. They were to encourage nurses to interact with patients. Sadly this was something which was increasingly lost within the busy wards and departments of hospitals. As the clinical areas became busier, communication with patients, the very thing which made patients feel safe and part of their care, became more limited.

Nurses had begun to move towards communicating with patients only at the point of intervention. Patients described isolation and a lack of people to discuss their worries and fears with. Care rounds enable patients and nurses to regain the relationship that maintains continuity of care. Carried out properly they create an opportunity for nurses to engage patients and their families, share information about their care and encourage questions.

It is vital that the leaders of nursing, including Senior Sisters and Charge Nurses, recognise the importance of being a role model, demonstrate a commitment to effective communication, regular review of each patient and challenge nurses who care by habit or by rote. These leaders are the key to excellent nursing care and where they are found wanting, care will deteriorate.

In short, nursing must move with the times, learn to do things efficiently, effectively and in less time than nurses before them. In doing so they should not leave behind the things that make nursing about care. This is not about stopping progress, for instance, education does not prevent nurses from being excellent care givers, it helps them to review their care and enables them to do a better job. Training and access to role models is essential to developing the skills that make that care about people rather than about tasks. Leadership ensures that these skills are maintained and taught effectively to new nurses and to the rest of the workforce.

Above all, supporting well selected individuals to do the right job, in an environment that shares responsibility for teaching the staff to deliver the best care they can, to people and not to conditions, is what will take nursing and nurses forward into the future.