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How to solve the nursing crisis, by an insider


AS the government ponders NHS and social care funding, and crises of staffing, maybe some answers can be found in common sense.

Undoubtedly there are deep problems. For example, Robin Lewis, senior lecturer in adult nursing at Sheffield Hallam University, writes that nurse staffing is in crisis with ‘44,000 unfilled vacancies for nurses in the UK’, and that the service is reliant on overseas nurses. As he states, nursing has changed over the last forty years and most ‘nursing’ is now carried out by health care assistants with variable amounts of training. 

As I have written elsewhere, nurses are now ‘educated’ in universities to be decision-makers and problem-solvers, leaders and managers, with communication skills. It is deeply ironical that this nursing university education is questionable as to its rigour, skills level, content and evidence base. 

Baroness Caroline Cox, a former nurse, writing in the 1970s, argued that higher education for nurses is important to enable them to think critically. She herself was unhappy with ward sisters ordering her about during her training without allowing her to ask questions. But she had a warning: that education should be ‘academically sound, and not ideology in disguise’. I wonder what she thinks of the Marxist ideas that dominate much of current university nursing education.

It is self-evident that the system of nursing and nurse training is not working for patients needing the fundamentals of care at home, or in hospitals or care homes. Nor is it working for the profession which for forty years has had the wrong focus: that is, a preoccupation with how to build up the status of the profession rather than the primary objective of how to serve the public and what the public needs. 

Having written to Baroness Blackwood, the former MP for Oxford, on the subject but receiving no reply, I am hoping that by setting out these proposed reforms on Conservative Woman they may reach government eyes.

First, reform nurse training to improve patient care, recruitment and retention and be economically beneficial.

1.    Student nurses should be paid for all their practice in the community and in hospitals. They would be part of the workforce and health care team, subject to employment law, and no longer supernumerary. This would be a ‘win-win’ for the NHS and wellbeing, and recruitment and retention of student nurses because:

a) The NHS could rely on nurses in training to deliver care as part of the team and could therefore cut down on the need to employ health care assistants and agency nurses. 

b) Student nurses would no longer need to work as health care assistants alongside their placements to earn money to support themselves.

c) Patients and clients would have a more consistent and higher quality care by staff who are all employed members of the team.

2.    All nursing lecturers would work for a large proportion of their time in clinical practice supporting and supervising student nurses, ensuring evidence-based standards are being practised, and supporting the managers and other members of the team.

a) This would ensure nursing lecturers are kept up to date with their skills in practice in the NHS.

b) This would ensure student nurses are carefully supervised and supported and their competence tested.

c) For patients and clients, standards of care would be supported by the clinical teacher in liaison with the manager and necessary for Care Quality Commission assessments etc. and particularly in the light of the Francis Report.

3.    There should be a radical overhaul of the curriculum for state registration to ensure national standards of both theory and practical skills, perhaps with the use of OSCEs (observed structured clinical examinations) set and tested by an external body, a reformed and refocused Nursing and Midwifery Council.  This should be coherent and systematic, building up a body of knowledge and affirming the importance of anatomy, physiology and pathology. Understanding of diseases and disease processes is essential to all nursing fields. As the role of the nurse seems to be changing, with an emphasis on taking over more medical work, it would make sense for nurse training to work with medical training in some way for the early years.

a) National standards for registered nurses would be assessed and tested outside the teaching process, and this would ensure consistency.

b) A curriculum that focuses on pathologies of patients and clients would be more relevant to their needs in regard to their illnesses, disabilities etc and care in these illnesses and disabilities, as well as in the promotion of health, for example eating well, not smoking etc.

c) If nurses are to undertake more medical work as now and in the future, competence for patients could be ensured by sharing a proportion of medical training.

Alternatively, or in addition, health care assistants could be trained and tested on wards and in the community to a national standard, and thereby registered as ‘nurses’. That is where Florence Nightingale comes in, because it was exactly for the reason of training people to be competent and compassionate, and to end the ‘Sarah Gamp’ world of ‘care’, that she began her nurse training school at St Thomas’ Hospital in 1860, as I have written elsewhere

Though training health care assistants to be ‘proper’ nurses may be a bit like a reinvention of the wheel, it would meet the needs of patients in hospital and at home and in care homes, raise standards of care uniformly and nationally, be cheaper on the public purse, and provide an answer to the problems of staffing in the NHS. It would also be an answer for the social care crisis. Health care assistants would be titled ‘nurse’ to reflect their role in performing fundamental care, and university-trained people would be titled ‘health care organiser’ or ‘administrator’ or even ‘facilitator’.  

Is that not a return of common sense?

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Ann Bradshaw
Ann Bradshaw
Dr Ann Bradshaw is a recently retired SRN and senior lecturer in adult nursing at Oxford Brookes University. She is the author of The Nurse Apprentice 1860-1977and The Project 2000 Nurse

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