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A New Start for Nursing in England

Posted on Sep 23, 2013 by Michael Loftus

The recent national concern regarding the operation of the Health Service in England is producing a range of reform and fresh starts for health care. The most significant of changes to come about will affect the current operating systems of both wards and operating theatres. Furthermore, the nursing profession, which is of course at the very heart of care is also coming under scrutiny and new regulations regarding this profession are underway.

The health service ‘crisis’ began with concerns regarding care and management at a particular hospital in the Midlands that was  experiencing  mortality rates well out of line with other comparable institutions. The process of review and investigation at that hospital opened up a much wider review process which caused thorough searching in the health service across the nation as a whole.

Although the management and administration process in hospitals were the subject of detailed criticism, it was the failures in medical care that probably generated the most serious concern. In particular, it was the specific failings in nursing care and professionalism that caused public anxiety.

The issue of clinical care is being addressed in part through a programme that will lead to a regular publication of the ‘ success’ rates of individual surgeons. In fact, this has already begun in respect of cardiac and some other high profile surgical disciplines. In addition, other doctors will have to pass through five yearly reviews which will include an assessment by  peers and patients.

The issues within the nursing profession are more complicated, not least because a new process of regulation would need to take account of the fact that there are some 670,000 nurses working in the country. Up to now, the burden of regulation has been a process of ‘ self- certification’ whereby under a system called renewal, nurses declare themselves as being fit to practice. The sense is that with changes in the nature of care and the technologies that are used, this system is no longer adequate and certainly fails to meet heightened public expectation.

The current system was the subject of major criticism from a Parliamentary Select Committee earlier this year which examined the profession in a changing environment. Their report came to the unfortunate conclusion that the Nursery and Midwifery Council, responsible for ensuring best professional practice, were falling down in the job. The committee expressed particular concern about the backlog of cases of poor performance that had been recorded and the time that such cases generally took to come to a conclusion (there is a current backlog of around two years). It was also highlighted that there were particular problems with regard to turnover and to skills in IT within the profession that needed to be addressed and resolved. An earlier investigation by the Council for Healthcare Regulatory Excellence has come to similar conclusion as the MPs, stating that the gap between expected and actual performance of the regulator was unacceptable.

The response of the nursing profession was to propose a system of revalidation of individual nurse’s skills and competencies. The preferred option will mean that each nurse in practice undergoes an assessment every three years which will include feedback from colleagues, patients and employers on performance. Anyone not operating at the necessary standards could be prevented from practising as a nurse at all.

A programme along these lines has in fact been under discussion for some years but these developed proposals will now form the basis of a consultation process with the express aim of bringing it into operation in 2015 and the ongoing refinement of the programme after it is implemented.

However, the Council acknowledged that additional staff resources may be required to get the system up and running, particularly in the initial phases. This has been the case for doctors whereby ‘responsible officers’ are being appointed to implement their equivalent programme. Meeting the costs of this system will of course be an issue and to manage the financial implications of this, an alternative proposal envisages that the revalidation process might have to slip to being a five yearly exercise.

The Government, the regulator and the Royal College of Nursing all agree that there is a major task to undertake which needs to ensure that the ability all nurses – whether newly qualified of with experience – meets the dual needs of achieving the expectations of patients as well as the wider public in respect of both technical skills and the exercise of compassion and sensitivity. The imperative of being both competent and caring in equal measure presents it challenges but patients and their families are entitled to expect this.

The significant challenge to the profession in the immediate future is to develop the practicality of a revalidation system and to implement it to the satisfaction of all of the relevant stakeholders at a time when nursing continues to experience an unfamiliar and uncomfortable, although necessary, degree of public scrutiny.

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