Education matters
Good nursing does not come cheap Fiona Ross
L
ast week, I attended the graduation ceremony of newly qualified nurses who trained through Kingston University and St George’s, University of London programmes in Gibraltar. A small British overseas territory on the edge of Europe and a stone’s throw from Africa, Gibraltar’s health and social welfare system is based on the British NHS and represents a health and social care system in microcosm. Although the population is only 30 000, the government has to provide the full range of services and training. It is impressive that the Gibraltar government believes that investing in high-quality training for its nurses through a university franchise is important to deliver high-quality care. It therefore puzzles me that our own government and media seem to need convincing about the value of university education for nurses and underplays the importance of the knowledge base for good nursing care, for instance, combining knowledge of disease, evidence-based treatments and human and social behaviour with finely tuned practical skills and qualities of respectfulness, empathy and understanding for others. Although nursing is one of the most popular university degree choices, as evidenced by the University and Colleges Admissions Service (UCAS) applications, it worries me that prospective applicants may feel morethan-a-little apprehensive about pursuing it in the current climate with a hostile media and negative stories coming from practice. This does not affect only nurses, and can be seen with other professionals working in the public sector and service roles who are under pressure and in the political spotlight as never before. For example, there are some who say teachers are letting educational standards slip; social workers are failing to remove children from abusive families; general practitioners are not accessible or do not provide a service around the clock, which means patients are inappropriately ending up at the Accident and Emergency (A&E); and nurses, as we know, are being criticised for neglecting basic care, particularly for older people. The questions often asked are: Has nursing
lost its way? Has it become too academic? Have nurses forgotten how to give practical basic care? Nurses can and should always improve what they do and how they do it, but I believe there are other factors at play here that explain the perceptions that nursing is failing to meet expectations. These factors include a rapidly ageing population for which health systems are not prepared, poorly developed and resourced communitybased services, and financial pressures leading to cuts in nurse training places, which are now resulting in workforce shortages. In short the mantra of ‘more has to be done with less’ cannot be without consequences for the patient experience. I will illustrate this with a personal story–— three years ago, my 96-year-old mother broke
© 2013 MA Healthcare Ltd
‘
British Journal of Nursing, 2013, Vol 22, No 21
If we value the quality of care for older people, we cannot have nursing on the cheap
’
her femur. She was in the hospital for 3 weeks. I had plenty of time to observe the care, which in many ways was excellent, but she rarely saw a qualified nurse. She was in a busy 26-bed ward with mostly older people/patients of high dependency (not in the intensive care sense, but with a high level of physical, social, psychological and emotional need). They were at various stages of post-operative recovery overlaid with high degrees of mental and physical frailty. The increasing incidence of dementia within the patient population was causing pressure on staff who had to be endlessly patient with the confused–—calling for help (when someone had just been and given them time), trying to escape the ward, raiding lockers (believing it was theirs) and sometimes even getting into other patients’ beds. It was clear that there were too few nurses. The nurses who were around were kind and attentive, but horribly stretched and it was the healthcare assistants who were most visible. The problem with my mother was that
she would not drink or eat. It was not for the want of the staff trying, but tea got cold and water sat untouched. One day, as I was trying to coax her to drink, she answered flatly ‘Why, what is the point?’. I knew then there was only one thing to do and that was to get her home where she could feel more positive about herself. My point here is if an old lady has feelings of despair and is refusing to drink for her family, then in order to avoid the type of neglect we saw at Mid Staffordshire hospital, we need high level skills of observation and clinical judgment to shape individual solutions and interventions. In other words we need trained staff to recognise the signs of lassitude, depression and despair, which are common following major trauma, illness and hospitalisation. Those staff also need to have the skills to motivate, rebuild hope and rekindle interest. Understanding the links between emotional and physical wellbeing are vital for recovery and rehabilitation. These are advanced interpersonal and therapeutic skills that take experience and education to develop–—although they are difficult to articulate and challenging to measure. To complete the story about my mother, 3 years later, she is comfortable in her own home and managing with mostly family care and support. It is reassuring that Gibraltar believes in investing in its nursing workforce. In the UK, we need to stand up for education too and acknowledge if we are to give the right quality of care we need to train enough staff, support learning in practice and develop nursing home-based care. Therefore, if we value the quality of care for older people, we cannot have nursing on the cheap. I am glad about the government’s recent announcements that nursing staffing levels will be publicly available at the ward level. BJN This is a step forward.
Fiona Ross Dean and Professor of Primary Care Nursing, Kingston University and St George’s, University of London
1255
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 26, 2015. For personal use only. No other uses without permission. . All rights reserved.
Good nursing does not come cheap Fiona Ross
L
ast week, I attended the graduation ceremony of newly qualified nurses who trained through Kingston University and St George’s, University of London programmes in Gibraltar. A small British overseas territory on the edge of Europe and a stone’s throw from Africa, Gibraltar’s health and social welfare system is based on the British NHS and represents a health and social care system in microcosm. Although the population is only 30 000, the government has to provide the full range of services and training. It is impressive that the Gibraltar government believes that investing in high-quality training for its nurses through a university franchise is important to deliver high-quality care. It therefore puzzles me that our own government and media seem to need convincing about the value of university education for nurses and underplays the importance of the knowledge base for good nursing care, for instance, combining knowledge of disease, evidence-based treatments and human and social behaviour with finely tuned practical skills and qualities of respectfulness, empathy and understanding for others. Although nursing is one of the most popular university degree choices, as evidenced by the University and Colleges Admissions Service (UCAS) applications, it worries me that prospective applicants may feel morethan-a-little apprehensive about pursuing it in the current climate with a hostile media and negative stories coming from practice. This does not affect only nurses, and can be seen with other professionals working in the public sector and service roles who are under pressure and in the political spotlight as never before. For example, there are some who say teachers are letting educational standards slip; social workers are failing to remove children from abusive families; general practitioners are not accessible or do not provide a service around the clock, which means patients are inappropriately ending up at the Accident and Emergency (A&E); and nurses, as we know, are being criticised for neglecting basic care, particularly for older people. The questions often asked are: Has nursing
lost its way? Has it become too academic? Have nurses forgotten how to give practical basic care? Nurses can and should always improve what they do and how they do it, but I believe there are other factors at play here that explain the perceptions that nursing is failing to meet expectations. These factors include a rapidly ageing population for which health systems are not prepared, poorly developed and resourced communitybased services, and financial pressures leading to cuts in nurse training places, which are now resulting in workforce shortages. In short the mantra of ‘more has to be done with less’ cannot be without consequences for the patient experience. I will illustrate this with a personal story–— three years ago, my 96-year-old mother broke
© 2013 MA Healthcare Ltd
‘
British Journal of Nursing, 2013, Vol 22, No 21
If we value the quality of care for older people, we cannot have nursing on the cheap
’
her femur. She was in the hospital for 3 weeks. I had plenty of time to observe the care, which in many ways was excellent, but she rarely saw a qualified nurse. She was in a busy 26-bed ward with mostly older people/patients of high dependency (not in the intensive care sense, but with a high level of physical, social, psychological and emotional need). They were at various stages of post-operative recovery overlaid with high degrees of mental and physical frailty. The increasing incidence of dementia within the patient population was causing pressure on staff who had to be endlessly patient with the confused–—calling for help (when someone had just been and given them time), trying to escape the ward, raiding lockers (believing it was theirs) and sometimes even getting into other patients’ beds. It was clear that there were too few nurses. The nurses who were around were kind and attentive, but horribly stretched and it was the healthcare assistants who were most visible. The problem with my mother was that
she would not drink or eat. It was not for the want of the staff trying, but tea got cold and water sat untouched. One day, as I was trying to coax her to drink, she answered flatly ‘Why, what is the point?’. I knew then there was only one thing to do and that was to get her home where she could feel more positive about herself. My point here is if an old lady has feelings of despair and is refusing to drink for her family, then in order to avoid the type of neglect we saw at Mid Staffordshire hospital, we need high level skills of observation and clinical judgment to shape individual solutions and interventions. In other words we need trained staff to recognise the signs of lassitude, depression and despair, which are common following major trauma, illness and hospitalisation. Those staff also need to have the skills to motivate, rebuild hope and rekindle interest. Understanding the links between emotional and physical wellbeing are vital for recovery and rehabilitation. These are advanced interpersonal and therapeutic skills that take experience and education to develop–—although they are difficult to articulate and challenging to measure. To complete the story about my mother, 3 years later, she is comfortable in her own home and managing with mostly family care and support. It is reassuring that Gibraltar believes in investing in its nursing workforce. In the UK, we need to stand up for education too and acknowledge if we are to give the right quality of care we need to train enough staff, support learning in practice and develop nursing home-based care. Therefore, if we value the quality of care for older people, we cannot have nursing on the cheap. I am glad about the government’s recent announcements that nursing staffing levels will be publicly available at the ward level. BJN This is a step forward.
Fiona Ross Dean and Professor of Primary Care Nursing, Kingston University and St George’s, University of London
1255
British Journal of Nursing. Downloaded from magonlinelibrary.com by 138.253.100.121 on November 26, 2015. For personal use only. No other uses without permission. . All rights reserved.
