The Future of Nursing and Midwifery

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The Future of Nursing and Midwifery Powered By Docstoc
					              Sue Bernhauser

Dean of the School of Human & Health Sciences,
           University of Huddersfield,
    Chair of the Council of Deans of Health
               and Commissioner
•Sometimes I think I understand everything,
       then I regain consciousness.
• The following picture has 2 identical dolphins in it.

• It was used in a case study on stress levels at an NHS hospital.

• Look at both dolphins jumping out of the water.

• The dolphins are identical. A closely monitored, scientific study

revealed that, in spite of the fact that the dolphins are identical, a

person under stress would find differences in the two dolphins.

• The more differences a person finds between the dolphins,

the more stress that person is experiencing.
Part 1: Introduction

 The Commission was a year-long process…

• Why was it needed?
• Who was involved?
• What did we do?

                                Nurses and midwives are responsible for so much of
                                what we have achieved over the last 10 years. They
                                are experts who know best how the service can meet
                                the needs of patients and their local communities.
                                We must be bold in putting them in control and at
                                the heart of our plans for a world-class NHS.

                                Prime Minister Gordon Brown, launching the
                                Commission on 10 March 2009
Why was the Commission needed?

• First overarching review of nursing and midwifery since 1972
• Changing health needs
• Major advances in treatment and care
• Rising public expectations
• Nursing and midwifery needs to be better understood,
  developed and supported
• Changes need to go further, faster
Who led the work?

• Chaired by nurse MP Ann Keen, Parliamentary Under Secretary
  for Health Services
• 20 Commissioners – expert nurses and midwives from practice,
  management, education, research and policy-making
• Support Office hosted by Department of Health

                                    The debate exposed many myths and
                                    misunderstandings about nursing, perhaps above all
                                    the mistaken idea that compassion can be separated
                                    from competence. Compassion is vital, but it is not
                                    enough: nurses and midwives must also be well
                                    educated to deliver safe, effective care.

                                    Ann Keen MP, Chair of the Commission
What the Commission did

• Extensive engagement with the public, service users, nursing
  and midwifery staff, other professionals and stakeholder
  organizations. Activities included:
    • National listening events in London and Manchester
    • Events in all 10 NHS strategic health authorities
    • Stakeholder events including a students’ day
    • Debate via the media and the Commission’s website
    • Round table discussions, one hosted by the Prime Minister.
• We received over 2500 submissions, representing the views of
  many thousands of people, and supporting evidence
Part 2: Context, policy and vision
The context

  The Commission analysed nursing and midwifery today in the
  context of:
• Socioeconomic, health and demographic trends
• The education, continuing professional development and
  supervision needed to meet future needs
• Management and workplace cultures
  We then developed:
• A value-based vision of the future that sees nurses and
  midwives in the mainstream of service planning, development
  and delivery
• 20 high-level recommendations
Our vision: six dimensions

1 High quality, compassionate care
Nurses and midwives will champion, deliver and coordinate
physical and psychosocial care for every service user, family
and carer, throughout the care pathway, and be supported
in doing so
2 Health and wellbeing
Nurses and midwives play important roles in health promotion,
disease prevention and maintaining health and wellbeing. They
champion health and wellbeing at work and elsewhere
Our vision: six dimensions

3 Caring for people with long-term conditions
Nurses’ central role in the care and support of people with
  long-term conditions and the complex health needs of ageing
  will be recognised and enhanced
4 Promoting innovation in nursing and midwifery
Nurses and midwives will work in new ways and sometimes
  new roles in response to service users’ needs
Our vision: six dimensions

5 Nurses and midwives leading services
  Nurses and midwives will be confident and effective leaders
  and champions of care, with a powerful voice at all levels of
  the health system
6 Careers in nursing and midwifery
  Nursing and midwifery offer worthwhile, appealing careers with
  high levels of responsibility and autonomy, plus opportunities
  for personal and professional development and fulfilment
Part 3: Meeting the challenge
Meeting the challenge…

• Considerable investment is made in developing nursing
  and midwifery capital – but its potential is underdeveloped
• Basic and continuing education need further investment
  and improvement, especially with the move to degree level
• Workplace cultures and teams need to be more supportive
• The public image needs updating
Meeting the challenge…

The impact of nursing and midwifery on health and health care
should be better evaluated. The Commission made two specific

1 Evaluate nursing and midwifery
Gaps in evidence-based evaluation of nursing and midwifery must
be identified to see what further research is needed
2 Measure progress and outcomes
The development of a framework of explicit, nationally
agreed indicators and outcomes for nursing and midwifery
must be accelerated
Part 4: The way forward
The nursing and midwifery pledge

Nurses and midwives must declare their commitment to society
and service users in a pledge to give high quality care to all and
tackle unacceptable variations in standards

                                      The pledge complements the NMC Code, the NHS
                                      Constitution and other professional codes and
                                      regulatory standards. Nurses and midwives must use
                                      it to guide their practice, adapting it to their work
                                      settings, and regulators and employers must ensure
                                      that their codes, policies and guidance on nursing
                                      and midwifery support it.

                                      The Commission
The pledge…

The pledge asks every nurse and midwife to:
• Uphold the NMC Code and the NHS Constitution
• Take personal responsibility for delivering effective,
  evidence-based, high quality care
• Acknowledge that service users are partners in their care
• Live up to the responsibility of being seen as role models
  for healthy living
• Engage with policy-making and decision-making

In addition to the pledge, we make
• 19 further recommendations that reflect the outcomes
  of our engagement process and provide a Call to Action
• They cover the six key themes outlined above
Theme 1: high quality, compassionate care

Senior nurses and midwives’ responsibility for care
• Uphold the pledge
• Accept full individual accountability for care
• Maintain clinical credibility
• Champion high quality care from point of care to board

Corporate responsibility for care
• Health boards must accept full accountability for commissioning
  and delivering high quality care
• Boards must appoint directors of nursing to champion care
• Cultures and structures must recognise and support senior
  nurses and midwives to deliver high quality care
More on Theme 1…

Protecting the title ‘nurse’
• The title ‘nurse’ should only be used by those registered
  by the Nursing & Midwifery Council
Regulating advanced practice
• NMC must regulate advanced nursing practice and define
  required competencies
• Consider advanced level regulation for those working in
  specialist or consultant roles
Regulating support workers
• Government and stakeholders to review and recommend
  type and level of regulation of non-registered staff
Theme 2: health and wellbeing

Nurses and midwives’ contribution to health and wellbeing
• Nurses and midwives should be supported to turn every
  interaction into a health improvement opportunity
• Active engagement in service design and monitoring
A named midwife for every woman
• To ensure coordination of care, reduction of inequalities
  and provision of support and guidance
Staff health and wellbeing
• Nurses and midwives must recognise they are role models,
  and take personal responsibility for their health and wellbeing
• Employers must care for the carers’ health and wellbeing
Theme 3:       caring for people with long-term conditions

Nursing people with long-term conditions
• Greater recognition for nurses’ lead role
• Care pathways must maximise nursing contribution
• All barriers to effective practice must be removed, for example
  to enable direct referrals from nurses to other professionals
  and agencies
Flexible roles and career structures
• Nurses must be competent and willing to work across the full
  range of health and social care settings
• Flexible career structures must be designed to support this
Theme 4: promoting innovation

Building capacity for innovation
• Nursing and midwifery fellows should be appointed to promote
  innovation in service design and delivery, as champions of change
  and leaders of transformational teams
• Develop entrepreneurial skills

Making best use of technology
• Establish a high-level group to determine how to build nursing
  and midwifery capacity to understand and influence the
  development and use of new technologies.
Theme 5: nurses and midwives leading services

Strengthening the role of the ward sister
• Take immediate steps to strengthen this linchpin role in hospital
  and equivalent in midwifery and community
• Clearly defined authority and lines of accountability for clinical
  lead roles, which must drive quality and safety
• No more than two levels between sister and nursing director
Fast-track leadership development
• Regional schemes must be established to develop and support
  potential nursing and midwifery leaders
• Successful candidates who reflect the diversity of the workforce
  must be fast-tracked to roles influencing care delivery
Theme 6: careers in nursing and midwifery

Educating to care
• Fully implement degree-level registration of all new nurses
• Effective revalidation
• Greater investment in continuing professional development
Marketing nursing and midwifery
• Tell a new story of nursing and midwifery
• Position this career as a good choice
• Recruit high-calibre candidates of all ages and backgrounds
Integrating practice, education and research
• Facilitate sustainable clinical academic career pathways
• Further develop research skills
Part 5: What next?
The next steps

• The 20 high-level recommendations provide an ambitious
  agenda and call to action
• Acting on this agenda would provide an excellent return on
  the public investment in nursing and midwifery
• It will require sustained effort and commitment from the
  Government, employers, educators and other stakeholders
• And from nurses and midwives!
                                     This will require nothing less than the renewal and
                                     revitalisation of nursing, and full recognition of the
                                     autonomy of midwifery. It will demand honesty about
                                     where things are going wrong, and commitment to
                                     making the systemic, social and cultural changes
                                     needed to put them right. We urge you to support
                                     us, and all nursing and midwifery staff, in our quest
                                     to deliver world-class health care to the people of
                                     England in the 21st century.
                                     Commendation from the Commissioners
What can I do?

• Encourage debate on the report
• Hold meetings in your workplace, union, professional
• Discuss it with colleagues, managers, Chief Executives,
  other professionals
• Think about what needs to change in your workplace
• Think about how it relates to your own work
• Use the recommendations as a lever for change and a
  platform for campaigning
• Contact your SHA lead nurse to get involved in their strategies
Campaigning tools

•   Full report and recommendations
•   Executive summary
•   Leaflet for service users
•   DVD of the report launch
•   Promotional DVD

All available at