GAPFON is born!

HULL, United Kingdom—I have just returned from Switzerland, from the inaugural meeting of GAPFON (Global Advisory Panel on the Future of Nursing). It was a privilege to be there. Established by Hester Klopper, PhD, MBA, RN, FANSA, president of the Honor Society of Nursing, Sigma Theta Tau International (STTI), GAPFON is chaired by Martha Hill, PhD, RN, FAAN, immediate past dean and professor, Johns Hopkins University School of Nursing (USA). The meeting was attended by Patricia ‘Pat’ Thompson, EdD, RN, FAAN, chief executive officer of STTI, a glittering host of global nursing stars … and me! The full list of participants is available in this news article in Reflections on Nursing Leadership, and the work of the panel will become public through various events across the world over the next two years. I intend that the Lancet Commission on UK Nursing will work very closely with GAPFON.

GAPFON was held near Basel in the idyllic town of Mariastein, a Catholic Marian grotto owned and run by the Benedictine brothers and Franciscan sisters. Mariastein means “Maria in the stone,” in honour of reported miracles in which the Virgin Mary was said to have protected children who fell down a cliff and escaped injury. In observance of those events, a statue of the Virgin was placed in a nearby grotto.

We were accommodated in the Hotel Kurhaus Kreuz, and it was the ideal venue for a few days of peace with time to think and begin planning for the future of nursing globally. We were in the mountains, the sun shone every day, and the scenery was beautiful. Apart from the slightly thin air—my excuse for a pounding heart and heaving chest—and the frequent hills in the road, this was an ideal running spot. There was hardly any traffic on the roads, and, on my second run, I left Switzerland and ran into France for around 10 miles. It was the first time I registered two countries on my Garmin webpage on the same day.

Hotel Kurhaus Kreuz

Next week I will be in London for the Research Excellence Framework subpanel meeting, and the rest of the week I will be in Glasgow at the Royal College of Nursing of the United Kingdom International Nursing Research Conference. I look forward to hearing about the latest nursing research, meeting old friends, co-presenting on the use of social media in nursing, and launching Nursing Open.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Another expert on nursing!

HULL, United Kingdom—My next entry was to be from Basel—a report on fresh Swiss mountain air and a Who’s Who? of global nursing personalities. And then something annoyed me.

My wife got to the Sunday Telegraph (14 March 2014) the weekend before I did, taking great interest in an interview with Angela Rippon. Rippon is one of our national treasures: the first female newsreader on U.K. television and a former dancer who took the nation by surprise with a famous routine in a 1976 Christmas comedy special of the duo Morecambe and Wise. Now she fronts the occasional television special and co-chairs the dementia friendly communities champion group, something she became interested in after her mother died with dementia. Although my wife gave me some snippets from the interview, she failed—on the basis that she did not want Sunday spoiled—to read out the following quote (page 23): “Nurses themselves say that everything changed when nurses were learning in a university lecture hall, and not in the ward with hands-on practice. Because they trained on wards, they had contact with patients all the time.”

I had to take some time to catch my breath after typing the above; I nearly stopped breathing on Sunday. I am astonished by how ignorant some people are about nursing education and how ready they are to blame the ills on university education. Everything is not perfect; in fact, much is wrong. But pointing the finger at something that took place at a time when things, allegedly, got worse is simply irresponsible.

Since the halcyon days of nursing care by good-hearted angels of mercy called to the profession by God, or because they were not clever enough for medical school, so many things have changed—in the U.K. National Health Service, in the profile of patients in hospital and at home, and in our society. Of course, public figures often live in an evidence-free zone where they use their opinions to first convince themselves and, then, by taking every opportunity to air those opinions, to convince others, with each utterance making them more sure they are correct.

Linda Aiken et al.’s recent Lancet paper demonstrates the worth of graduate education for nurses. I doubt that Angela Rippon has read it, would read it, or would change her mind if she did read it. However, the most obvious error in the argument against university-educated nurses is that they do all their learning in a lecture hall. Note how “lecture hall”—as opposed to “classroom”—is often used pejoratively in these arguments, as lecture halls represent the epitome of a university education. The argument is wrong, because nursing students have always, demonstrably, spent 50 percent of their time in clinical practice. This was emphasised recently by the U.K. Nursing and Midwifery Council in response to the Francis Report on appalling standards of care in one U.K. National Health Service Trust.

OK, relax!

Good things continue to happen. Despite my present workload, my first loves—data analysis and writing—have not been neglected.

I, together with my good colleagues, David R. Thompson, PhD, FRCN, FAAN, of Australian Catholic University in Melbourne, and Wenru Wang, PhD, RN, of National University of Singapore, submitted a manuscript to Personality and Individual Differences (PAID) on the scale properties of the Mental Health Inventory. It contained a warning about the phenomenon of invariant item ordering, a desirable property of scales whereby the way in which the scale orders people is the same as the order in which they respond to the questions. Still with me?

The initial response from reviewers was longer than the submitted manuscript. However, we received some expert help on person-item fit statistics from Rob R. Meijer, PhD, professor of psychometric and statistical techniques at the University of Groningen in the Netherlands, and it has just been accepted for publication. The next paper, using the quality-of-life SF-36 scale will address some problems associated with local stochastic independence of items in questionnaires. It’s all fascinating stuff about which I love to talk, but I wonder why people avoid me in the coffee room?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

The cabbie test

HULL, United Kingdom—Wherever I go, cabbies (a UK expression for taxi or cab drivers) are never backwards at coming forwards with their views, whether in London, Dublin, Washington, D.C., or my hometown of Hull. Race, religion, or politics—no subject is off the agenda, and they tend not to care what your views are; only giving you theirs. I have twice had vociferous views on nursing expressed to me, always with frank disgust at the thought of nurses going to university.

Many years ago—1999 to be precise—I was the first professor of nursing in Ireland and part of a government committee charged with the task of establishing nursing degrees in that country. While en route from the Dublin airport to my apartment, the taxi driver asked what I did. I told him, and he “let fly” with a stream of invective about the move of Irish nursing education into universities. I thanked him for his views and took a mental note never again to tell a taxi driver what I did, exactly.

However, this week, on my way home from the railway station, lulled by a false sense of security, I told a taxi driver my occupation—and promptly regretted it. He had, at one time, worked as a nursing auxiliary, and his view was that everything nursing stood for had been lost with the move of “nurse training” into universities. My mind drifted to gratitude for that “loss.” I, too, used to be a nursing auxiliary, and I recall patients tied to chairs; tea, sugar, and milk being served in the same pot; medicines being forced on patients; and stealing from clinical areas on an industrial scale. But I kept quiet; I just wanted to get home to bed.

I have decided to inaugurate a new test—the “cabbie test.” Cabbies seem to be a barometer for the extremes of public opinion, and the opinion expressed by my drivers is not uncommon amongst the UK public. I rarely meet anyone who is glad about nurses being educated in universities, and I reckon that, even if public opinion were changed, we could not be sure it was permanent until a taxi driver asked what I did and then expressed support for university-educated nurses. When that day comes, if ever, I’ll know that a major milestone for the image of nursing has been achieved.

Running and climbing

I mentioned in my last entry that, for months, I had not broken 22 minutes in the local Saturday-morning 5 kilometre race. Well, last weekend I achieved a time of 21 minutes and 2 seconds, beating my daughter, who is an army physical-training instructor. Competitive or what! I now have 21 minutes in my sights, and, since Christmas 2013, have put the first 1,000 miles on my GPS watch.

My oldest daughter is a rock climber, and she borrowed some equipment from me this weekend to do some real climbing. During these cold, wet months, we mainly climb indoors, but my daughter—a cardiothoracic intensive-care nurse—is clearly getting outdoors. I’m keen to follow. A day on the rocks, with its unique combination of pain and terror, is one of the best forms of meditation available. It will take my mind off cabbies.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

A good week for nursing

HULL, United Kingdom—I have just returned from a week in Genoa (Genova to the locals) in the Ligurian region of Italy, on the country’s northwest coast. Once again, I taught research students at the University of Genova and liaised with collaborators about various research and writing projects. My colleagues there have translated the Edinburgh Feeding Evaluation in Dementia scale into Italian, and I was helping them test its psychometric properties. This provides me with another database on which to run my own beloved method of Mokken scaling. The sample size is small, but the results are promising and point, as does most psychometric work, to the need for a larger sample. We should get a preliminary publication out of this work.

The most important nursing paper in Europe

Linda Aiken

I said it was a good week for nursing, and I was referring to the publication last week of a paper by Aiken et al. titled “Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study.” (Linda H. Aiken, PhD, RN, FAAN, FRCN, Claire M. Fagin Leadership Professor in Nursing, professor of sociology, and director of the Center for Health Outcomes and Policy Research, University of Pennsylvania, USA, is on the Lancet Commission on UK Nursing, which I will chair, as is another co-author of the paper, Anne Marie Rafferty, PhD, CBE, PhD, FRCN, chair of nursing policy, King’s College London, UK.) The paper, published in The Lancet, is one outcome of the RN4CAST study and, in addition to showing the effect of inadequate staffing levels on failure to rescue patients, shows—clearly—the benefit of degree-level education for nurses.

Alvisa Palese, MNS, BMS, RN, associate professor, Udine University, Italy, and I were among referees of the Aiken et al. paper, and we published a comment in The Lancet alongside it. I am pleased to have played a small part in such a seminal paper, a document many of us hope will have a profound influence on European nursing education and practice. Watch for further correspondence in the pages of The Lancet. My Italian colleagues have already submitted a letter and some “heavyweights” in Canadian, U.K., and Australian nursing are “limbering up.” (They emailed me the morning before I left Genoa.)

It has also been a good week for nursing in Italy. I’m a bit late with this news, but the first six nursing academics have just been given licences for employment as full professors. (I was able to confirm the numbers just this week.) Until now, nursing academics have been promoted only to the level of associate professor. It especially pleases me that Alvisa Palese, my good friend, colleague, and—ironically—research student, is one of the six.

The Italian process for appointing senior academics is national and very rigorous. A committee—the Abilitazione Scientifica Nazionale (ASN)—makes annual judgments on the basis of individual applications. Although I am one of an international panel of assessors for the ASN, I was not involved in this last round. The primary “unit of currency” for promotion is publications, and these must be in refereed journals with an international reputation. Those with impact factors are at the top of the hierarchy.

There is worrying news that the ASN is going to make future recommendations on the basis of an individual’s h-index, and there is a rumour that an h-index of 23 will be the requirement. I have been consulted by Italian nursing academics and organisations about this, because the h-index is something about which I have written. My view on the use of h-indices per se is that caution should be exercised. Moreover, I think an h-index requirement of 23 is ludicrous. Few academics attain that level, and it is especially the case that few nurses have attained it, or will. I’m glad to say I have, but only after a 16-year professorial career.

Next ports of call

Next week, I will be in Belfast to sit on the validation panel of a nursing programme at the University of Ulster, and I have dinner booked with Hugh McKenna, CBE, PhD, FRCN, FAAN, pro vice-chancellor, University of Ulster, UK. Later this month, I go to Basel for a long weekend to discuss issues that face nursing globally with Hester Klopper, PhD, MBA, RN, RM, FANSA, president of the Honor Society of Nursing, Sigma Theta Tau International, and a select group of colleagues. We’ll be meeting under the umbrella of GAPFON (Global Advisory Panel on the Future of Nursing).

I put more than 20 Genovese miles on my Garmin GPS watch, and I plan to add Northern Ireland and Switzerland for the first time this year. My 19-year-old son just broke 20 minutes for the first time in our local 5-kilometre parkrun race. Pressure to perform in my family is terrific, but what I like most is that none of my children—most of whom are runners and climbers—expect me to do any worse than they do. For your information, my fastest 5 kilometres is 21 minutes 38 seconds, and that was last year when I was a young man of 57. I am now 58 and have not broken 22 minutes this year, but I’m working on it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.