01 March 2014

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.


  1. Very interesting and informative - what do you think of introduction of apprenticeship scheme for HCAs in UK? - Will the programme be based solely on clinical scholarship - clinical pathway? Will the apprenticeship be paid? Who will replace these experienced HCAs - pre-nursing students?

  2. Thanks for the question about HCAs; what the UK government proposed was a
    scheme whereby all prospective nursing students spent a year working as
    an HCA before taking up their education. The recommendation came from
    the Francis Report (which only recommended three months) which was an
    investigation into poor standards of care in one UK National Health
    Service (NHS) Trust. The scheme is designed to give students experience
    of 'hands on' care but is very misguided. There is an assumption that
    people giving such care are the real carers as opposed to those who have
    been to university. I worked for twelve months as the equivalent of an
    HCA before I undertook my nurse 'training' (education did not feature
    when I was at that stage) and I learned a great many shortcuts to care
    and some very bad practices - HCAs are not bound by any regulatory body
    or professional standards and it is fanciful to think that the RNs swill
    have time to look after all these apprentices. The other thing is that
    the scheme is hugely expensive, the UK Council of Heads and Deans of
    Health calculated £400 million annually and the government has said that
    the costs need to be found from current budgets - it somply has not been
    thought through. There are various pilots across the country to test the
    scheme and, according to a recent article in Nursing Standard, one in ten
    of the HCAs is dropping out.