'I'm only a nurse'

HULL, United Kingdom—I was teaching a group of students last week who were finishing the return-to-practice course we offer at the University of Hull. All of the students in the class are registered nurses who have taken a career break and, as a result, not met the prescribed number of hours of practice as specified by the United Kingdom’s Nursing and Midwifery Council. My task was to tell them about recent developments, including various commissions and commission reports—such as the Francis Report—that have made recommendations relevant to nursing.

The class session could not have been better timed, as publication of the Shape of Caring report had just been announced. I had not seen the report, but I was aware, based on advance information and discussions with colleagues close to Lord Willis, chair of the Shape of Caring review, what was likely to be recommended.

I knew, for example, there would be proposals for widening access to the nursing register by making it easier for health care assistants to enter nursing education by receiving credit for previous experience and undertaking a shortened programme. I questioned the wisdom of this proposal, as I have discussed previously in “Nursing education,” another blog I write. Repeating what we often hear, one of the students in the class observed that the proposal to broaden access addresses the problem of prohibiting good, caring people who wish to look after patients from doing so. 

Time to drop the apologetic "I'm only a nurse."

Michael Jung/iStock/Thinkstock

I replied that—assuming they are given the right assignments—such people should not be excluded from working with patients, but if they wish to become registered nurses, I saw no reason why they should not meet the expected entry-level educational qualifications and undertake the full educational programme. After all, we are trying to produce accountable and responsible professionals. Many may wish to become physicians, but I hear no call from anyone for widened entry gates to medicine.

The student actually agreed with me—a first! I think the problem is, many of our all-you-need-to-be-a-nurse detractors who make statements about nursing are rarely challenged. As a result, their rhetoric sticks in the minds of the public and the profession.

Wanted: An end to ‘I’m only a nurse’

I have been asked, along with others, to address in May a UK Royal College of Nursing forum that focuses on some aspects of nurse education and attitudes toward nursing. In the five minutes I’m allotted, I intend to address the apologetic “I’m only a nurse” reply that many of us give when we are asked what we do—especially if a few “high fliers” have just introduced themselves at a conference dinner table. If I never hear those words again, I will retire happy.

Lancet Commission update

Earlier in the year, after considerable thought, I decided to relinquish the lead of the Lancet Commission on UK Nursing. A few things have changed personally and professionally, and I was beginning to lose sight of our aims and how we would get there. I am glad to say that leadership is now in the excellent hands of Anne Marie Rafferty, PhD, CBE, FAAN, professor of nursing policy at the Florence Nightingale School of Nursing and Midwifery, King’s College London, and I will continue to serve on the commission.

We still aim to report in early 2016 and, despite my negative reflections on the Shape of Caring report, there is much in it that the Lancet Commission may be able to build on. Vitriolic criticism of the commission—its composition, its purpose, and the fact that it was inspired by The Lancet—continues in the nursing press, additional evidence of just how narrow minded we can be in UK nursing.

The Far East and Middle East beckon

I am in the process of packing for a week in China where I will address a conference in Luzhou. After returning for a few days over Easter, I leave for 10 days in Saudi Arabia. You can bet you will hear all about those visits, and I will resume production of my “travelcast” podcasts.

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.