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.

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.

Home for Christmas

UNITED KINGDOM—I love Christmas, and I’m not afraid to admit it. There is the underlying Christian message, which, along with a dwindling minority in the U.K., I actually believe. I also like the more Victorian aspects of Christmas: Christmas trees, Christmas cards (if my wife writes them), and Christmas Day. Aware that many spend Christmas alone and face hardship here and across the world, I am grateful that my family gathers together. At some point in the holiday season, all of our eight children and five grandchildren will visit, plus husbands, partners, friends, and a dog. I won’t answer email for a fortnight. Initially, I suffer withdrawal symptoms and then settle down, to emerge at the other end ready to face the next year. And next year is going to be one of my busiest.

Looking back on 2013

This year has been busy, too, but not exceptional. I have been lucky to visit 13 countries outside the U.K., and past blogs recount my visits to Hong Kong, Italy, Finland, Germany, Ireland, Australia, the United States, Taiwan, China, Singapore, Thailand, Saudi Arabia, and Bahrain. With the exception of Thailand, I have run in each of these places, which was one of my unstated goals for the year. My running miles on the ground this year amount to 700; my miles in the air 150,000. I am, I realise, very lucky to have the funding and freedom to do this.

Looking forward to 2014

A large part of my work next year will be taken up with the United Kingdom Research Excellence Framework (REF). A periodic exercise—recent ones, then called Research Assessment Exercises, took place in 2001 and 2008—it is the mechanism whereby the British government allocates core-research funding to British universities. I serve on the subpanel for dentistry, allied health professions, nursing, and pharmacy (subpanel 3 of main panel A), led by Hugh McKenna, CBE, FRCN, FAAN, pro-vice chancellor, research and innovation (equivalent to a university vice president) at the University of Ulster. 

McKenna a mental-health nurse, is one of the leading U.K. academic nurses. The REF is multifaceted, assessing research outputs (publications and patents), environment, and impact. However, at the heart of the exercise lies peer review, and the majority of the work is reading and rating publications for their international excellence. This will occupy almost all my waking hours between January and October 2014—in my office, on trains, and on planes.

I mentioned in a previous blog that I have been asked to lead a Lancet commission on U.K. nursing. This will take place over approximately the next two years, and I am in the process of assembling the commissioners this week. Once they are in place, the work of the commission can begin, and I will let you know who my colleagues are and keep you informed of progress. Each of the people I have contacted has received a statement from me, which is my assessment of the situation in the United Kingdom at present, and I have made this available on my own blog. Comments on this are welcome, as they will inform the commission.

Everyone’s an expert

Like last year, I thought I would make it to the end of the year without some public figure making an adverse pronouncement about nursing education, but I was wrong. This time it was Vince Cable, MP (member of Parliament), secretary of state for business, innovation, and skills in the British government. Cable claimed that degrees are superfluous to many jobs and, of course, he had to include nursing. I spotted this while I was in Singapore and, just as my blood pressure was rising, I saw that Ieuan Ellis, professor at Leeds Metropolitan University, had responded in the pages of THE (Times Higher Education).

I was especially gratified at his response, titled “Sterile debate,” because Ellis speaks with authority. He is chair of the U.K.’s Council of Deans of Health. Moreover, he is not a nurse; he is a physiotherapist and a pro-vice chancellor at Leeds Metropolitan University. In his response, Ellis said of Cable, “It is unfortunate that he is seemingly unaware of the benefits to patients of nurses being educated to degree level.” He cited a large body of work as follows: “The international RN4CAST study of nurses in more than 10 European countries (including England) shows that mortality is approximately 7 percent lower for every 10 percent increase in the proportion of nurses with degrees. This backs up work in the [United States] by University of Pennsylvania scholar Linda Aiken, who found that a 10 percent increase in the number of nurses with a bachelor’s degree was associated with a 5 percent reduction in the likelihood of patients dying within 30 days of admission.”

Season's greetings

I would like to thank the many people who have visited this blog; I hope that most of those who have read it will return in 2014. This is me, signing off for 2013 and wishing you all a very Merry Christmas and a Happy New Year!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.