Examining in the Kingdom of Bahrain

MANAMA, Kingdom of Bahrain—The last time I visited Bahrain, I arrived on a Sunday night and took a taxi to the nearest Catholic church to attend Mass. This proved to be a mistake. The “five minutes” from the hotel, as estimated by the hotel receptionist, turned into a considerable taxi ride, miles from the Diplomatic Area (DA) where I was staying. The class of housing dropped and the width of the streets steadily reduced and, eventually, I found myself downtown, where the walls had slogans in English and Arabic. This was immediately following the Arab Spring risings, which had reached the Kingdom and the television screens. My hosts, my employers and my wife would have had a collective fainting fit if they had seen me.

I attended Mass, the only westerner, and then tried to hail a taxi. Plenty went past, but none would stop. As a mild sense of anxiety set in about my predicament—lost, dark, miles from my hotel, and in an area of obvious unrest—I was rescued by a diminutive Indian gentleman, clearly amused at my attempts to hail a taxi in that area. He promised, and duly fulfilled his promise, to lead me to safety. My escape took me through a series of back alleys and past some dubious looking local characters to an area where taxis were available. I hailed one, and my saviour disappeared down one of the alleys from which we had emerged, hardly stopping for thanks.

This is my second visit to the Middle East this year (blog passim) and my second time here as an external examiner at the Royal College of Surgeons in Ireland-Medical University of Bahrain (RCSI-MUB). I have not ventured beyond the DA and, apart from a five-kilometre run that I worked out for the early mornings (30 degrees Celsius; 86 degrees Fahrenheit) before the temperature rises to a searing 40 degrees C (104 F), I have only been to the college and restaurants. The RCSI-MUB was established in 2005 and represents one aspect of the work of the RCSI in Dublin to expand and find business in this region. As such, the RCSI is both innovative and entrepreneurial and has established a very good name for itself in Bahrain and Saudi Arabia.

The RCSI-MUB runs a School of Nursing and Midwifery here that provides undergraduate programmes, including a bridging programme for local diploma-educated nurses and a master’s programme. I examine the bridging programme and the master’s programme and, as my reports to the college have indicated, have been impressed with the standard of work and, in particular, by some of the master’s students, who have to present their work to members of the school in my presence. I predict that the School of Nursing and Midwifery here will become a powerhouse for academic and clinical nursing in the region.

In my previous entry from Finland, I promised to let you know if any of my colleagues have been invited to become fellows of the American Academy of Nursing (FAAN). I am happy to report that Sally Chan, the subject of a previous post, has been selected; also Mark Hayter, my Hull colleague and fellow editor of Journal of Advanced Nursing. The contingent of FAAN international fellows is growing, and I am very happy to be part of that group. I always look forward to my visits to Washington, D.C., but I predict that this year is going to be more fun than usual. If you see me there in October, please say hello.

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

From the land of the midnight sun

TURKU, Finland—The flight from Helsinki to Turku barely gets in the air before it lands in Turku. This very short flight takes you from the capital of Finland to the mouth of the river Aura on the nation’s southwest coast. Turku boasts a fine university, the University of Turku, which houses the Department of Nursing Science and an array of nursing scholars of truly stellar reputation in Europe and beyond, including Helena Leino-Kilpi, PhD, RN, Sanna Salanterä, PhD, RN, and Riitta Suhonen, PhD, RN. It is remarkable to find such talent in so small a department.

I, together with Ian Norman, PhD, RN, FEANS, my rival in editing and friend in research and scholarship, have been teaching writing-for-publication classes to Finnish postgraduate students—not all from Turku and not all in nursing. Norman is professor and associate dean of the Florence Nightingale School of Nursing and Midwifery at King’s College, London, and editor-in-chief of the International Journal of Nursing Studies. Over the years, I have researched, written, and published with him and have learned a great deal about acquiring research funding and managing research projects. The classes were challenging. These are some of the best research students in Scandinavia, and they questioned nearly every point we made. As usual, I came away realising that my ideas and my PowerPoints need further revision.

Compared with England and Ireland—I visited Ireland on the way here—the weather in Turku is superb. The British Isles are mostly shrouded in mist and still experiencing very cold weather despite the time of year, but Turku was 25 degrees Celsius (77 degrees Fahrenheit) with bright sunshine that only receded for about three hours after midnight. This is, almost, the “land of the midnight sun.” I managed two runs along the Aura River, still navigable well into the town of Turku, where some splendid tall ships and lots of boats moored along the banks are used as bars and restaurants. Wednesday night in Turku is Harley-Davidson night, and I think that nearly 1,000 of them were parked along the river last night, with their riders—average age easily more than 60—admiring each other’s bikes.

Work continues wherever I am. When classes ended this morning, I spent the rest of the day in my hotel room in close contact via Skype and email with Parveen Ali, PhD, PG Cert (HE) RN, RM, my good colleague at Hull. She and I, together with our expert in orthopaedic nursing, Julie Santy-Tomlinson, MSc, RGN, RNT, were awarded a small amount of money by the Royal College of Nursing (of the United Kingdom) Society of Orthopaedic and Trauma Nursing to conduct a systematic review of acute lower limb compartment syndrome (ALCS). The work will inform a consensus conference of the society convened to produce nursing guidelines for detection and management of ALCS. The report is due to be submitted by 5 p.m. today. I think we made it.

The rest of the year is shaping up. I will be in Bahrain before the end of the month. Then, after a relatively quiet two months, August will find me in Taiwan and Australia. In October, I head, in quick succession, to Hong Kong and mainland China, returning to the United Kingdom between those trips to teach at my university. The China visit leads directly—after the longest Cathay Pacific flight of 18 hours—to Washington, D.C. for the annual meeting of the American Academy of Nursing. Next month, we should hear who the new fellows are, and I am hoping the list contains at least two international fellows who are well known to me. You will be the first to know.

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

A quick visit to Rome

ROME—Frequent visits to Italy make me appreciate my proximity to continental Europe. Running along the banks of the Tiber at 6:30 a.m., with Rome waking up around me and the sun already burning the top of my head—much less protected by hair than it used to be—is one of the most memorable things I have done this year. Rome is beautiful. It certainly represents no hardship to visit these visually stunning and deeply historic places, so easily accessible from the United Kingdom.

I am here at the invitation of Gennaro Rocco, president of Ipasvi (Nursing Board of Rome) to deliver a paper, “The ethics of publication,” at the Ministero della Salute (Italian Ministry of Health). Rocco is the epitome of Italian style, manners, and leadership. He has been elected to his presidency for more than a decade, and his vision and drive have helped Ipasvi establish a Centre of Excellence for Nursing Culture and Research.

My role at the Centre of Excellence, along with other international advisers, has been to provide advice on academic publishing with a view to helping Ipasvi develop the first Italian academic nursing journal. Once again, I have been reflecting on why I am here and why I should be so lucky to visit the capitals of the world, to work with the cream of international nursing, and to do so at no expense to me or my university. Another chance encounter, the subject of a recent post, played a part.

In 2004, I co-organised a symposium on quantitative methods in nursing research at the annual International Research Conference of the Royal College of Nursing of the United Kingdom. The symposium was well attended and very well evaluated. However, the most important outcome for me was my first meeting with Alvisa Palese. Flamboyant, immaculate, and affectionate—in a word, Italian—she enthused about the session, and I have been in contact with her ever since. She is now my PhD student at Hull. This contact led to a regular series of workshops delivered to Italian postgraduate nursing students in Trieste and Genoa. These students are pioneers, especially the doctoral students, as doctoral-level education for nurses is a fairly recent development in Italy.

This has been a very short visit, but one worth reporting on, as I think that the Centre of Excellence for Nursing Culture and Research is going to become a major force for nursing change in Italy. There is such a centre in Spain, which is similar to, though slightly ahead of, Italy in development of nursing education, but I know of no other centres like this anywhere in the world.

What struck my U.K. colleagues and me most was the integration and common purpose amongst nurses engaged in professional regulation, clinical practice and education. I have also witnessed this in the United States and Australia. Sadly, in the United Kingdom, there is a void between clinical practice and academia, and our regulatory body is not especially proactive in developing the profession. We were there to advise, based on our experience, but we would give a great deal to have a Gennaro Rocco in our midst, and I envisage a day, not too far away, when senior Italian nurses are advising us in the United Kingdom. Moreover, I welcome that day.

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

Return to Riyadh

RIYADH, Kingdom of Saudi Arabia—Listening to “Brothers in Arms”—loud—on the Emirates Airline entertainment system as the Boeing 777 descended into King Khalid International Airport (KKIA), Riyadh, Saudi Arabia, I brushed away several tears. During the First Gulf War, I used to listen to this haunting and emotional song on headphones to drown out the overhead roar of American B-52 bombers, accompanied by massive refuelling planes, as they took off from the military airport in Riyadh to rain down fire and death on forward lines of Iraqi troops.

The bombers were so laden with weaponry that they took off underfuelled. After takeoff, and before proceeding to the Kuwaiti border to lighten their loads, the bombers’ fuel tanks were topped off nearby, in midair, enabling them to proceed to their target and create “fields of destruction,” a phrase from Dire Straits’ song, “Brothers in Arms.” These takeoffs were always followed by the release of a Scud missile in our direction, to which we replied with a Patriot missile from the front gate of our compound. The sickening shockwave, as it broke the sound barrier at ground level, used to make my chest reverberate.

My first visit to Saudi Arabia was courtesy of Her Majesty’s Armed Forces in which I played a small role as a nursing officer in the Royal Army Medical Corps. This time, upon exiting the plane at the airport terminal, I recognised the underground car park where, a couple decades earlier, we had established a 1,000-bed military hospital and set up our evacuation ward. And on my journey home, I walked through shops and lounges where, more than 20 years before, we set up operating theatres and general wards in what was then a newly built, but deserted, building.

This visit was entirely peaceful. I was in Riyadh at the invitation of the General Directorate of Nursing Affairs at the Saudi Ministry of Health to address the Saudi International Conference of Excellence in Patient Care  (SIEPC 2013) on the topic of writing for publication. The conference was attended by “local” nurses from the Gulf states and Jordan, as well as Europeans, Australians, and Americans. The theme of the conference, ostensibly, was about hospitals in the region achieving Magnet status, but it was an opportunity to learn about nursing and, especially, nursing education in Saudi Arabia and Jordan. If the words “Europe” or “United Kingdom” had replaced “Saudi Arabia” or “Jordan” on the program, the discussion would have been much the same.

We share many of the same problems, such as shortages of nurses and nursing faculty, and the employment of immigrant nurses, with the Philippines being a major provider. One difference in Jordan from the rest of the world is the higher proportion of men in nursing, a remarkable 60 percent. It’s actually an issue they would like to address, as it is a symptom of very high unemployment among Jordanian men. There is a deliberate strategy in Saudi Arabia toward “Saudi-ization”—the education, training, and employment of Saudi nationals in a range of professions—including nursing. The initiative is still, however, in its early days.

Meantime, many Saudi nurses visit the United Kingdom and North America to pursue master’s degrees and doctoral education. I have personally benefitted from this. I was met at the airport by Mansour Al-Yami, in full Arab dress, whose studies I supervised at the University of Sheffield. Worth following on Twitter, Al-Yami is involved in his role at the Ministry of Health in recruiting nurses to Saudi’s workforce. Soon, he defends his doctoral thesis in Sheffield.

Yours Truly with Mansour Al-Yami, former student of
mine who is now at the Saudi Ministry of Health.

At the fabulous Four Seasons Hotel, I had dinner with Professor James Ware, director, Medical Education and Postgraduate Studies, the Saudi Commission for Health Specialties, along with Wafaa Al-Johani, who works in nursing education in Jeddah. Al-Johani is one of my former doctoral students, and she made the journey especially to see me.

Wafaa Al-Johani, one of my former doctoral students.

My time in Saudi has been informative, enjoyable and, as I alluded to above, moving. I have three children and a future son-in-law in the military. One daughter returns from Afghanistan soon; she was preceded by her fiancé. Her older sister, a nursing officer in Queen Alexandra’s Royal Army Nursing Corps, leaves for Afghanistan next week. My daughters complete four generations of Watsons who have gone to war.

I often end these entries on a light note, related to my current location or next flight (Rome in May, as it happens), but I must end this one with a rhetorical question: Will the madness of war ever end?

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

Spring and winter on same day; must be Canada!

EDMONTON, Alberta, Canada—I am used to leaving the United Kingdom in cold weather and stepping out of the Sydney airport terminal into the middle of Australia’s summer, but I have never been in glorious spring one day only to be in the dead of winter later the same day—and still be in the same country.

Canada is massive, and my visit to the Faculty of Nursing at the University of Alberta in Edmonton took me through Vancouver, British Columbia, for a weekend of running, coastal walks and sitting outside with my family, watching the sun go down. After a one-hour-and-10-minute flight and one hour forward on the clock, I am now in Edmonton, and it has taken two men working all day—one with a small snowplough/digger machine, the other with a dumper truck—to clear the hotel car park. And it’s cold!

I am visiting the University of Alberta as an international visiting scholar for a few days. My visit was organised by Wendy Duggleby, PhD, RN, and Kathleen Hunter, PhD, RN, NP, GNC(C), NCA, and I have had the chance to meet a co-author of mine, Alex Clark, PhD, RN, for the first time as well as a host of other people, including Carole Estabrooks, PhD, RN, FCAHS, FAAN, who serves on the editorial board of the Journal of Advanced Nursing.

The time here is busy, with two intensive days of lecturing and leading sessions with students and staff. I was able to present some of the latest work on assessment and alleviation of feeding difficulty in older people with dementia in the Geriatric Grand Round at the Glenrose Rehabilitation Hospital in Edmonton. In addition to the audience of more than 50 people, the presentation was linked to 45 other telehealth centres in Canada. The question-and-answer session was stimulating, and encouraging. Later, I met Susan Slaughter, PhD, RN, GNC(C), together with other members of the chronicity research group, to hear about her seminal research into the causes of feeding difficulty in dementia. I was unaware of this work, and it was a lesson to me to take more time—like I used to—to scan the literature in my field of research.

My lectures were on the emergence of new methods of scholarship through social networking, and on mentorship and career development. I am not sure that everyone was convinced about the social networking, so that talk may need more development. The highlight of my time here, undoubtedly, was meeting the Master of Nursing students, who had sent me, in advance, a challenging series of questions. They covered almost everything, from my decision to enter nursing to my latest ideas for research as well as a lot in between about getting published and the future of doctoral education for nurses.

A final dinner with colleagues impressed on me that academic nursing in Canada suffers many of the same prejudices that it does in the United Kingdom. At least, I realised, we are not alone. I introduced the phrase, used against university-educated nurses in the UK, “too posh to wash,” which folk here had not heard. I hope they keep it to themselves, as I would not like that phrase to become part of the anti-university educated nurse lexicon in Canada. If it does, then blame me. My final morning here will be spent planning some future work with Alex Clark, who is as dedicated as I am to Twitter and can be followed on @alexclark1944.

In addition to meeting my family and undertaking this highly enjoyable visit to Edmonton, I came across a new Canadian “Indie pop” band called Dear Rouge, comprised of Drew McTaggart and his highly photogenic and talented wife Danielle, backed up by some excellent musicians, including Andrew Stewart. They are currently touring Canada and are well worth exploring on YouTube. Quite possibly, you heard that here first.

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

The importance of chance encounters

UNIVERSITY OF HULL, UK—As a young academic at the University of Edinburgh in the early 1990s, I attended the Royal College of Nursing of the United Kingdom Research Society Conference in Birmingham, UK. An argument with a taxi driver over the fare meant that I walked to my accommodation under a very dark cloud.

Walking in the opposite direction to me was a man, clearly of Chinese origin, who looked as if he wanted to speak—the last thing I wanted to do. However, he introduced himself as the PhD student of a colleague and good friend of mine in Glasgow, which brightened my mood a little, and we spoke for a few minutes.

More than 10 years later, I found myself sitting opposite him, unaware of who he was, at lunch in Hong Kong, and he recalled that we had met. His name was Thomas Wong. One of the most influential figures in nursing in Hong Kong, he was professor and head of nursing at Hong Kong Polytechnic University. He has, variously, chaired the Nursing Council, been dean of his faculty of health care and a vice president of the university. Currently, he is president of Tung Wah College in Hong Kong.

I have just returned from one of many visits to Hong Kong, my previous visit being the subject of an earlier blog. I was undertaking visiting-professor duties at Hong Kong Polytechnic University, where nursing is now led by another friend and colleague, Professor Alex Molasiotis. Clearly of Greek origin, Alex is a leading expert in cancer and palliative care nursing, with an outstanding CV and previous working experience in Hong Kong and mainland China. We met unexpectedly in Singapore and found a common interest in the Far East and Southeast Asia, and also my hometown of Hull, UK, where Alex studied for his master’s degree and still has family links.

Courtesy of the Cathay Pacific long-haul flight to the United Kingdom from Hong Kong, I was reflecting on the past decade, during which I have made more than 50 visits to Hong Kong. I thought about the important place that this unique and extraordinary Special Administrative Region of China (and former British colony) has had on my personal and professional life.

Personally, it is a place that is now familiar to my wife and several of my children; where I feel almost as “at home” as I do at home. Professionally, the influence Hong Kong has had on my career is obvious. It has been for me, literally, the gateway to the Far East, Southeast Asia and Australasia since, at the invitation of Professor David Thompson, then of The Chinese University of Hong Kong, I found myself in Hong Kong for the first time.

Since then, I have collaborated on research grant applications and publications with colleagues across the Far East and Southeast Asia. I am now a part-time professor in Australia and a visiting professor in Singapore. People like Thomas Wong—who I very nearly ignored the first time I met him—and Alex Molasiotis, together with countless others who took the time to get to know me—thankfully, I reciprocated—have kept me constantly engaged in activities that are amongst the most rewarding of my professional life.

If this blog entry has a moral, it is this: Never underestimate the next person you meet, never ignore people at conferences, and set no limits on where your next conversation may lead you, professionally and geographically.

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

The Mid Staffordshire Report

UNIVERSITY OF HULL, UK—In January, I referred to the Mid Staffordshire Foundation National Health Service Trust. On 6 February 2013, a final report of the Mid Staffordshire NHS Foundation Trust Public Inquiry included the following statement: “Between 2005 and 2008 conditions of appalling care were able to flourish in the main hospital serving the people of Stafford and its surrounding area.”

If you want to see just how badly wrong things can go in a nationalised system of health—the so called “jewel in the crown” of U.K. public services—read this report. Beware; it is 1,781 pages long, excluding the executive summary. Few will need to read every word, and fewer still will do so. Nevertheless, for a rapid assessment of the systemic, professional and personal failures that conspired to create the biggest scandal in the history of the U.K. National Health Service, the executive summary will suffice.

As a U.K. citizen and nurse, I am well aware of the problems in Mid Staffordshire. The U.K. media have had little difficulty in deciding what to headline in the past week, and there have been the inevitable swipes at nurses with degrees, another subject of past entries in this blog. While the public are provided with further depths to the scandal and shock and informed that no ‘heads have rolled’… yet (disciplinary proceedings may now begin), the professions are more concerned about the recommendations made by Lord Francis QC, who chaired the enquiry.

The recommendations are copious, and those related to nursing cover several pages. The range of recommendations covers the “whole nine yards,” from sublime common sense to the ridiculous type of ignorant knee-jerking that is so common when non-nurses comment on nursing. At the ridiculous end is the recommendation that the U.K. regulatory body for nursing, the Nursing and Midwifery Council (NMC), together with universities, should work over the course of several months to produce a system for testing the aptitude of nursing candidates, paying special attention to caring attitude and compassion. This ought to tie the NMC and university schools of nursing up for months deciding what to measure and how to measure it.

Surely, the three-year programme of undergraduate nursing education is at least partly supposed to weed out those unsuitable for nursing and also to mould those with promise into good nurses. I can see where Lord Francis’s idea stems from: 1) the ubiquitous driving force of the well-meaning public servant that “something must be done (about it)” and 2) that “there is something that can be done (about it).” There were manifest failures of medical and surgical care, yet there is not a similar recommendation that aspiring doctors be pretested for aptitude.

Giving credit where it is due, Lord Francis did make two excellent recommendations that would be easy to implement. The first of these, which seems uncontroversial but has eluded nursing in the United Kingdom since the mid-1980s, is a national standard for testing the competence of nurses to practice. While not wishing to use the tragic circumstances surrounding Mid Staffordshire to illuminate my own good sense and that of some close colleagues, it is interesting to reflect on some recommendations made by a few of us in 2002: “A clear finding (from this study) is that no single method is appropriate for assessing clinical competence. A multimethod UK-wide strategy for clinical competence assessment for nursing and midwifery is needed if we are to be sure that assessment reveals whether or not students have achieved the complex repertoire of knowledge, skills and attitudes required for competent practice.” I doubt we can take the credit now, but at least we can demonstrate that some nursing academics were making common-sense recommendations over a decade before Lord Francis.

The other excellent recommendation is that: “The Nursing and Midwifery Council and other professional and academic bodies should work towards a common qualification assessment/examination.” The United Kingdom long ago abandoned a national state examination for nurses but, again, along with a colleague, I have published the view that we should return to a national curriculum and a state examination for nursing. Surely, this is a recommendation worth pursuing.

This entry has been very U.K.-, not to mention self-, centred. March finds me in Hong Kong, Saudi Arabia and Canada, and also in front of my colleagues speaking about international strategy. I will also be delivering a paper on nursing leadership at a local event of the Honor Society of Nursing, Sigma Theta Tau International. I expect that next time I post, Mid Staffordshire will no longer be in the headlines and that I can report something that illuminates the best in U.K. and international nursing. Meantime, I contemplate approximately 25,000 miles of flying, jetlag and hotel rooms; actually, not the worst prospect.

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

The apprenticeship sorcerers

UNIVERSITY OF HULL, UK—As the festive season approached, I looked forward to a fortnight away from work when I could safely read the U.K. newspapers without finding cause for alarm. The end of the year is usually reserved for funny stories, advertisements by charities and reflections on the past year. However, I was wrong.

On 27 December 2012, The Daily Telegraph featured a piece titled “Become a lawyer with no degree, pupils told,” and I realised I was not going to make it to the end of the year without controversy. I made an entry on my Twitter feed the next day: “UK government wants lawyers trained by apprenticeships not degrees – parallels with nursing? where will this go?” which elicited some responses from nursing colleagues and a lawyer I know well.

I was surprised that the nurses seemed less bothered about this thinly veiled criticism of university education than the lawyer! While I trained as a nurse under the apprenticeship model and enjoyed and appreciated every day of it, I have long defended the value and necessity of nurses having degrees and the fact that there is no evidence that having a university education reduces their ability to care. There is room for both aspects of preparation in the nursing curriculum.

I was actually more interested in what the response of the legal profession would be and, specifically, if nurses with degrees would feature in it. And guess what? There were several letters in reply and extensive entries in the letters page weblog under the banner “Qualifying for a profession without taking a degree – or running up debts” and, of course, both sides of the argument were represented.

There were two references to nursing, as follows: 1) “The Government may mean well by its plan for an apprenticeship route for traditional professions, but it is ill-founded. Unless other industries, such as hospitality and nursing, abandon the requirement for a degree, a peculiar imbalance will be introduced into the higher education system.” 2) “SIR – And while we are at it, can we also please return to apprenticeships for nurses?” I find it strange and infuriating that nursing is juxtaposed with the hospitality industry and is used as an exemplar of where university degrees are inappropriate. For my non-United Kingdom readers, I must say that this is a uniquely U.K. phenomenon; the value of degrees for nurses has never been questioned—in my experience—in the United States, Australia, the Far East or Southeast Asia.

It did not end there. The year was nearly over when The Sunday Times, never a great supporter of academic nursing, managed to include nursing in a retrospective swipe by Minette Marrin—foremost amongst our critics—at everything that had annoyed her over the year in a piece titled “Pesky clerics, Europhiles, nurses’ leaders – it’s all change for you” on 30 December 2012. Referring to the frequent reports of poor nursing care in the U.K. media, Marrin questioned the purpose of nursing leaders in the United Kingdom; easy and obvious targets, of course, but not the people directly responsible for the delivery of poor care that appears to take part in isolated pockets such as the Mid Staffordshire Foundation National Health Service Trust, where a bullying culture has developed and there is a general cynicism about continuing professional development—the very thing usually criticised by people like Marrin.

Therefore, 2012 ended on a slightly negative note from my perspective, but a new year lies ahead and, while reports of poor care and unwarranted criticism of academic nursing in the United Kingdom will continue, I have a lot to look forward to elsewhere in the world. In 2013, I will visit Italy, Finland, Canada, Bahrain, Hong Kong, China, the United States and Australia. I look forward to blogging from some of these places.

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

Meet Professor Sally Wai-Chi Chan!

SINGAPORE—I am spending a month in Singapore, the “melting pot” of Southeast Asia. Singapore is a melting pot for two reasons. First, the heat and humidity are excruciating. Even the mildest exercise outdoors induces profuse perspiration and laboured breathing. The only respite this time of year is the daily monsoon downpour, but even that is lukewarm.

Singapore is also a melting pot in another sense; it is one of the most multicultural places in the world. And it is entirely peaceful. Draconian sentencing and harsh punishments by the local judiciary tend to enforce good manners and tolerance. Nevertheless, appreciation of other cultures seems genuine. The place is fabulously rich with 17 percent of the population being millionaires (Singapore dollars).

This visit—my third to Singapore—is to the National University of Singapore, currently ranked No. 25 in the world in QS World University Rankings (No. 2 in Asia). Specifically, I am at the Alice Lee Centre for Nursing Studies, located in the Yong Loo Lin School of Medicine, recently ranked the top medical school in Asia by QS. Founded in 2006, the centre is led by Professor Sally Chan.

Sally Wai-Chi Chan

I have known Sally for more than 20 years, ever since we both arrived in Edinburgh. I was a new lecturer and Sally, along with her husband Bing-Shu Cheng, was a new MSc in nursing student. A decade later, we met again when Sally was working in the Nethersole School of Nursing at Chinese University of Hong Kong, where I had been appointed external examiner for their master’s in nursing programme. Thus began my frequent travels to the Far East and Southeast Asia and a rekindled professional relationship with Sally.

Sally is energetic, ambitious and productive. She has always been visible and vocal, both as a student and as an academic. Her leadership in mental health nursing research and the mark she made on delivery of services in Hong Kong is remarkable, and her output of publications is impressive. Sally was clearly destined for leadership, and she is now in a key position to lead the development of this relatively new centre and to contribute to academic nursing in Singapore.

I am lucky to benefit from being one of a succession of international visiting scholars and professors to the Alice Lee Centre for Nursing Studies. Sally has made it her trademark to work with the best and learn from the best. In turn, those of us lucky enough to come here frequently learn a great deal from the diligence, dedication and sheer hard work of the local academic and nursing population. Working days are long here, but the rewards are concomitant.

Sally is an outward-looking, horizon-scanning person, and this was recently exemplified by her visit to my own University of Hull. At present, Singapore does not allow nurse prescribing, but an ageing demography, together with nursing and medical-personnel shortages, will necessitate some new approaches to delivery of care and some shifting of professional boundaries. Sally wants to be at the forefront of this change, and the purpose of her visit to the United Kingdom was to learn about nurse prescribing programmes—Hull was a pioneer in this respect—and to see what links could be formed to help prepare her for advancing this initiative in Singapore.

Leadership

Leadership is hard to define but obvious when you see it. It is demonstrated in many ways and under different circumstances. The circumstances in Singapore could not be more ready for leadership such as that displayed by Sally Chan and, as a result of her far-sighted thinking in pursuing an academic career in Australia and the United Kingdom, (largely outside her native Hong Kong), she could not have been more ready for her current leadership role.

I often ponder my own leadership skills and wonder if the opportunity awaits me to demonstrate them; it has eluded me to date! Next week finds me in Bangkok and then Hong Kong before I head home to the UK for Christmas. In the meantime, at leisure, I think about the vagaries of professional and academic life, and where better to do so than the world-famous Long Bar of Raffles Hotel in Singapore.

"Barman!"

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

Impacting the impact factor

UNIVERSITY OF HULL, UK—The impact factor, a proxy measure of journal quality using citations, is often maligned and rarely praised. Nevertheless, it is studied avidly and regularly. And when there is evidence of journal editors blatantly trying to manipulate it by artificially increasing the number of citations to their own journals in their own journals, it creates controversy. However, all editors of journals cited in the impact factor league tables keep a close eye on impact factor and make—legitimate—efforts to ensure that they maximise their opportunities to maintain and improve their positions. It is well known, for example, that review papers, methodological papers and controversial papers (even ones that are wrong) are rapidly and highly cited and make a significant contribution to impact factor.

What is the impact factor?

The impact factor is a measure of citations (A) in a given year (e.g., 2011) to particular papers (B) published in the previous two years (e.g., 2009 and 2010). The impact factor is A divided by B. Excluded are contributions such as correspondence and editorials. However, it is worth noting that citations in these entities do contribute to A.

It is also worth noting that papers cited in a particular year from that year—2011 papers cited in 2011, for example—do not contribute to the impact factor. In fact, papers cited within their calendar year of publication have no effect on the impact factor. Therefore, if editors want to play the impact-factor game—legitimately—it is obvious that they must: 1) publish as many highly citeable papers as possible; 2) increase citation of them by generating comment in letters and editorials (within reason) and 3) time the publication of citing entities properly. For example, an editorial that cites a paper published in 2011 is better published in January 2012 than December 2011. It must be noted that Thompson Reuters, who “owns” the impact factor, does police the process and look for anomalous patterns of citation.

Can editors influence impact factor?

The answer is, clearly, yes. However, how long does it take an editor—say, one appointed in January 2011—to influence the impact factor of a journal, and is this a legitimate measure of editor performance? In the year of appointment, an editor has no influence on impact factor because the metrics, which are based on the previous year, are already fixed.

In the second year of appointment, the editor has minimal influence, because only one year’s worth of material published under his or her tenure may be considered for citation, and a high proportion of this is likely to have been accepted by the predecessor. However, measures taken in the second year to increase citations to the journal’s content can have an influence, but only to the extent that they reference the one year’s worth of content controlled by the new editor.

In the third year of appointment, all material published in the previous two years and some of the year preceding is the responsibility of the editor, and any measures taken to increase citations in that year are restricted to those two years.

Only in the fourth year of appointment can the editor take full responsibility for citing content and content being cited in the journal. Therefore, following appointment, it takes four years (until the end of 2015, using the present example) for an editor to significantly affect the impact factor.

If measures taken are successful, the editor is lauded and is safe in the job. If measures taken are not successful, the publisher has a dilemma: sack the editor in the knowledge that his or her successor will take four years, fully, to influence the impact factor, or continue with the same editor in the hope of improved performance.

Things usually continue with little change for a year after an editor’s contract expires and a new editor is hired. Therefore, my conclusion about impact factor is that, while it is a controversial measure of journal quality, it is a useless measure of editor performance.

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