'And this is winter?'

My daughter’s first words on stepping outside at the Sydney airport form the title to this entry. It gets “cold” here, and there is even snow on the mountains, but what the average Australian considers cold would be an above-average summer day back home in the UK. I have lost count of my visits to Australia, but this is the first time my wife has been here, and I love to see old places through new eyes.

Two of my sons and another of my daughters have already been here, so my wife decided to see what all the fuss was about. In my view, part of the “fuss” is the unique combination of early morning frost in the suburbs of Sydney against the background of a deep blue sky that seems uniquely Australian. By midday, it’s officially warm—by UK standards—yet the locals are in coats and scarves, and, because I am mainly in shirtsleeves, I’m always being asked, “Aren’t you cold?”

View from my hotel.

University of Western Sydney

As mentioned in previous entries from Australia, I’ve been based at the University of Western Sydney (UWS). As the name suggests, the university serves the western side of Sydney but, in fact, it is not really in Sydney at all. It has campuses in Campbelltown, Paramatta and Hawkesbury, with an outpost in Liverpool, the Centre for Applied Nursing Research. During my recent two weeks in Sydney, I visited all the campuses where nursing is provided.

These visits often involve drives that would take you from one side of the UK to another. As with my sense of what is hot and cold here in terms of weather, I have to adjust my sense of distance in this vast country. I told someone I used to drive 60 miles to work and back, trying to instil a sense of horror at this daily feat. They looked at me with a “so what?” expression.

I was really pleased recently to notice that UWS had made the Times Higher Education list of the top 100 universities less than 50 years old (ranked 87th), alongside a very interesting list of younger universities across the world. While here, I have held scholar-in-residence consultations, given two seminars, and I had time to post online slide presentations about open access publishing and the uses and abuses of impact factor. This evening, in the presence of Rhonda Griffiths, dean of nursing and midwifery at the University of Western Sydney, and Scott Holmes, deputy vice chancellor for research and development at the school, I address a function at the university for senior people from local hospitals and health authorities. My topic is “The Francis Report: You simply could not make it up.”

Australia and onwards

This is the first of two visits to Australia this year. In October, I return to Canberra to speak at the 2014 Australian Capital Region Nursing and Midwifery Research Conference.

Aunt Jean, at age 90, the oldest member of the party,
meets the youngest, Rebecca, age 15.

In addition to the professional aspects of my trips here, the past few years of regular visits have enabled me to connect with my extended family of cousins and one remaining aunt. I was especially pleased that my wife and daughter (Rebecca) were able to meet my Aunt Jean, who turned 90 in February.

Tomorrow, we leave Australia for Hong Kong and, after two days, we return to the United Kingdom. August is relatively quiet, but September and October will be intensive with final scores and report writing for the 2014 Research Excellence Framework, after which I must turn my attention to the slightly neglected Lancet Commission on UK Nursing.

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 published.

Working on the Italian Riviera

HULL, United Kingdom—Last week, I made my third visit to Italy and my second to Genova this year. It is a pleasure to visit that historic and beautifully situated city. The weather was superb and, despite a classic running injury—plantar fasciitis—I managed two 10K runs along the two-mile esplanade called the Corso Italia. I had to make several loops but, because the sea was clear and blue and the sun was shining, this was no hardship.

You do not have to go far to experience a different culture, and this became evident in three incidents in which I was a customer—in two restaurants and a shop.

In the first incident, I took a table, asked the waiter for a beer, and, just as I began to say, “and could I see the menu?” was berated for my ignorance. This was not a bar, he informed me, but a restaurant. If I wanted a beer, I should go next door to the bar. I stood up, shrugged my shoulders, and walked out.

I then tried to buy some gelato and liked the look of the yogurt-flavoured variety. My idea of the perfect ice cream is one with no “bits” in it, or any other kind of adulteration. The vendor—who sensed I was not local—simply looked at me and told the person next to me in the queue that I ought to be trying something more typical of Italy or Sicily, from where he originated. So I pointed to some brightly coloured bitty concoction at the back of the display, which he seemed happy to serve me. I left muttering loudly, “So why do you have the yogurt-flavoured gelato?” And the one I bought was truly terrible. I made a mental note that, within a short time of my arrival, at least one restaurant and one shop were out of bounds in the future.

The final incident involved me buying coffee—which I did not want—after dinner, albeit I was able to have decaf. The coffee was “special,” explained the proprietor. It was made with limoncello, a highly alcoholic lemon drink. The coffee was terrible, too! But the restaurant was very good and an interesting place—a former, and I emphasise “former,” house of ill repute. (I can see the tweet now: Travelling professor visits a brothel.) I’ll say no more than that because, although the establishment’s mission had drifted, the decor remained what I imagine—I emphasise imagine—what one of those places may have looked like.

The University of Genova

I was not in Genova to report on local hostelries but to work for a few days at the University of Genova. I met PhD students to teach and discuss various aspects of research, including writing for publication. This time, I gave three sessions—open access publishing, impact factor, and the process of proceeding from data to published paper. While there, I also spent time with colleagues, advising on their research and publication strategies and looking for areas of common interest with our research at Hull.

One specific area of interest in health promotion is related to avoidance of melanoma, and the vast layers of seminaked bodies on the beaches of Genova suggest they may have a significant melanoma problem in Italy. In Australia, to cite one example, sunbathing, though not eliminated, has become almost a thing of the past. People there are very “sun-safe,” using clothing and protective creams to good effect. Italians have not yet gotten the message. Why we have such an interest in melanoma at Hull, where the sun rarely shines, is a mystery. But we do, and I hope my colleagues can begin to visit Genova and establish some collaboration.

There is one final incident to report, and that was running into a street demonstration while en route from Genova to the airport. The protestors—trade unionists—were blocking the road, and we had to stop. They had also blocked side roads leading to the main road. My anxiety level rose slightly, but we took an impromptu tour of the back streets of Genova, which was fascinating, and we arrived at the airport via a route I had never taken and from a direction I considered impossible. I have no complaints about Genovese taxi drivers, possibly the fastest and most intrepid in the world.

In case anyone wonders if I actually ever work at Hull, I was here the week before I went to Italy, and I am here this week. I am in the process of preparing a new online module in quantitative research methods for our Master’s of Research (MRes) students. MRes is something possibly unique to the UK. It is a genuine master’s degree, which can be taken as an exit point or, after graduation, for the first year of a PhD. Other master’s degrees, if the student graduates, oblige the student to start in the first year of a PhD. This module will be entirely online and asynchronous, a model that works very well, I think, for master’s students.

The rest of the month is taken up with a week in Stratford-on-Avon, the birthplace of William Shakespeare, at a Research Excellence Framework subpanel meeting. Then I head to Hong Kong for the 25th International Nursing Research Congress, sponsored by the Honor Society of Nursing, Sigma Theta Tau International. Of course, you’ll be hearing about my time there. Maybe you’ll even be in my next blog.

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.

Middle East to UK to Far East

HONG KONG, SAR, China—I am always happy to visit a new country, and, last week, I was in Oman for the first time. I was examining at the College of Nursing at Sultan Qaboos University in Muscat. Muscat, located on the northeast coast of Oman, faces the Gulf of Oman, which separates the Persian Gulf to the north from the Arabian Sea to the south.

I have to stoop to superlatives to describe the weather. The temperature was over 50 degrees Celsius (122 Fahrenheit), with humidity that exceeded anything I have experienced in the Far East and Southeast Asia. Leaving any air-conditioned building was like being hit in the face with a wet, warm sponge. One evening, at an outdoor cocktail party, I decided to check my phone for messages, and the phone, which had been in my air-conditioned room for hours, simply started dripping with water. I survived and even managed to run, at 0530, but my GPS watch was a victim of the humidity and stopped working—permanently.

The view from my hotel in Oman.

Sultan Qaboos

Sultan Qaboos University is enormous and located on the same campus as Sultan Qaboos University Hospital (SQUH). Together, they serve as a major centre of medical and nursing education for the region. My own University of Hull has a long-standing relationship with both the College of Nursing and the hospital. One of my colleagues at Hull was a recent examiner at SQUH; colleagues from SQUH visit Hull and our local hospitals—my daughter has looked after them on the local cardiothoracic intensive care unit; and, over the next few years, we plan to take several cohorts of staff members into our post-registration, undergraduate degree program me.

In Oman, I met members of a recent delegation to Hull, who enthused about the personal and detailed care they received while at Hull. Although they visited many centres in the UK, they chose us because of our hospitality—crucial in Arab culture—and we have my colleague, Jeremy Jolley, PhD, RN, international coordinator, to thank for this. Jeremy preceded me as examiner at the Sultan Qaboos University College of Nursing, and his legendary sense of humour and easy way with international colleagues meant I had a lot to live up to. I don’t yet know if I passed the test, but will conclude I did if I am invited back.

New friends

I was not examining alone; I was reunited with my colleague from Bahrain, Seamus Cowman, PhD, RN, FAAN, head of nursing at the Royal College of Surgeons in Ireland–Medical University of Bahrain. Also, I was delighted to meet, for the first time, Marilyn Lotas, PhD, RN, FAAN, associate professor, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA, and Shadia Yousuf, PhD, RN, assistant professor, King Abdulaziz University Faculty of Nursing, Jeddah, Saudi Arabia, who gave me news about two of my previous PhD students, now working in Jeddah.

We examined the students in the clinical areas, presenting patient cases and interacting with patients, and following up with a series of very demanding oral examinations. We do nothing like this in the United Kingdom and, while I questioned the value and sustainability of some of the examination procedures (suitable for small numbers but probably unworkable for large numbers), I also wondered if we were not a bit “soft” on our own students.

Professor Cowman and I with male nursing students in Oman.

Hong Kong … again

I returned to the UK for a day to remind my wife and family what I look like and then left for Hong Kong. This week, I am working for the University Grants Committee of the Hong Kong Special Administrative Region (SAR). Specifically, I am serving on the humanities and social sciences committee, reviewing research grant proposals related to health.

The view from my hotel in Hong Kong.

I know Hong Kong well and have many friends and colleagues to see. Last night, I went to one of the best places here to get a haircut, the YMCA Salisbury Hotel. If your image of the YMCA is one of old sports halls with table tennis, pool, and a song by Village People, think again. The YMCA has two very good hotels here, and I often use them. In a few weeks, on the way back from Australia, I will be staying at one of them with my 15-year-old daughter.

The haircut at the YMCA reminds me of one of my funniest moments in Hong Kong. The first time I decided to have my hair cut there, I went in and an older Hong Kong lady was sweeping the hair from the floor. Nobody else was there. I asked about a haircut and, with no English, she pointed to me to sit down and proceeded to cut my hair—very well. I asked about the cost, and she said “one hundred dolla’,” meaning HK$100, which I gave her. She put the note in her pocket, and I thought no more about it until my next visit a few weeks later. The lady was still sweeping the floor, but there was also a young man there, who proceeded to cut my hair. At the end, I took out a HK$100 note and handed it to him. “No,” he said. ‘You must pay at the shop,” and handed me a bill for HK$110. I stole a glance at the hair-sweeping lady on the way out. I think I saw her smiling!

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. 

Finland to United Kingdom to Bahrain

MANAMA, Bahrain—There could be no greater contrast than between the lush greenness and clean air of Finland and the scorched, dehydrated, and dusty landscape of Bahrain. That contrast is even more striking when you have only 24 hours between the two places with a very short visit home. The visit home was even shorter than planned, due to being stranded in Helsinki by one airline, having to transfer to another airline and another city in the UK, and finding my way home after public transport was closed. Such are the joys of international travelling, which some look upon in envy. As ever, I thoroughly enjoy what I do around the world, but the process of getting there can be tedious.

Finland

I was in Turku, as I was last year at this time, to give sessions on writing for publication to postgraduate research students at the University of Turku. This time, it was a Journal of Advanced Nursing (JAN) show, as I was with fellow editor and Hull colleague Mark Hayter, PhD, FAAN, professor of sexual and reproductive health at the University of Hull. The sessions were enjoyable, and the students interacted well.

The weather was fantastic, the food excellent, and it is always good to catch up with international colleagues. If there is a link between Turku and Bahrain, it is the open-access journal I edit, Nursing Open. One of the editors, Riitta Suhonen, PhD, RN, works in Turku, and, here in Bahrain, I am with Seamus Cowman, PhD, FAAN, who is now head of nursing at RCSI Bahrain, affiliated with the Royal College of Surgeons in Ireland (RCSI). Cowman is another editor of Nursing Open and, incidentally, the first Irish nurse to be elected a fellow of the American Academy of Nursing.

Bahrain

Bahrain continues to develop since my previous visit and, despite the desiccated landscape and dusty Middle Eastern backdrop, it has paradisiacal elements as land is reclaimed along the coast and small, exclusive communities emerge. I should be used to living in hotels—not all of which are five-star, believe me—but the luxury of the Gulf Hotel, Bahrain, and the tranquility and service of its Platinum Club provide an insight into a lifestyle that, but for generous hosts, I will never be able to afford. The dilemma is: Do you eschew it for fear of getting used to it and missing it; or do you indulge, knowing it will rarely be on offer again? As I stare out over the night lights of Bahrain from the top floor of the hotel and the waitress pours me another (free) drink, I think you see how I solved the dilemma. I’m going to miss this one day!

The purpose of my visit to Bahrain is to work as an external examiner on the master’s in nursing programme at the RCSI. I examine the same programme in Dublin, and part of the job is to ensure that the same standards are applied in both locations, on behalf of the RCSI and on behalf of the National University of Ireland, which is the degree-awarding body.

The Nursing Open theme continues, as one of the editorial board members, Catherine McCabe, PhD, RN, assistant professor, Trinity College, Dublin, Ireland, arrives today in her capacity as external examiner for the undergraduate nursing programme. I am very pleased that my contract has been extended for another year and that I will also be starting as an examiner next month at Sultan Qaboos University, Oman. By sheer coincidence, my fellow examiner is none other than Cowman from RCSI. The Honor Society of Nursing, Sigma Theta Tau International (STTI), is represented here by the relatively newly formed Rufaida Honor Nursing Society, which is seeking to become a full chapter of STTI. Catherine O'Neill, senior lecturer, RCSI Bahrain, played a major role in establishing it, along with local colleagues.

Running, climbing, and football

My efforts to get out on the rocks are being thwarted by an inordinate amount of travel, both in and out of the United Kingdom. This is probably the busiest year of my life. However, I continue to train indoors, and combine rock climbing with running. Finland was a joy to run in, but my 0530 run today in 30 degrees Celsius (86 degrees Fahrenheit) to avoid the sun, had me almost at my physiological limits. I don’t understand why this should make your legs feel as if they had lead weights attached. In addition, the expatriate workers waiting for their transport to work shared incredulous looks as I panted past. To make a living, they are forced to work in this heat. I could be in bed in an air-conditioned room.

Finally, the UK football (soccer) season has ended, and the highlight of the English season, the Football Association (FA) Cup included, for the first time in the club’s 110-year history “The Tigers,” my local Hull City team. The match was played at Wembley, the 90,000-seat national football stadium in North London. The opposition was the mighty Arsenal, a North London club, and 25,000 of us made the journey south to watch the game, including the three Watsons pictured.

We lost, but only after taking a 2-0 lead and taking them into a period of extra time. Nobody expected that, and I think we were happier than the Arsenal fans. We stayed to see Prince William award the FA Cup runners-up medals and departed, elated. My voice took a week to recover, and I look back on what was, surely, a once-in-a-lifetime experience.

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 quick visit to Rome

I was in Rome again this week to attend a conference. I missed by one day the 4 million visitors who were here for the double papal canonisation (Pope John XXIII and Pope John Paul II) on 23 April in St. Peter's Square. To non-Catholics, these events are unfathomable, and the ordinary “Catholic in the street” would have difficulty explaining the criteria, the significance, and the effect, if any, on their lives. As one of them, I won’t try to enlighten you.

The weather in Rome was a pleasant change from the U.K., where we are still having subzero Centigrade nights and the garden (the “yard”) is still a place to be endured rather than enjoyed. The conference, held in the Italian Ministero della Saluta (Ministry of Health), was run under the auspices of IPASVI (Nursing Board of Rome) and showcased the work of the Centre of Excellence for the Development of Nursing Research.

The research theme focused on the importance of nurses in feeding patients and contributing to health, and Gennaro Rocco, president of IPASVI, outlined the work of the centre. Since 2010, they have produced an impressive 82 publications from 48 funded projects, a great many in top journals and most in collaboration with other disciplines. Italian colleagues bemoan the poor state of academic nursing in Italy. I know everything is not perfect, but something seems to be working, and this is largely due to President Rocco.

The location of my accommodation was not ideal for running, but I managed to piece together two 3-mile runs early in the morning. Following my first half-marathon (see previous entry), I realised I was not as fit as I thought I was. So, I’ve been studying Run Fast: How to Beat Your Best Time—Every Time, by Hal Higden, and learning the difference between repeats and intervals—not the same thing—and what “fartlek” training is. If you sniggered at fartlek, go to the back of the class. It’s a real word; Google it.

Another review of UK nursing

I tried, without success, to take some days off at Easter, but, at least, I was mainly able to work at home. Once again, just when I thought it safe to read the newspapers without risk of stroke or heart attack, I see another review of nursing education has been commissioned by the U.K. government. The review will be led by Lord Willis, who led a commission on behalf of the Royal College of Nursing a few years ago. That commission looked at preregistration nursing education and came to the conclusion that there is no evidence that being an educated nurse means you are an uncaring nurse. It seems that this new commission will review all aspects of nursing education with a view to recruiting into nursing older candidates with the “right attitude.”

This strays into the territory of the Lancet Commission I will be leading, which I do not mind, but this newly commissioned review begins with the premise that there is a problem—that nurses are not caring enough and that they have little regard for patient dignity. These things may be true, but I am determined that the Lancet Commission is distinguished by the fact that it is not out to solve problems. It does not start from the premise that there is a problem—we don't deny there may be one. Instead, we want to see—whatever the current state of nursing—how best we can prepare nurses from registration throughout their careers to meet the challenges of the next 20 to 30 years.

Bad news

I mentioned in a previous entry that I was revising a research grant application for the Alzheimer’s Society. The proposal was duly revised, resubmitted, and rejected. I have never expressed irritation to a grant-awarding body in the past, but I did this time on the basis that I considered they had wasted my time. Everyone feels angry and let down when a research proposal representing months of works and investment of time and hope is rejected, but the task I was given was huge and the space in which it could be accomplished a challenge, and I failed—apparently. Back to the proverbial drawing board.

On the bright side, I have had several papers published, the most recent being one where, along with my co-authors David R Thompson, PhD, FAAN, Wenru Wang, PhD, RN, and Rob R. Meijer, PhD, we looked at issues affecting measurement of a property called invariant item ordering in the Mental Health Inventory. It was published in Personality and Individual Differences. Reviewer comments were extensive and very helpful, and, in the process of revision, we were asked to consider something that was new to me—person-item fit (PIF).

I contacted my Mokken scaling colleague Rob Meijer in the Netherlands, who has written about this. It just happened that he was developing software to analyse the kind of data I was looking at. In fact, he ran it for me and joined in authorship of the paper. Since then, his colleague Jorge Tendeiro, PhD, provided me with a link to the software and the syntax to run it. 

They also provided me with a draft article (“Practical Guide to Check the Consistency of Item Response Patterns in Clinical Research through Person-Fit Statistics: Examples and a Computer Program”) they wrote for people like me who may not, unlike them, have the programming and statistical knowledge to do these things without a lot of help. In fact, the paper quoted what I said to Meijer when I read one of his papers on PIF: “I have read the 2001 paper; frankly, most of this is beyond me and Google is not much help.” My ignorance has spurred a paper, and I was glad to be of service.

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

A very strange week!

HULL, United Kingdom—Last week I was in London at a Research Excellence Framework subpanel meeting and then in Glasgow at the 2014 Annual International Nursing Research Congress, sponsored by the Royal College of Nursing of the United Kingdom. In Glasgow, I launched, together with Wiley colleagues, Nursing Open with a huge cake bearing a facsimile of the journal’s cover. I have not had my name on a cake since my childhood birthdays.

The conference was very good. I spent the first day in the registration and exhibition hall, where I was able to do some very valuable networking, catch up with old friends and colleagues, and answer questions about Nursing Open and Journal of Advanced Nursing. At the end of the day, I co-presented a workshop on the use of social networking in nursing. Led by my good friend Alison Twycross, PhD, RN, head of Department for Children’s Nursing, London South Bank University, and my new friend, Calvin Moorley, PhD, RN, senior lecturer, London South Bank University (we had only previously met on Twitter), the workshop was well attended and generated a good discussion.

The evening began with a reception at the magnificent Glasgow City Chambers, followed by dinner with Wiley colleagues at Glasgow’s excellent Urban Bar and Brasserie. I had black pudding starter and haggis sausages, and you probably don’t want to know what either of these Scottish delicacies contain.

On my second day, I lined up some research sessions to attend, and I was not disappointed. I gravitate towards sessions on quantitative research, and there were some excellent methodological sessions on Rasch analysis, questionnaire development, and stress and burnout in nursing. In particular, I enjoyed meeting Nina Geuens, PhD student, Karel de Grote-Hogeschool, Belgium, and her supervisor, Erick Franck, professor in applied psychology in health care, Universiteit Antwerpen, Belgium. My long journey home by train was filled with thoughts of the Sheffield half marathon I was due to run on Sunday, 6 April, which brings me to Part 2 of this entry.

Nina Geuens, Yours Truly, and Erick Franck

Rebel runners

My early mornings in London and Glasgow were taken up with final preparatory runs. I followed a very strict half-marathon training programme by Hal Higdon. As my children would say, I was “up for it.” If you Google “Sheffield half marathon” or, on Twitter, go to “#sheffieldhalfmarathon” or “#rebelrunners,” you will immediately see what an interesting day this turned out to be.

My wife and I arrived at the starting line, along with more than 5,000 others, at the appointed time and were then held there for 50 minutes without explanation. Rumours abounded but, as it turned out, insufficient water had been supplied for the number of runners involved and, at 9:50 a.m., the run was cancelled. What followed will go down in running history. A predominantly middle-class, law-abiding crowd of runners expressed its disgust the only way we could: We started running, and the police were unable to stop us. I don’t advocate civil or any other kind of disobedience, but this was one of the most moving events of my life. I think Mahatma Ghandi would have been very proud of us.

The general public of Sheffield, which had waited for more than an hour to watch us run, went into their houses, food shops, and coffee bars and emptied fridges and cupboards of all the bottles of water they could find. There were bottles of water on the top of parked cars and runners—normally a selfish and competitive bunch—were handing half-finished bottles to other runners. Where the official water stands were closed by race officials, people stood nearby handing out bottles and paper cups, along with the runners’ best friend: Jelly Babies. These incredible, high calorie-sweets are made in Sheffield, and they are exactly what you need halfway round a long route. If you eat them when you are not taking exercise, the sugar high that results is unique.

The intrepid Dr. Watson

Did I hear you ask how we fared in the race? Well, my wife dropped out, as she has to save herself for official races and has another one coming up soon. When I realised that the police had backed down and saw that the crowd of runners was beginning to snake its way through the town, I decided to complete the course, which was my first half-marathon. I enjoyed the first 10 miles but realised, at that point, that my plan for a fast final three miles was not going to happen. By 11 miles, I was considering ending it all by jumping into the oncoming traffic and, at 12 miles, had it not been for my wife and sister-in-law shouting my name, I might have knelt down and cried. But I carried on to the finish line and was glad to see that the organisers had decided to stay and hand out running vests, water, and medals.

My ambition was twofold: to remain standing at the end and to complete the run within two hours. My time: 1 hour, 47 minutes and 28 seconds and, with wobbly legs and bleeding nipples (exceedingly painful), I was still standing. Some might consider my inability to speak for a considerable length of time another positive result.

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.

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.