Sunday, 10 December 2017

Exploring my delusions of grandeur in the company of Florence Nightingale

I think I may be having delusions of grandeur. If I have anything to do with it, in the future, nurses from all 4 fields of practice will be able to describe what a delusion of grandeur is. Typically they are thought of as being a fixed, false belief that one has superior qualities and attributes such as genius, fame, omnipotence or perhaps having great wealth. Individuals with delusions of grandeur often have the conviction that they have some great, but unrecognised talent or insight. Mine is being a Prophet in My Own Time (PiMOT) – which is slightly different from being a Legend in Ones Lunchtime, which also shouldn’t be confused with being a Legend in One’s Own Lifetime. Florence Nightingale is described as the latter in Giles Lytton Strachey book: Eminent Victorians, 1918 (still available on Amazon). So why do I think I am a PiMOT? Well last week just seemed to be jam packed with a wide variety of news items which resonated with thoughts I’ve been writing about for some time.

Back in 2014 I wrote a blog about both the dangers and absolute stupidity of smoking tobacco. I cautioned against the use of e-cigarettes as a substitute to tobacco. E-cigarettes simply haven’t been around long enough for the possible adverse health impacts to be known. It just seems common sense that our lungs are not meant to accommodate smoke or vapour of any kind. Last week researchers from the University of North Carolina Chapel Hill published a report which found that e-cigarettes can lead to as many lung diseases as tobacco. Whilst the study doesn’t make a connection between the use of e-cigarettes and lung cancer, it showed the association with diseases such a COP, bronchitis, asthma. These are outcomes that challenge the notion that switching to e-cigarettes is a safer option than smoking tobacco.

Back in 2015 I wrote a blog about the removal of NHS bursaries for student nurses and the possible rise of the Nurse Associate role. Probably because of the way my mind is wired, I chose to illustrate the blog that week with an image of a 2010 commemorative £2 coin featuring Florence Nightingale (still available on Ebay). At the time I was the Executive Dean of a School, which provided both undergraduate and postgraduate programmes of education and training for many health and care professions. The pre-registration nursing programme always had the largest group of students. We had 2 intakes each year, recruiting 700 pre-reg nursing students annually. The doom merchants, both within the School, the University and across the profession predicted that the removal of the student bursary would have a catastrophic impact on the number of people choosing to undertake a nursing degree.

My view was there would of course be an impact in year one (2017), with a reduction in the numbers of students over the age of 25 being offered a place being the most likely one. I also thought that whilst the number of applications might go down, overall it would still be possible to recruit to the same number of students. Time (and of course being a PiMOT) has proved me right. The Universities Central Council on Admissions (UCAS) published their interim report last week (full report due on the 14th Dec). This showed that despite there being an 18% drop in applications, this year 28,620 students were accepted onto pre-reg nursing programmes across the UK. This was the second highest figure on record, and a reduction of just 0.9% on the 2016 recruitment numbers.

Across the UK there was a record number of 18 and 19 year olds accepted, although as I predicted, there was a 13% decline in students aged 21 – 25 and a 6% reduction in those over 25 years old. So while it’s difficult at this stage to see where the extra 10,000 nurses, midwives and allied health professionals promised by the current Government to be trained by 2020 will come from, the removal of the NHS bursary doesn’t appear to be catastrophic. The introduction of the Nurse Associate role also provides a different and welcome entry route into nursing. Initially I fully supported this new role. I then moved to a position of challenging the development. More recently I have returned to seeing the Nursing Associate as being a valuable contributor to the future provision of care. Partly this shift has come about by meeting some student nurse associates, and partly because of the work I have been involved in with the NMC looking at the future graduate nurse. 

I first started the future graduate nurse work in 2015. After the very first Thought Leader Group (TLG) meeting at the NMC I wrote a blog in which I painted a word picture that I hoped captured what was a very exciting discussion. One of the things we discussed was the need for future nurses to become health promoters and health educators and to do so through role modeling. As you might imagine it was a rather heated debate: could a nurse who smoked really provide healthy life style choices; should we recruit student nurses who were obese; and so on. It was a challenging debate and one the TLG returned to many times over the last 2 years. I am firmly in the camp that it is possible to offer advice on improving health and wellbeing, even if it is patently obvious to others that you perhaps haven’t taken the advice yourself.

Maybe my stance is OK. Last week the BMJ published a research report that showed 1 in 4 nurses were obese, and obesity rates were even higher in unregistered care staff, such as care home workers and nursing assistants, where the rates were 1 in 3. Rates of obesity in health care professionals was higher than that found in the general population.  Obesity is a major public health issue, and is linked to diseases such as cancer, cardio-vascular disease and diabetes. So it is critical that we find ways of better looking after those that do so much in caring for others. 

I think across the UK, this might be something that is already happening. For example, in 2014, Professor Angela Tod was one of 4 newly appointed Florence Nightingale Foundation professors, and the first to be appointed in the North West, to take up a post as chair in clinical nurse practice research. The post was a joint appointment between the University of Manchester and what was once called the Central Manchester University Hospital FT. The challenge is to examine, review and develop best evidence for nurses to deliver the highest quality care to individuals, their families and the communities they live in. An approach I think Florence, who as far as I can find out, had no delusions of grandeur, would have approved of.