Sunday, 25 October 2015

Raising the Bar in the Brave New World of Nurse Education

For the first time in 4 weeks I am writing this week's blog from the sanctuary of the House in Scotland. The last 4 weeks have been very busy and have left me emotionally and physically exhausted by all I've been involved with. The cough/cold I acquired on my recent flights to and from Australia settled firmly in my chest leaving me with a chest infection and a painful bout of sinusitis. However before leaving for Scotland I managed to get an appointment at the local GP practice and came away equipped with the very best that the pharmaceutical industry can be provide.

I didn't see a GP, but one of the nurses. She was an Advanced Practitioner, highly skilled, knowledgeable and possessed great interpersonal skills. She was able to make a diagnosis, sort out the poly-pharmaceutical complexities in prescribing, empathised over the pain in my face, ear and neck and provided advice to avoid any further fainting episodes. I was impressed. For me, she also epitomised what the qualified nurse of the future might look like, someone who I believe is also likely to be able to work in this way.

Last week I had the opportunity to join 9 other professors (or thought leaders as we were referred to) in meeting with Lord Willis (Phil to his friends), Dame Jill MacLeod Clarke, Jackie Smith (CEO and Registrar of NMC) to explore what we might expect from newly qualified nurses 5 or 10 years in the future. All 4 nations of the UK were represented, as were all fields of nursing practice. Most of us were also Deans of Schools of Nursing and Allied Health Professionals. We all agreed to abide by Chatham House Rules, so I am not able to share the detail of our discussions but can provide some key headlines.

The first headline is that the NMC as a body were very open to change. It was acknowledged that the current standards used to construct and approve pre-registration nursing programmes were in need of a review. However, it was also acknowledged that perhaps we could learn from the work of others in undertaking such a review – and one such example we had been asked to look at in preparation for the meeting was the standards and outcome documents published in July this year relating to the ‘Tomorrows Doctors’ initiative. These documents make good reading for educators! You can see for yourself here (standards; and outcomes).

The second headline was that the group shouldn't concern itself with process (how future programmes might be delivered is open to all suggestions), or the current limitations arising from developing an overcrowded curriculum around four fields of socially constructed professional practice. Arguably  these fields of practice have increasingly little relevance to the exponential pace of change seen in the way health care services are being delivered. The focus for the group was firmly on the outcomes of educational programmes aimed at delivering the nurse of the future.

The discussions around what we expect that nurse to be like and what they should be able to do, form the basis of my third set of headlines. Collectively, we anticipated the nurse of the future, at the point of qualification would be: knowledgeable, and a knowledge broker, confident at working in the space called not knowing and uncertainty; a confident care navigator, able to signpost patients, carers and families to specialist service providers; digitally literate and able to effectively use new technology in providing care; a health promoter and health educationalist, personally role modelling how to maintain good health and well-being; a co-creator with patients and their families in the production and delivery of care; a team leader, working within teams made up of new entrants to the health care work force perhaps along the lines of the Nurse Associate concept. 

Of course there was much more, but you will have to wait until the report presents this and other consultation discussions to see the full picture.  From an educators perspective there were also some thoughts to ponder on. One that resonated was that we should perhaps stop treating our students as if they were our patients, failing to fail is not a helpful approach, but addressing this phenomena needs to be matched by a review of the payment by attendance and progression system we have in England (not the case in Northern Ireland). Likewise while the bio-science elements of future programmes needs to be reviewed this should be with the aim to make the nurses knowledge deeper not broader. 

It was a very interesting conversation to be part of, and I am to continue being part of the discussion.  For me it feels like a once in a life time opportunity to do something different for nurse education and the nursing profession, something different that will more effectively help prevent disease, promote health and well-being and provide high quality care when its required. And for all of you busy working on seeking NMC re-approval for your programmes in 2016, don’t worry, if you are not ready to embrace this brave new world just yet, you perhaps don’t need to. But if on the other hand you want to be big, bold and bad in terms of your programme development, well I think you will increasingly find some very receptive like minded folk to work with. Well done Phil, Jill, Jackie and all at the NMC for raising the bar in this crucial discussion over the future of nursing.