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. 

Coughing my way through breakfast to dinner, but with some great conversations along the way

I am not really a breakfast person, but when travelling on university business and staying at hotels I do like to indulge in the Full English Breakfast meal. And so it was this last week, on Monday I had breakfast in Singapore, Tuesday it was Leeds, then Wednesday it was Wigan, Thursday’s breakfast was in Sheffield and Friday it was back to Salford. I felt I needed to keep my strength up as after a quick visit to Australia, I had been left with a jet plane traveller’s hacking cough, streaming cold and raging sore throat.  More than 23% of all flyers think that the cabin air has made them ill.

There is evidence to support that this might be the case. US studies have revealed that many disease causing bacteria can survive for up to a week inside plane cabins, on surfaces such as seat pockets, tray tables, arm rests and so. Staphylococcus aureus (more familiarly known as MRSA, once the scourge of UK hospitals) and a bacteria that can cause infections, skin disease, pneumonia, and sepsis, was found to survive for up 168 hours; and Escherichia coli (E coli), which can cause urinary tract infection, respiratory illness and diarrhoea, was found to survive for up to 96 hours. If you really want to see the full horror of contemporary air travel, watch this video.

In any event I started with a cold and cough somewhere over Dubai and it’s still with me. Last Tuesday I gave all at home a bit of a shock when my coughing fit sent me crashing unconscious to the floor. One minute I was walking out of the room on my way to bed when the next I was on the floor with Cello barking, and W slapping my face asking if I was alright.

What I had experienced was an episode of transient loss of conscious (TLoC). TLoC is usually defined as a short-lived, self-limiting loss of consciousness with spontaneous recovery to normal.  TLoC is secondary to a cardiovascular or neutrally-mediated disorder resulting in transient global hypoperfusion, where in my case the specific term to use would be (cough) syncope.  Interestingly, such episodes account for 3% of all presentations at A&E departments in the UK. However In my case I was just told to get up and to stop making the place look untidy.

Whilst looking tidy was important for me last week, I would defy anyone to look anything other than rather dishevelled after 15 hours flying in a plane. However thereafter I did my best. I had a great meeting and exploration of possible opportunities with Peter Viqueria on Tuesday, many thanks Peter. Wednesday I was proud to facilitate a superb presentation and discussion on understanding mortality data in the NHS at the Wrightington, Wigan, and Leigh Foundation Trust Quality and Safety Committee. This is work led by the internationally respected Dr Martin Farrier (Consultant Paediatrician and someone who lists as one of his speciality areas, syncope). On this occasion he was joined by Dr Debapriya Mondal from the university's School of Environment and Life Sciences, who had brought her considerable skill as a statistician to help unlock the issues involved in better understanding mortality data and reducing avoidable deaths.

Thursday it was conversations with colleagues from the Council of Deans (Health) at the Full Council meeting in Sheffield, some outstanding discussions and presentations, not least of which was a key note form Professor James Ferguson, an Emergency Care Surgeon and Director of the Scottish Centre for Telehealth and Telecare. I, like many others sitting in the room, was spell-bound by the possibilities he opened our eyes too, and with often nothing more complicated than a smart phone! These days the technology is available, is cheap and easy to use. Any limitations to what might be possible are only those we impose upon ourselves or are imposed by our professions and by the culture of organisations we work in.

I have a great team who make it possible for me to do the above. So thank you Elaine, Debbie, Brian, Nick, Jennie, Neil and Gill. And if last week was all about starting the day eating breakfast in different places, next week it’s a travelling dinner experience: Monday –Wigan; Tuesday – Chester; Wednesday – London; Thursday –Manchester; and Friday, after 4 long weekends away, it will finally be dinner in Scotland!

The beat of Cajun Drums drown out the sounds of Richard Clayderman at #ACMHN2015

It was quiet when I flew back into Singapore last night. Compared to the previous few days and nights things were a little slower but it was back to listening to Richard Clayderman type irritating piano music. If you don't believe me, about the irritation level, just listen to this. It is guaranteed to send you running for ear plugs after you hear the first few bars. I had flown back from Brisbane, a city with music on every corner, bar and restaurant. There was music for every mood and taste, (even I guess irritating piano music if that what floats your boat) and I had been spoilt for choice. I had been there for the 41st International Mental Health Nursing Conference. 

Now you might ask me, why go 20500 miles, to attend a mental health nursing conference. It would be a fair question, and s my sore legs will attest, it is a long way to travel. The answer for me is that there is simply nothing that is comparable in the UK. The joint Mental Health Nurse Academics UK and RCN held once a year for the last 21 years is a poor relation. Paradoxically, the latter was held this year in Manchester! There are a couple of mental health nursing conferences in Europe, but they tend to be on at the same time as the Australian one. No the ACMHN conference is the best in the world if you want to network, present your research and meet other like minded people. I also got to have a drink last night in the Raffles Long Bar, something I failed to do last weekend. 

The last time I had been in Brisbane, was in Oct 2007, a couple of weeks after my younger brother Christopher had died. It was the last time I had seen my sister Sarah in person as well. We had planted an olive tree in his memory, a tree still going strong. Ever since that time, I hadn't been able to face the long journey to Australia and in particular to the conference that had such painful memory associations. That said,I had made the journey to Australia in 2011 after being head hunted for a job at the University of South Wales. Although the Business Class ticket made the journey more bearable, and I was offered the job, it wasn't a move I wanted to make.

However, all these years on it felt right to accept the invitation to present at this year’s conference. The conference was held in the Brisbane Exhibition and Convention Centre, which is also home to the Queensland Symphony Orchestra. There was music, colour and activity everywhere. I did like the advertising for a forthcoming production of Indiana Jones and his full orchestra. I had thoughts of Indiana fighting his way through the forest wondering where his string section had got to.

The conference theme was - Mental Health Nurses; shifting culture, leading change. In some ways it was not that different to the theme back in 2007- Mental Health Nursing: making waves. Unlike in the UK, where mental health nursing is a recognised field of practice, like children and young people’s nursing, in Australia it is an area of practice that nurses go into once they have graduated from a generic education and training programme. 

So there was much discussion over the sense of a lost professional identity; a loss of power and feelings of being a very subservient second best to those nurses working in physical care services. However, there were also many papers presented on innovative approaches to education, research and practice. Music and art featured widely. There was everything from Cajun Drum Therapy in a Secure Unit to Therapeutic Photography, and there was also much emphasis on looking after the physical health of people with a mental health problem, with plenty of ideas to try out in the School! It was a great conference and whilst thankfully, Richard Clayderman didn't appear in any of the papers presented, the journey was a worthwhile one and I have much to bring back for consideration in our development of the new C16 pre-registraion nurse programme.  

A flying visit to Raffles, but there is no gin-sling to be had!

This weeks blog is being posted from a smog covered Singapore. I am slightly tired from the travelling, so apologies for any typos. However, having said that, I did cram a great deal into last week, and although busy, it was a very exciting week. I met some really interesting people, had some fabulous conversations which made me feel alive and buzzing. For example, on Monday I was pleased to be part of our School celebrations of Saudi Arabia National Day. We have a growing number of PhD students from Saudi, and they are a real privilege to work with. The day’s events celebrated the birth and growth of the Saudi nation, and its many achievements in education and health care over what has been a relatively short period of time.

The Mary Seacole building was decorated in the Suadi colours, green and white (growth) and there were tastes of Saudi life illustrated through food, pictures, music, the opportunity to dress in traditional Arabic dress, and if you wanted, even henna tattoos. It was a wonderful day and I was so proud of the hard work of our students in organising and facilitating the day – it was brilliant! Monday evening I had dinner with one of my Deans of School colleague’s, Hisham. He is the Dean of the School of the Built Environment (SoBE).

It was an opportunity to talk about mutual ambitions and of course the odd whinge and moan, but essentially it provided us with some time to reflect on where we had got to in facilitating the achievement of  the ambitions of our colleagues working in both Schools. I learnt lot about what colleague’s in SoBE were up to with their research, and there was plenty for colleagues in our School to join in with. Friday I was on a plane on my way to Singapore and sitting next to me was a young man by the name of Louis who had just joined SoBE as a student. He was on his way to spend a long weekend in Dubai. Louis wants to be a Quantity Survey and after my conversation with Hisham, it was clear he had chosen the best place to be in realising his ambition.

Last Tuesday and Wednesday was given over to further exploring the opportunities of 'Devo Manc' and considering where the thinking had got to over the governance and decision making processes for the transformational board. Tuesday also included an opportunity to reflect on the opportunities afforded by the very welcome decision that the Salford Royal Foundation Trust and Wrightington, Wigan and Leigh Fount Trust had gained approval for a Vanguard 2 bid for Acute Services. Being part of the WWL bid was a wonderful experience, and it felt like I was really able to contribute to the re-shaping of health and social care services for the North West of Greater Manchester - again a great privilege to be part of this work.

My last meeting on Thursday was with colleagues working in the Manchester Clinical Commissioning Group and the Manchester City Council. I was able to discuss some ideas around entering into a partnership to work with them in taken forward one of Simon Stevens (Chief Executive of the NHS) top three ambitions around making the health and social care workforce a healthier one, and the organisations they worked in healthy places to work. Greater Manchester has some of the worst socio-economic indices in Britain, and health and social care workforces are really well placed to make a difference to the lives of the population in general and those they employ in particular.

Of course I said yes in terms of becoming a partner and have already alerted colleagues in both the health schools at the University to start the conversations while I am away. For me it was a good example of what might be achieved through our new strategic Industry Collaboration Zone (ICZ) initiative. The ICZ initiative looks at creating synergies where there weren't any before, allowing new teaching programmes to be developed and new research areas to be funded and taken forward. It allows our students access to industry organisations, in this case the 'health industry' and reinforces the strategic and powerful partnerships the university can have with its stakeholders. For the first time ever, I made a podcast. It's focus was  what I think the ICZ might deliver to the School, and this was published online last Friday. So far I have received mainly positive reviews about its usefulness. 

Singapore is 7 hours ahead of the UK, so yesterday, after travelling from Manchester I had a bonus day to spend in Singapore. There was only one thing to do, and this meant going to one of my favourite places, Raffles Hotel. I fancied a drink in the Long Bar, famous for its still colonial décor and ambiance and of course the monkey nut shells which form a carpet across the floor. I was unable to do so however, as there was queue of people all waiting to go in. It was clearly a popular place to go to. As I have been there a few times before and as it was baking hot, I chose to go somewhere else for a glass of lemonade. Later today I start the final leg of the journey to Australia. I will tell you all the news of the conference in next week’s blog!