Unique

Do you consider the role of the nurse to be unique? And what does being unique actually mean? Some of the synonyms for the word unique are not so encouraging; sole, only, solitary, single, individual, lone especially when considering the current debate about the numbers in the nursing profession or that many registered nurses are the sole registered nurse in their workplace setting.

It is preferable to refer to the more positive synonyms such as exceptional, excellent, brilliant, special, extraordinary, incomparable, outstanding, remarkable, inimitable, distinctive, individual; words that may be applied to the “soon to be registered nurses” from my institution.

Musing on the word unique reminds me of the classic definition of nursing created by the American nurse, Virginia Henderson, still referred to by the International Council of Nurses “The unique function of nurses in caring for individuals, sick or well, is to assess their responses to their health status and to assist them in the performance of those activities contributing to health or recovery or to dignified death that they would perform unaided if they had the necessary strength, will, or knowledge and to do this in such a way as to help them gain full of partial independence as rapidly as possible” (Henderson, 1977, p.4).

But does it remain so as many others are involved in the care of individuals?

There is growing concern about the numbers of nurses on the Register in the UK, putting it simply there are more individuals leaving the register than joining it. Figures from the Nursing & Midwifery Council in July 2017 showed an increase in numbers of nurses and midwives leaving the professions.

The NMC in its report dated 30 September 2017 “The NMC Register” noted that 35,363 individuals left the register between October 2016 and September 2017 and 27,786 joined it. This equates to a figure of 27% more leaving than joining. Just over 29,000 UK nurses and midwives left the NMC register in 2016–17, up 9% from the previous year. 18.2% of nurses and midwives on the registered are over 56 years old and may be in a position to retire. The nursing and midwifery profession are ageing but the NMC figures also show that registrants below retirement age are leaving in increasing numbers.

Nurses and midwives from the European Economic Area make up around five percent of the register.  Between September 2016 and September 2017 there was a decrease of 89% in the number of nurses and midwives from the European Economic Area joining the register and an increase of 67% leaving the register from the previous year.

The figures on the register are constantly fluctuating as individuals join it for the first time as they embark on their careers; and those who decide to leave as they retire at the end of their careers. There are seasonal fluctuations which coincide with individuals graduating from pre-registration programme mainly in the Autumn. This blog is being written just before individuals from my institution will shortly swell the numbers on the nursing register as they complete their pre-registration programmes. Congratulations if they will be joining your teams.

NHS Digital published the NHS figures on 16 January 2018 which demonstrate that more nurses left the health service in England last year than joined, mirroring the trend published by the NMC in Autumn 2017.

The Commons Select Committee published on 25 January 2018 stated “In too many areas and specialities, the nursing workforce is overstretched and struggling to cope with demand”. It was noted that there were 36,000 vacancies in the NHS in England. The conclusions and recommendations include strategies aimed at improving: retention, professional development, working conditions, a greater focus on staff wellbeing, assessment of the impact of the withdrawal of bursaries and the introduction of student loans and apprenticeships on the numbers of individuals entering the profession, and specific plans to prevent the high attrition of student nurses.

The Committee also recommended that nursing associates; the new care role in the nursing family, “need and deserve a clear professional identity of their own” a view that is echoed by the NMC’s Chief Executive Jackie Smith who commented “There must be clear blue water between the role of a nursing associate and a registered nurse. We welcome the Committee’s recommendation that nursing associates have a clear professional identity, which is also of paramount importance to the public.” Some individuals believe that nursing associates are nursing on the cheap, some are apprehensive and still worry they will be used as substitute nurses and as a means to a solution to the current workforce crisis despite the assurances about the role from the Commons Select Committee and the NMC. Some of those older registered nurses may be experiencing a certain sense of deja vu as they themselves may have been individuals who made the transition from enrolled nurse to registered nurse as part of their professional journey and view the nursing associate role in a similar manner.

There is currently a lack of clarity about the nursing associate role. Nursing associates will be registered professionals in their own right, with a supplementary role working alongside the unique role of the nurse from the Spring of 2019. A Nursing Times investigation revealed a wide variety of approaches to the training of nursing associates had been implemented across the pilot sites. Whilst it has now been agreed that the NMC will become the regulator for nursing associates the professional standards against which they will be regulated are still being developed and the underpinning legislation to give the NMC the power to regulate nursing associates has yet to be passed. It is expected to happen in July 2018.

NMC 2017

The NMC published the Draft Nursing Associate Skills Annexe on 16 February 2018. The list of skills will form part of the NMC’s overall competency standards for nursing associates. The list is still in development and has been released “to allow people to see how the skills annexe is developing and what it contains”.  A final draft version will be published for consultation in April 2018. Once the NMC is the regulator in law, it will approve nursing associate programmes. This is likely to be from Autumn 2018.

Everyone is likely to benefit from the recommendation that “a ‘plain English’ guide to the new role should be developed, published and communicated at both a national and a local level. This guide should include examples of tasks that nursing associates will, and will not, be expected to undertake, but will need also to reflect the scope of their practice across a range of healthcare settings”, The Commons Select Committee 2018. It is essential that it is understood that the role of the nursing associate is the support the unique role of the registered nurse and not to replace it.

Added to this situation are the concerns about the reduction of individuals engaging with educational programmes leading to professional registration. The Universities and Colleges Admission Service published its latest statistics in January 2018 about applicants across all undergraduate programmes including specific information about nursing applications. The Royal College of Nursing and The Council of Deans of Health have both expressed concern about the decline in applications to nursing programmes, particularly from mature students, albeit from different perspectives Both organisations comment about the need for a strategic plan and investment in the current and future nursing workforce to ensure the workforce which is needed to care is available. The introduction of alternative routes into health careers such as the nursing associate and registered nurse apprenticeship programmes are expected to improve the situation.

Consideration of the latest information about the numbers of nurses in the profession, the vacancies in the NHS and the current information about applications to nursing programmes may indeed lead us to believe that the profession is in crisis.  There is evidence of serious challenges for the nursing workforce. Undergraduate and post-graduate pre-registration degree programmes continue to be an important route to an internationally recognised professional qualification and the springboard to a wide range of professional opportunities and personal achievement in the unique role of the nurse.

Returning to the synonyms; let us hope that the “unique” role of the nurse never becomes rare or scarce and that registered nurses are not few in number but rather that the term recognizes the valuable, special and unique contribution registered nurses can, and do, make to the care of everyone in need of healthcare.

 

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24 thoughts on “Unique

  1. Thank you for a thought-provoking blog post.

    I have very much enjoyed following your entries throughout my three years at Salford. As I am nearing the end of my training, I am of course apprehensive about the challenges the profession is facing. I am however hopeful at present that my contribution, along with our shared passion for helping patients will somehow allow us to move forward, despite the obstacles. Hopefully our goodwill in this regard will not continue to be abused.

    I have chosen to write my dissertation on the role of leadership in improving working conditions for nurses, for which I think your link to the Select Committee report on the nursing workforce will be useful to read.

    Thank you again for posting.

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  2. I enjoyed reading this blog post because I strongly agree with the idea that nursing is a ‘unique’ profession, it requires a unique set of skills and characteristics for a person to be a ‘good’ qualified nurse along with this, the amount of job prospects and opportunities that the qualification can take someone on to is ‘unique’ which makes the prospect of becoming qualified very exciting to me.
    Its interesting and saddening to read about the amount of nurses leaving the profession and how understaffed with nurses that the NHS is, and how the new role of a nursing associate may change this issue.

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  3. I enjoyed reading this blog post as it highlights all of the reasons as to why I wanted to be a nurse. It is a “unique”, privileged role that ensures something different everyday. I found it intriguing to see that 35,363 had left the register. This figure disheartens me, as I understand a lot of it will be due to nurses and midwives retiring, but some will have left it because they feel nursing isn’t for them. We are an ageing population and there is the fear that there will not be enough nurses in the future.

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  4. I enjoyed reading this post as it was interesting to read about the unequal balance about the amount of nurses joining the register compared to the amount of nurses leaving the register. It is saddening to think that if this trend continues where will this leave the ‘unique’ role of the nurse and how will this impact the NHS.

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  5. Working towards my Nursing Degree and working part time as a Nursing Assistant I can understand the confusion of the role of the Trainee Nursing Associates. Having discussed the role in class I think that the TNA can be used in a really supportive way on the wards if only some of the already Registered Nurses understood how to utilise the TNAs knowledge and skills.

    In regards to the ‘unique nurse’, I’m excited to work together with Nursing Associates, newly Registered Nurses and existing Registered Nurses as each have been taught in different ways to reach the same end goal. Each patient case is unique, why shouldn’t the nurse be too.

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  6. I have very much enjoyed reading this blog post and it has made me think of different ways that a nurse is unique. I thought it was quite important to think about how many people are leaving nursing and why this is. To me this was very poignant and made me think what would happen if this were to continue. Would this leave the NHS in crisis and also how would it effect unique nurses.

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  7. I believe that the new nursing associate role is very important at this time in nursing, to help fight the pressure on the NHS, especially due to the increasing number of nurses leaving the register, and I am excited to work with them through my training and when I am registered. I hope the unique role of the nurse continues throughout my life, and many lives to come, and that many people work together to find a solution to this problem.

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  8. I have always considered the profession of nursing as being a unique one. The commitment to education, to caring and to well, serious responsibilities is not for everyone.
    Reading this blog has provoked a sadness and a desire for solutions that are difficult to obtain. Although it seems we are in trouble, I do have hope that with the help of nursing associates and other implementations we will resolve those isssues.

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  9. Having nearly finished my second hospital-based placement I have watched and understood the pressures of being a nurse in this setting and how this may lead to some leaving the register. It is upsetting to think that so many nurses are leaving the profession that they were once passionate for due to these struggles and how this may effect the healthcare service in time. However, I am hopeful that by the time I become a registered nurse I will be working alongside other nurses and nursing associates and this issue will be resolved and the role of the nurse will still be considered ‘unique’.

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  10. I agree with Nursing being a very Unique career, however it is really concerning that the number of nurses that are leaving the career is growing. I totally understand the pressure this is having on the NHS, as I have just completed my first placement in a hospital. i think Nursing Associates is a good start to help relieve the pressure of the NHS and pressure it is having on the Nurses. I just pray that within the future, the number of people that apply for Nursing courses increase, and the number of Nurses that are falling out decreases.

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  11. I wholly agree with this blog. A nurse is often described as ‘unique’ however, this implies the nurse as being praised for their individuality when in fact a nurse works among other nurses and practitioners in the most effective and efficient way. These are the attributes that should be praised rather than using the term ‘unique’. Describing a nurse as incredible or exceptional, allows every aspect of the nurse to be praised including the way they work in a team, this may be the most outstanding factor within their talents.
    Admittedly it is a terrifying thought of the lack of people applying to study nursing, as students when we finally join the resister, the thought dawns upon is, will there still be an NHS to join?

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  12. As mentioned in the blog, nurses are very unique and after being on placement on a ward I can honestly say that no two days in the life of a nurse is the same. Everyday they encounter many different situations and come across many conditions on a day to day basis which then improves the variety of knowledge and skills a nurse has.

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  13. I think that the term ‘unique’ is fitting to describe a nurse as nurses are indeed incredible and exceptional individuals. I also agree with the fact that solitary is a rather negative synonym, as nurses work as a fantastic team together to provide excellent care. I was deeply concerned by how many nurses are leaving the register as compared to the number that are joining it, but I am encouraged by the fact that nursing associates will be joining the NHS in order to support the registered nurses. It is important for the standard of care to remain outstanding, and I truly believe that this quality is down to the staffing.

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  14. Thank you for posting this article, I found this interesting, especially in relation to the new roles that are being introduced to tackle the pending crisis of a shortage of Registered Nurses.
    This article highlighted to me, the strategic challenges ahead for the NHS/NMC in terms of ‘filling the gap’ that will be left as nurses reach retirement age and leave services. I think that it is essential that we begin to think about nursing differently, and I am glad to welcome the introduction to the Trainee Nursing Associate role to practice.
    So, in 2002, I embarked on a similar venture and enrolled onto a Health and Social Care Foundation Degree, as one of the first Trainee Assistant Practitioners. At the time, there was also much role confusion, shock and it took a long time to be welcomed by other professionals in the workplace. At the time, we were also being considered for registration by the NMC, but sadly this never materialised.
    I’m pleased to see that the NMC are now taking some ownership for the TNA’s and I wish each and everyone of them success in their roles. I wonder, how they have found their initial year of training and the challenges they have faced in terms of role transition and being accepted by other healthcare professionals. I hope that they have not had to endure some of my earlier challenges, as they were not always positive nor pleasant!
    I feel that we have now to be innovative and to move the nursing profession onwards, embracing technology and different ways of working in order to meet the demands of the 21st century and to keep the profession alive and desirable to the new generation.

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  15. Great post!

    It’s widely understood there is a national shortage of nurses, but reading actual figures makes you realise how alarming the situation is. With more nurses leaving the register then joining, and a large percentage of nurses reaching retirement age paints a bleak future. The question is why is this happening? Those in charge are they carrying out exit interviews and collating the findings on a national level to understand why? I’m in my final year now and due to qualify in March 2019. NHS bases its service on 6 C’s, yet I have heard of and witnessed many situations where the NHS has fallen short of providing care, compassion, commitment to Nurses. I’m extremely excited about working in Emergency Medicine as a nurse, but I do not see myself working for the NHS until retirement. At some point I will leave for better pay, working conditions and support.

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  16. Thank you for your post.

    This was a very interesting read and I agree that the term ‘unique’ is fitting when considering the role of the nurse. In one respect nurses are incredible and exceptional and should be recognised for this but I also agree that nursing can be a solitary profession, particularly when considering fitness to practice and The Code (2015) as the nurse is solely responsible for their actions and is required to explain them when required. Therefore, I can appreciate the reasons why some nurses feel the pressure of the role is becoming increasingly apparent, particularly when considering that more nurses are leaving the register than joining it, meaning that there are a shortage of registrants working within the NHS.

    I do, however, think that pre-registration nurses are well aware of the pressures which face them upon entry to the register and would like to believe that in light of the pressures that face them there choice to enter to the register is based upon their overwhelming desire to provide the best possible care for clients, in accordance with The Code (2015). With this in mind it could be preferable to consider that although the number of registrants are decreasing it is the quality of those which remain, and that are joining which is the more important issue.

    Nicola Haugh

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  17. Before becoming a student nurse I worked in a Health Visiting Team and so was surrounded by nurses who used to work on the wards before starting a family. I never really understood why nurses were so special and unique. It seemed to me that a nurse was a nurse, nothing special really. How wrong was I. Since working as a HCA on wards and doing my training on placements, my eyes have been opened to what an individual, special and unique group of people nurses really are.

    Victoria Wilkinson

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  18. I find the issue surrounding nurse associates a very concerning one. I do not feel they will replace registered nurses, however I find the lack of clarity surrounding their role and absence of a supernumerary status, could be detrimental to their training and reduce their learning opportunities. Without a clear role they may lack key skills, which will be required of them on qualification and they could experience inconsistencies within their training; already reduced from that of a registered nurse to just two years. I hope the confusion within their training will not be to the detriment of nurse associates or future patients when they begin to qualify in 2019.

    However, I do feel once this role has overcome the pilot stage; nurse associates will be highly beneficial and supportive for registered nurses. Adding another variation to our ‘unique’ role as a nurse and a welcome addition to any clinical area.

    Jessica Halsall

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  19. I do believe the role of the nurse is unique as it’s a very demanding yet rewarding, however, it’s ‘unique’ role can be the same reason why many current nurses are leaving. The role of a nurse is already hard when the right number of nurses are on a shift, but it’s becoming the norm to stretch the few nurses that are left on the register and many nurses have had to deal with a great workload until their breaking point, hence why they leave the register. As a student nurse myself, reading Kramer’s transition shock theory has taught me that I need o stay strong throughout the transition from being a student nurse to a registered nurse, however, the reality is that it will be difficult, and at points it will become unbearable. The key is to remember why you went through training and this will act as your fuel to continue to achieve the ‘unique’ role that your job requires.

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  20. This post led me to feel quite emotional considering the decline in the number of nurses leaving the profession and lack of those choosing to join the profession. However, it also made me feel proud that I will be hopefully, eventually joining the register in 2019. I believe nursing is a unique profession and one that the world simple can’t do without. This informative blog and I’ll admit I would benefit hugely from reading this more than I have been doing. This will be my goal towards the rest of my pre-reg programme and as ongoing professional development in the future. Knowing about what’s going on around the profession you are choosing to go into is very important!

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  21. Thank you for your post.

    You raised some very poignant points in regards to the impending staffing crisis which the UK will experience as more nurses leave than join the profession and I wonder to what degree of severity this will have on our ability to provide safe and effective care to our patients.

    I still do not agree with the removal of the bursary (which, I myself am a beneficiary) as I feel that many enter the profession as a mature student (yet again, myself included) and who may be discouraged by the necessity of a student loan. So, for me, it is no surprise that less are wishing to undertake a degree course and may instead consider the shorter and less costly training of a nursing associate with a mind of taking further studies later to become a nurse.

    As a member of the University of Salford March 16 cohort, I am aware that I will be one of the first to graduate with the newly formed Nursing Associate roles and I admit I am worried about the level of responsibility I will have to oversee as a newly qualified nurse. I also feel that there will be some confusion and indeed, maybe resentment with current nurses as to where we will all fit in the multidisciplinary team which I hope will be a clearer come Autumn 2018.

    However, I choose to remain positive that the nursing associates will help to ease our joint burden in providing care during a time of austerity and hope that they will help add “boots on the ground” as we step together into the uncertainty that comes with leaving the European Union and beyond.

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  22. As I am just starting my adult nursing reading through this blog gives me great hope and positivity that I will hopefully be joining the NMC register in 2021. I strongly agree that nursing is a ‘unique’ profession and without us nurses health care would just not be the same. However reading this blog can also be daunting seeing how many nurses have actually left the register which no doubt as time goes on will put more pressure on nurses if numbers do not start to increase, and in time to come this will be me and this is also a daunting factor however I will continue to read this blog along with many others throughout the duration of my course as it makes me as an individual not feel alone on my course.

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  23. Very informative and helpful blog!

    After reading the previous blogs unique, trustworthy and wonderful this has highlighted some very key aspects in relation to the nursing profession within today’s society. It was empowering to read the recent publication from IPSOS Mori Veracity Index (2018) to find that the nursing profession was ranked 1st across all longitudinal studies. When participants were asked which professions they trusted the most, nursing came 1st receiving a massive 94% of all votes. This highlights how as nurses it is important we act as advocates for our clients. As a second year student nurse I have learnt that in order to gain the trust of my patients I need to provide my client with the best available evidence, remaining open and honest at all times, in addition the patient should take an active role in making their own decisions which should be respected at all times (even in cases where their decision does not follow the best available evidence).

    In contrast with this it was disheartening to read that over 35,363 nurses left the register within 2016-2017, with just 27,786 joining in the same year, with The Commons Select Committee publishing that within the NHS we have 36,000 health care vacancies. This dramatic number of vacancies will no doubt be contributing to the gaps in care provided by our National Health Service.

    After attending the Queens Nursing Institute (QNI) event in relation to Homelessness I increased my knowledge base. Learning from a wide variety of professional organisations and charities. The QNI report for homelessness (2018) surveyed over 200 nurses. This report highlighted the barriers for nurses and the homeless community, with a view improve capacity and capability, improve access to health care and housing systems and increase knowledge and awareness in relation to this national issue.
    As a student nurse it was also interesting to hear from Anne Trotter, Assistant Director: Education and Standards at Nursing and Midwifery Council at the QNI event, Highlighting new standards set out within the NMC, this included one set of proficiency’s relevant to all fields of practice and various methods to increase readiness and leadership for student nurses transitioning into a fully qualified nursing role. This included delegation of tasks and obtaining an equal role within the Multi Disciplinary Team (MDT).

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