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.