Nursing may not quite be in crisis, but it is certainly going through a rough patch. So the launch today of a commission of inquiry into nurse education and training is enormously significant both for its timing and for who is behind it.
The commission is to be led by educationist Lord [Phil] Willis, a Liberal Democrat, and it has been initiated by the Royal College of Nursing. Hitherto an unswerving advocate of the model of training that the profession has been moving to over the past 20 years, culminating in it becoming degree-entry only from next year, the RCN is seizing the initiative before it is grabbed by others.
As its chief executive and general secretary Peter Carter acknowledges, "nursing has recently come under increased scrutiny from various sources, some of which have questioned the compassion and dedication of the profession". In setting up the commission, the college has decided to act "rather than refuse to accept that there may be issues in some areas".
This is an important and sensible admission. The charge sheet is now too long to deny that some nurses lack a certain something in the way they approach the job. Stories of ward staff chatting at nursing stations while their patients struggle to reach food and drink are legion, while the horrors of the mid-Staffordshire scandal – involving hundreds of unnecessary deaths of neglected patients – will be revisited later in the year by publication of the report of the public inquiry.
And the evidence keeps coming. In a new report on Leeds general infirmary, inspectors of the Care Quality Commission describe how they felt obliged to step in to seek help for patients during a recent two-day visit. "Had we not intervened, we believe some needs would not have been met," they say, formally registering "major concerns" about care standards and staffing levels.
Plainly there were questions of adequacy of staff numbers at Leeds. But the outlook for NHS funding means that hospitals and community health services will be waiting a long time for reinforcements. Besides which, many critics of modern nursing think the profession's leaders are too ready to hide behind defences of team size and skill mix.
The draft report of the Commission on Improving Dignity in Care, published in February, argued forcefully that there is a compassion deficit in the attitude of many nurses and other health workers towards older patients. It called for recruitment to be based as much on assessment of a candidate's caring qualities as on their academic record. Others, however, think that basic caring skills are no longer being taught properly during nurse training, and this is where the spotlight will be on the RCN's new commission.
The argument goes that in replacing hospital-based training with a university-based system, with nursing students doing placements in care settings, the reforms of the early 1990s sowed the seeds of today's failings. Abolition of state enrolled or assistant nurses, and their replacement by cheaper healthcare assistants, served to compound the problem.
Will Willis, whose mother was a district nurse, venture into this territory? He says he has no preconceptions and is being given a free hand to explore the commission's remit of identifying the "defining features" of nurse education to produce a workforce fit for the future. That will, he makes clear, include looking at the curriculum and at whether there is "the right balance" between classroom and workplace.
It seems unlikely, though, that the commission will question the principle of degree-based training. Across the rest of Europe and beyond, Willis points out, there is "a strong move towards a graduate nursing profession". The Guardian
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