EDUCATION MATTERS
Generalist or specialist in nurse education? Elizabeth Rosser
120
and prevent unnecessary hospital admissions (Rosser, 2014).The move to this model seems to be making good progress in parts of the country (Ham, 2010) but the question remains as to how the four fields of nursing will equip qualified nurses to engage meaningfully with sufficient transferable skills to deliver what is required. Flexibility is expected of any qualified nurse who will face new challenges as the transformation of the delivery of health and social care services emerges. Ham et al (2012) recognise failings in the current system where, for example, mental health care in England fares well in the treatment of mental health problems but does so in isolation from supporting those with additional physical health needs. Ham et al (2012) confirm that those with severe mental illness also experience higher levels of physical illness, which has a serious effect on life expectancy. Additionally, one in four patients in acute hospitals has dementia (Lakey, 2009) and approximately one in three patients with longterm physical conditions has a mental health problem (Naylor et al 2012).As Ham et al (2012) suggest, tweaking the education programme will not bring the level of transformational change that is needed. They recognise the need for generalist and specialist knowledge to support the level of integration required. However, how will the introduction of a 2-year ‘common foundation’ of generalist nursing fare among our current specialist nurses, especially if the end point is a specialist qualification (with specialist title) in one of the four fields of nursing? Rather like the notion of integrated care where health and social care professionals speak a different language, so too do mental health and adult nurses. For these nurses, even the word ‘patient’ does not feature as common, with mental health areas using the term ‘service user’, underpinning a different philosophical value base. I suspect that, should this transpire as a recommendation in the final report, a major re-think would be necessary as to how this would be achieved, particularly in relation to placement opportunities. Would all four fields of nursing rotate around all four specialist placement areas to gain core skills pertinent across the fields, or would they be squeezed into
generalist adult placements to gain such skills? With the move to majority care delivery in the community, surely adult nursing is full of its own specialisms? What would constitute 2 years of a common foundation and how would all four fields learn the commonalities? Would they be expected to learn generalist theory and then apply it to the mental health setting or not gain any mental health experience until the third year when the specialist element begins? The UK is almost 10 years down the specialist path. Retracing our steps would, as I see it, support the adult nurse to gain further mental health grounding and children’s experience, but children’s nurses, mental health and learning disabilities nurses may feel they will lose their specialist identity. While a 1-year preceptorship programme will develop their specialist preparation, it begs the question as to whose responsibility this will become—education or practice? Clearly there are more questions than answers. We will have to wait until the publication of the report. What is certain is that radical change is necessary to support a transformation of the delivery system that is fit BJN for purpose for the next 10–15 years. Athlone Committee (1939). Inter-departmental committee on nursing services. Interim report. HMSO, London Briggs A (1972) Report of the Committee on Nursing. HMSO, London Ham C (2010) Working together for health: achievements and challenges in the Kaiser NHS Beacon Sites Programme http:// tinyurl.com/peszddn (accessed 8 January 2015) Ham C, Dixon A, Brooke B (2012) Transforming the delivery of health and social care. The case for fundamental change. http:// tinyurl.com/cshydnp (accessed 8 January 2015) Lakey L (2009) Counting the Cost. Caring for people with dementia on hospital wards. http://tinyurl.com/d4y6bu6 (accessed 8 January 2015) Lintern S (2014) Lord Willis reveals plans for the future of nurse education. Health Service Journal (online) 11 December. http://tinyurl.com/n6lkwhf (accessed 8 January 2015) Naylor C, Parsonage M, McDaid D, Knapp M, Fossey M Galea A (2012) Long-term conditions and mental health http://tinyurl. com/btcfudp (accessed 8 January 2015) Rosser E (2014) Shape of Caring: a whole systems approach to integrated care. Br J Nurs 23(21): 1158. doi: 10.12968/ bjon.2014.23.21.1158 Royal College of Nursing (2007) Pre-registration Nurse Education. The NMC review and the issues. http://tinyurl. com/6339zz6(accessed 14 January 2015) Willis Commission (2012) Quality with Compassion: the future of nursing education. Report of the Willis Commission 2012. http:// tinyurl.com/cvugp8t (accessed 8 January 2015)
Elizabeth Rosser Bournemouth University
© 2015 MA Healthcare Ltd
N
urse education has been the subject of numerous reviews and recommendations certainly since the Athlone report (The Athlone Committee, 1939) recommending student status. Many reviews (Briggs, 1972; Royal College of Nursing, 2007) have focused on the ‘employment’ status of the nursing student and the development of graduate status of the nursing workforce. Equally contentious has been the move of UK nursing from one generalist point at registration, into four ‘fields’ of nursing so that at point of registration, nurses are specialist in either adult, mental health, learning disability or children and young people’s nursing. While the rest of Europe continues to prepare nurses as generalists, it is only the UK adult nurse who complies with EU directives and is permitted to seek employment across Europe. Lord Willis, who published his review of nurse education following the first Francis Report in 2012 (Willis Commission, 2012), has been charged with a comprehensive review of the standards of education and training of the qualified nurse and care assistant workforce in his Shape of Caring review, due to report in February 2015. Speaking at the recent Chief Nursing Officer conference, he suggested that without change, nurse education would no longer be fit for purpose over the next 10–15 years (Lintern, 2014).Although the report will not be published until February, his current thinking is that nurse education should require students to spend the first 2 years of their programme learning a foundation of general nursing, beginning their specialism of mental health, learning disability or children’s nursing in their third year and continue into a 1-year preceptorship programme following registration. He suggests the 1-year preceptorship programme should be a continued and active contribution to the education process (Lintern, 2014). In this column, I recently discussed the implications of the Shape of Caring review and the move to an integrated care model of care delivery, with a focus on the education and training of the healthcare assistant workforce, and the need for a whole systems approach to bring together health and social care services
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 14, 2015. For personal use only. No other uses without permission. . All rights reserved.
Generalist or specialist in nurse education? Elizabeth Rosser
120
and prevent unnecessary hospital admissions (Rosser, 2014).The move to this model seems to be making good progress in parts of the country (Ham, 2010) but the question remains as to how the four fields of nursing will equip qualified nurses to engage meaningfully with sufficient transferable skills to deliver what is required. Flexibility is expected of any qualified nurse who will face new challenges as the transformation of the delivery of health and social care services emerges. Ham et al (2012) recognise failings in the current system where, for example, mental health care in England fares well in the treatment of mental health problems but does so in isolation from supporting those with additional physical health needs. Ham et al (2012) confirm that those with severe mental illness also experience higher levels of physical illness, which has a serious effect on life expectancy. Additionally, one in four patients in acute hospitals has dementia (Lakey, 2009) and approximately one in three patients with longterm physical conditions has a mental health problem (Naylor et al 2012).As Ham et al (2012) suggest, tweaking the education programme will not bring the level of transformational change that is needed. They recognise the need for generalist and specialist knowledge to support the level of integration required. However, how will the introduction of a 2-year ‘common foundation’ of generalist nursing fare among our current specialist nurses, especially if the end point is a specialist qualification (with specialist title) in one of the four fields of nursing? Rather like the notion of integrated care where health and social care professionals speak a different language, so too do mental health and adult nurses. For these nurses, even the word ‘patient’ does not feature as common, with mental health areas using the term ‘service user’, underpinning a different philosophical value base. I suspect that, should this transpire as a recommendation in the final report, a major re-think would be necessary as to how this would be achieved, particularly in relation to placement opportunities. Would all four fields of nursing rotate around all four specialist placement areas to gain core skills pertinent across the fields, or would they be squeezed into
generalist adult placements to gain such skills? With the move to majority care delivery in the community, surely adult nursing is full of its own specialisms? What would constitute 2 years of a common foundation and how would all four fields learn the commonalities? Would they be expected to learn generalist theory and then apply it to the mental health setting or not gain any mental health experience until the third year when the specialist element begins? The UK is almost 10 years down the specialist path. Retracing our steps would, as I see it, support the adult nurse to gain further mental health grounding and children’s experience, but children’s nurses, mental health and learning disabilities nurses may feel they will lose their specialist identity. While a 1-year preceptorship programme will develop their specialist preparation, it begs the question as to whose responsibility this will become—education or practice? Clearly there are more questions than answers. We will have to wait until the publication of the report. What is certain is that radical change is necessary to support a transformation of the delivery system that is fit BJN for purpose for the next 10–15 years. Athlone Committee (1939). Inter-departmental committee on nursing services. Interim report. HMSO, London Briggs A (1972) Report of the Committee on Nursing. HMSO, London Ham C (2010) Working together for health: achievements and challenges in the Kaiser NHS Beacon Sites Programme http:// tinyurl.com/peszddn (accessed 8 January 2015) Ham C, Dixon A, Brooke B (2012) Transforming the delivery of health and social care. The case for fundamental change. http:// tinyurl.com/cshydnp (accessed 8 January 2015) Lakey L (2009) Counting the Cost. Caring for people with dementia on hospital wards. http://tinyurl.com/d4y6bu6 (accessed 8 January 2015) Lintern S (2014) Lord Willis reveals plans for the future of nurse education. Health Service Journal (online) 11 December. http://tinyurl.com/n6lkwhf (accessed 8 January 2015) Naylor C, Parsonage M, McDaid D, Knapp M, Fossey M Galea A (2012) Long-term conditions and mental health http://tinyurl. com/btcfudp (accessed 8 January 2015) Rosser E (2014) Shape of Caring: a whole systems approach to integrated care. Br J Nurs 23(21): 1158. doi: 10.12968/ bjon.2014.23.21.1158 Royal College of Nursing (2007) Pre-registration Nurse Education. The NMC review and the issues. http://tinyurl. com/6339zz6(accessed 14 January 2015) Willis Commission (2012) Quality with Compassion: the future of nursing education. Report of the Willis Commission 2012. http:// tinyurl.com/cvugp8t (accessed 8 January 2015)
Elizabeth Rosser Bournemouth University
© 2015 MA Healthcare Ltd
N
urse education has been the subject of numerous reviews and recommendations certainly since the Athlone report (The Athlone Committee, 1939) recommending student status. Many reviews (Briggs, 1972; Royal College of Nursing, 2007) have focused on the ‘employment’ status of the nursing student and the development of graduate status of the nursing workforce. Equally contentious has been the move of UK nursing from one generalist point at registration, into four ‘fields’ of nursing so that at point of registration, nurses are specialist in either adult, mental health, learning disability or children and young people’s nursing. While the rest of Europe continues to prepare nurses as generalists, it is only the UK adult nurse who complies with EU directives and is permitted to seek employment across Europe. Lord Willis, who published his review of nurse education following the first Francis Report in 2012 (Willis Commission, 2012), has been charged with a comprehensive review of the standards of education and training of the qualified nurse and care assistant workforce in his Shape of Caring review, due to report in February 2015. Speaking at the recent Chief Nursing Officer conference, he suggested that without change, nurse education would no longer be fit for purpose over the next 10–15 years (Lintern, 2014).Although the report will not be published until February, his current thinking is that nurse education should require students to spend the first 2 years of their programme learning a foundation of general nursing, beginning their specialism of mental health, learning disability or children’s nursing in their third year and continue into a 1-year preceptorship programme following registration. He suggests the 1-year preceptorship programme should be a continued and active contribution to the education process (Lintern, 2014). In this column, I recently discussed the implications of the Shape of Caring review and the move to an integrated care model of care delivery, with a focus on the education and training of the healthcare assistant workforce, and the need for a whole systems approach to bring together health and social care services
British Journal of Nursing, 2015, Vol 24, No 2
British Journal of Nursing. Downloaded from magonlinelibrary.com by 147.188.128.074 on November 14, 2015. For personal use only. No other uses without permission. . All rights reserved.
