Editorial
Nurses must face skill-mix reality ursing has been subsumed within the personnel di rectorate at the Department of Health for over 6 months now, with the director, Mr Eric Caines, consist ently stating that nurses need to live in the real world. Basically, this means resources are finite, and profession als must come to terms with the changing demands on the Health Service. Now that Mr Caines has announced his forthcoming departure from the personnel directorate next March, we should take the opportunity to thank him for making his message so clear and reflect on what his message has meant for nurses. The personnel directorate is primarily concerned with the human resources of the NHS. This involves balanc ing effective use of skilled labour, to achieve quality of delivery and successful outcomes, with efficient, costeffective use. Human resources are limited because health demands are unlimited and finances are not. Deci sions are necessary to ensure that the right skills arc targeted to where they will bring the most benefit. This places skill mix at the centre of the personnel directorate’s role. However, the relationships between effectiveness, efficiency and human resources are highly complex and dynamic, varying between different clinical areas and from day to day. Skill mix can therefore only be planned at a local level. The personnel directorate has attempted to facilitate skill mix by influencing the environment in which we work. Key words for Mr Caines have been integration and collaboration. He sees good professionalism as a willingness to put ourselves in a human resource melting pot in order to forge the sort of flexible workforce that he believes is necessary in the real world. Nurses are asked to live in this reality instead of being protectionist and inflexible in their response to change. A closer examination of the real world will help explain why nurses might respond in this way. The most pressing reality is that of serious economic recession where public spending is under even tighter control. This has created a strong undercurrent of shorttermism, with the Treasury effectively dictating policy. The emphasis is on the short-term reality of cash limits, rather than longer-term effectiveness and efficiency. Skill mix, being an inexact art, is particularly open to manipulation when economies have to be made. Mak ing the role of healthcare workers fluid and arbitrary allows financially compromised NHS managers, includ ing ex-nurses, to make decisions that effectively deskill and marginalize all professionals. The fact that nurses are increasingly being employed to carry out the work of doctors and other professionals may suggest new opportunities, but nurses too arc an expensive resource. A great deal of energy continues to be invested in the development of national vocational qualifications (NVQs) for healthcare assistants. This form of training, at higher levels, is a direct challenge
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Hritish.lournalofNur.sing, 1992,Voi l.N o 14
to the current sphere of practice of registered nurses and other professionals. There is recent further evidence of many registered nurse posts being lost and replaced by jobs for support workers (Snell, 1992). This is mirrored by a continuing decline in entrants to the profession (Smith, 1992). Exist ing terms and conditions of employment remain threatened while Trusts are free of Whitley Council agreements, and rising nurse unemployment makes us vulnerable to accepting inferior contracts. Professional development is still not secure as funding for PREPP (UKCC, 1990) has been delayed and Project 2000 (UKCC, 1986) has still to be fully introduced. Change is not so much about forging new relation ships, but more about moulding a new workforce, orien tated away from the profession. Rather than integrating and collaborating in an environment of trust, confi dence and respect, we are threatened with a loss of ident ity, power and jobs. If nurses are being protectionist and inflexible in their response to change, this should be seen as a sign of conflict, adversity and resistance to an erosion of nursing. The Department of Health must be aware that the professionally qualified nurse provides more effective and efficient care (Carr-Hill et al, 1992). Professional nursing protects and raises standards of practice. Nurses value innovation and excellence, they are educated to be flexible to the demands of patients, and can adapt to changing healthcare environments. It must also be emphasized that UK nursing influences health, both na tionally and internationally, far beyond the increasingly limited scope of the NHS. There is a need for policies that continue the advance ment of the nursing profession both short- and long term, and that deal with the real world. For example, in this issue of BJN (see page 726), George Castledine presents the argument for transferring nurse education funding to the Department of Education. The message is that a commitment to securing and promoting our profession will be repaid by nurses continuing to im prove the health of the nation, long after Mr Caines’ and his successor’s time in office. m Mervyn Morris Project Manager The Birmingham College o f Nurse Education
Carr-Hill R et al (1982) Skill-Mix and the Effectiveness o f Nursing Care. University of York, Centre for Health Economics Smith A (1992) Entries into Nursing, Including District Nursing, and Health Visiting Education Programmes. Letter to College Princi pals. 28 May, I.NB, London. Snell J (1992) Staff trends used to push low award. Nurs Times 88 (42): 9 UKCC (1986) Project 2000: A New Preparation for Practice. UKCC, London UKCC (1990) The Report o f the Post-registration Education and Prac tice Project. UKCC, London
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Downloaded from magonlinelibrary.com by 129.215.017.190 on January 13, 2019.
Nurses must face skill-mix reality ursing has been subsumed within the personnel di rectorate at the Department of Health for over 6 months now, with the director, Mr Eric Caines, consist ently stating that nurses need to live in the real world. Basically, this means resources are finite, and profession als must come to terms with the changing demands on the Health Service. Now that Mr Caines has announced his forthcoming departure from the personnel directorate next March, we should take the opportunity to thank him for making his message so clear and reflect on what his message has meant for nurses. The personnel directorate is primarily concerned with the human resources of the NHS. This involves balanc ing effective use of skilled labour, to achieve quality of delivery and successful outcomes, with efficient, costeffective use. Human resources are limited because health demands are unlimited and finances are not. Deci sions are necessary to ensure that the right skills arc targeted to where they will bring the most benefit. This places skill mix at the centre of the personnel directorate’s role. However, the relationships between effectiveness, efficiency and human resources are highly complex and dynamic, varying between different clinical areas and from day to day. Skill mix can therefore only be planned at a local level. The personnel directorate has attempted to facilitate skill mix by influencing the environment in which we work. Key words for Mr Caines have been integration and collaboration. He sees good professionalism as a willingness to put ourselves in a human resource melting pot in order to forge the sort of flexible workforce that he believes is necessary in the real world. Nurses are asked to live in this reality instead of being protectionist and inflexible in their response to change. A closer examination of the real world will help explain why nurses might respond in this way. The most pressing reality is that of serious economic recession where public spending is under even tighter control. This has created a strong undercurrent of shorttermism, with the Treasury effectively dictating policy. The emphasis is on the short-term reality of cash limits, rather than longer-term effectiveness and efficiency. Skill mix, being an inexact art, is particularly open to manipulation when economies have to be made. Mak ing the role of healthcare workers fluid and arbitrary allows financially compromised NHS managers, includ ing ex-nurses, to make decisions that effectively deskill and marginalize all professionals. The fact that nurses are increasingly being employed to carry out the work of doctors and other professionals may suggest new opportunities, but nurses too arc an expensive resource. A great deal of energy continues to be invested in the development of national vocational qualifications (NVQs) for healthcare assistants. This form of training, at higher levels, is a direct challenge
N
Hritish.lournalofNur.sing, 1992,Voi l.N o 14
to the current sphere of practice of registered nurses and other professionals. There is recent further evidence of many registered nurse posts being lost and replaced by jobs for support workers (Snell, 1992). This is mirrored by a continuing decline in entrants to the profession (Smith, 1992). Exist ing terms and conditions of employment remain threatened while Trusts are free of Whitley Council agreements, and rising nurse unemployment makes us vulnerable to accepting inferior contracts. Professional development is still not secure as funding for PREPP (UKCC, 1990) has been delayed and Project 2000 (UKCC, 1986) has still to be fully introduced. Change is not so much about forging new relation ships, but more about moulding a new workforce, orien tated away from the profession. Rather than integrating and collaborating in an environment of trust, confi dence and respect, we are threatened with a loss of ident ity, power and jobs. If nurses are being protectionist and inflexible in their response to change, this should be seen as a sign of conflict, adversity and resistance to an erosion of nursing. The Department of Health must be aware that the professionally qualified nurse provides more effective and efficient care (Carr-Hill et al, 1992). Professional nursing protects and raises standards of practice. Nurses value innovation and excellence, they are educated to be flexible to the demands of patients, and can adapt to changing healthcare environments. It must also be emphasized that UK nursing influences health, both na tionally and internationally, far beyond the increasingly limited scope of the NHS. There is a need for policies that continue the advance ment of the nursing profession both short- and long term, and that deal with the real world. For example, in this issue of BJN (see page 726), George Castledine presents the argument for transferring nurse education funding to the Department of Education. The message is that a commitment to securing and promoting our profession will be repaid by nurses continuing to im prove the health of the nation, long after Mr Caines’ and his successor’s time in office. m Mervyn Morris Project Manager The Birmingham College o f Nurse Education
Carr-Hill R et al (1982) Skill-Mix and the Effectiveness o f Nursing Care. University of York, Centre for Health Economics Smith A (1992) Entries into Nursing, Including District Nursing, and Health Visiting Education Programmes. Letter to College Princi pals. 28 May, I.NB, London. Snell J (1992) Staff trends used to push low award. Nurs Times 88 (42): 9 UKCC (1986) Project 2000: A New Preparation for Practice. UKCC, London UKCC (1990) The Report o f the Post-registration Education and Prac tice Project. UKCC, London
695
Downloaded from magonlinelibrary.com by 129.215.017.190 on January 13, 2019.
