Why the NHS needs more graduate nurses

The Keogh report pointed to inadequate levels of nursing staff in hospitals. Photograph: Monty Rakusen/ Alamy

Care in the NHS has come under considerable scrutiny over the past year – the Francis report into Mid-Staffs, the Morecambe Bay investigations, and the review of the Liverpool care pathway have all pointed to issues of inadequate practice, leadership and staffing levels. In addition, the Keogh review of 14 NHS Trusts with higher than expected death rates has led to a focus on health care and nursing that hasn't been seen for decades. This has provided an unprecedented opportunity to recognise and address the failures while showcasing the excellence and good practice that everyone can learn from, and through which we can reassure the public that nurses are still there caring for them. We have seen some of the former but the latter has not been much in evidence.

The Keogh report published on 16 July points to inadequate levels of nursing staff. We note Sir Bruce's wording – not care staff, but nursing staff. This is a credible assertion from the medical director of the NHS stating that there is a relationship between the number of nurses and the quality of care. Why have there been no loud nursing voices reminding the government and providers of healthcare that the sick and health-vulnerable need expert nurses? It is not best value to have fewer qualified nurses supervising a less skilled workforce.

All organisations are well versed in the concept of value for money. Some of what we see now are the effects of interpreting staffing value for money as being about more people for the lowest possible wage bill, with no serious (evidence-based) attempt to define patient or indeed organisational need. It is time for leaders of nursing to grasp this opportunity and insist upon the improvements in care and the added value to organisations that a registered nurse workforce can bring. Reviews of skill mix should be well underway as a result of the Francis and Keogh reports. We hope that trust chief nurses will be tasked with bringing to their boards a strategy to increase the numbers of qualified nurses giving direct care and that their value to the organisation is demonstrated at every opportunity.

Simple nurse/patient ratios or minimum staffing levels are likely to be the initial response, but a significantly increased ratio of graduate registered nurses to support staff offers many more opportunities for enhanced care and cultural impact. The evidence clearly shows that graduate nurses offer better care than non-graduates and the more highly skilled and educated nurses there are in clinical areas, the better care outcomes are. The tendency to attack the academic elements of nurse education as being at the root of the current perceived crisis in care has no place in modern healthcare environments.

One of the most important changes for the future is that all nurse leaders – both clinical and academic – resist the political knee-jerk responses to the recent investigations. They must champion and celebrate the place of nursing in our universities as a positive influence on care and challenge any questioning or undermining of its place as an evidence-based, research literate profession. Clinical and academic leaders need to collaborate to drive a reinvigorated research agenda in nursing, patient experience and quality of care – an agenda that aims to develop a strong evidence base for the value and impact of nursing on the widest range of care.

All too often in nursing, the word "academic" is used as a pejorative term rather than as a signifier of the knowledgeable do-er that is so in demand. Graduate nurses can bring their knowledge and expertise to enhance patient experience and outcome and to contribute to innovation in care. In our view, a crucial component of the required cultural change is healthcare professionals who can offer much more than technical skill. This is the added value of the graduate nurse.

June Girvin is pro vice-chancellor and dean of the faculty of health and life sciences at Oxford Brookes University, Mark Hayter is professor in the faculty of health and social care University of Hull

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Why the NHS needs more graduate nurses

The Keogh report pointed to inadequate levels of nursing staff in hospitals. Photograph: Monty Rakusen/ Alamy

Care in the NHS has come under considerable scrutiny over the past year – the Francis report into Mid-Staffs, the Morecambe Bay investigations, and the review of the Liverpool care pathway have all pointed to issues of inadequate practice, leadership and staffing levels. In addition, the Keogh review of 14 NHS Trusts with higher than expected death rates has led to a focus on health care and nursing that hasn't been seen for decades. This has provided an unprecedented opportunity to recognise and address the failures while showcasing the excellence and good practice that everyone can learn from, and through which we can reassure the public that nurses are still there caring for them. We have seen some of the former but the latter has not been much in evidence.

The Keogh report published on 16 July points to inadequate levels of nursing staff. We note Sir Bruce's wording – not care staff, but nursing staff. This is a credible assertion from the medical director of the NHS stating that there is a relationship between the number of nurses and the quality of care. Why have there been no loud nursing voices reminding the government and providers of healthcare that the sick and health-vulnerable need expert nurses? It is not best value to have fewer qualified nurses supervising a less skilled workforce.

All organisations are well versed in the concept of value for money. Some of what we see now are the effects of interpreting staffing value for money as being about more people for the lowest possible wage bill, with no serious (evidence-based) attempt to define patient or indeed organisational need. It is time for leaders of nursing to grasp this opportunity and insist upon the improvements in care and the added value to organisations that a registered nurse workforce can bring. Reviews of skill mix should be well underway as a result of the Francis and Keogh reports. We hope that trust chief nurses will be tasked with bringing to their boards a strategy to increase the numbers of qualified nurses giving direct care and that their value to the organisation is demonstrated at every opportunity.

Simple nurse/patient ratios or minimum staffing levels are likely to be the initial response, but a significantly increased ratio of graduate registered nurses to support staff offers many more opportunities for enhanced care and cultural impact. The evidence clearly shows that graduate nurses offer better care than non-graduates and the more highly skilled and educated nurses there are in clinical areas, the better care outcomes are. The tendency to attack the academic elements of nurse education as being at the root of the current perceived crisis in care has no place in modern healthcare environments.

One of the most important changes for the future is that all nurse leaders – both clinical and academic – resist the political knee-jerk responses to the recent investigations. They must champion and celebrate the place of nursing in our universities as a positive influence on care and challenge any questioning or undermining of its place as an evidence-based, research literate profession. Clinical and academic leaders need to collaborate to drive a reinvigorated research agenda in nursing, patient experience and quality of care – an agenda that aims to develop a strong evidence base for the value and impact of nursing on the widest range of care.

All too often in nursing, the word "academic" is used as a pejorative term rather than as a signifier of the knowledgeable do-er that is so in demand. Graduate nurses can bring their knowledge and expertise to enhance patient experience and outcome and to contribute to innovation in care. In our view, a crucial component of the required cultural change is healthcare professionals who can offer much more than technical skill. This is the added value of the graduate nurse.

June Girvin is pro vice-chancellor and dean of the faculty of health and life sciences at Oxford Brookes University, Mark Hayter is professor in the faculty of health and social care University of Hull

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

Why the NHS needs more graduate nurses

The Keogh report pointed to inadequate levels of nursing staff in hospitals. Photograph: Monty Rakusen/ Alamy

Care in the NHS has come under considerable scrutiny over the past year – the Francis report into Mid-Staffs, the Morecambe Bay investigations, and the review of the Liverpool care pathway have all pointed to issues of inadequate practice, leadership and staffing levels. In addition, the Keogh review of 14 NHS Trusts with higher than expected death rates has led to a focus on health care and nursing that hasn't been seen for decades. This has provided an unprecedented opportunity to recognise and address the failures while showcasing the excellence and good practice that everyone can learn from, and through which we can reassure the public that nurses are still there caring for them. We have seen some of the former but the latter has not been much in evidence.

The Keogh report published on 16 July points to inadequate levels of nursing staff. We note Sir Bruce's wording – not care staff, but nursing staff. This is a credible assertion from the medical director of the NHS stating that there is a relationship between the number of nurses and the quality of care. Why have there been no loud nursing voices reminding the government and providers of healthcare that the sick and health-vulnerable need expert nurses? It is not best value to have fewer qualified nurses supervising a less skilled workforce.

All organisations are well versed in the concept of value for money. Some of what we see now are the effects of interpreting staffing value for money as being about more people for the lowest possible wage bill, with no serious (evidence-based) attempt to define patient or indeed organisational need. It is time for leaders of nursing to grasp this opportunity and insist upon the improvements in care and the added value to organisations that a registered nurse workforce can bring. Reviews of skill mix should be well underway as a result of the Francis and Keogh reports. We hope that trust chief nurses will be tasked with bringing to their boards a strategy to increase the numbers of qualified nurses giving direct care and that their value to the organisation is demonstrated at every opportunity.

Simple nurse/patient ratios or minimum staffing levels are likely to be the initial response, but a significantly increased ratio of graduate registered nurses to support staff offers many more opportunities for enhanced care and cultural impact. The evidence clearly shows that graduate nurses offer better care than non-graduates and the more highly skilled and educated nurses there are in clinical areas, the better care outcomes are. The tendency to attack the academic elements of nurse education as being at the root of the current perceived crisis in care has no place in modern healthcare environments.

One of the most important changes for the future is that all nurse leaders – both clinical and academic – resist the political knee-jerk responses to the recent investigations. They must champion and celebrate the place of nursing in our universities as a positive influence on care and challenge any questioning or undermining of its place as an evidence-based, research literate profession. Clinical and academic leaders need to collaborate to drive a reinvigorated research agenda in nursing, patient experience and quality of care – an agenda that aims to develop a strong evidence base for the value and impact of nursing on the widest range of care.

All too often in nursing, the word "academic" is used as a pejorative term rather than as a signifier of the knowledgeable do-er that is so in demand. Graduate nurses can bring their knowledge and expertise to enhance patient experience and outcome and to contribute to innovation in care. In our view, a crucial component of the required cultural change is healthcare professionals who can offer much more than technical skill. This is the added value of the graduate nurse.

June Girvin is pro vice-chancellor and dean of the faculty of health and life sciences at Oxford Brookes University, Mark Hayter is professor in the faculty of health and social care University of Hull

This article is published by Guardian Professional. Join the Healthcare Professionals Network to receive regular emails and exclusive offers.

View the original article here

"Bring your own device" to work tech trend helps nurses provide improved patient care

Main Category: Nursing / Midwifery
Also Included In: IT / Internet / E-mail
Article Date: 15 Aug 2013 - 2:00 PDT Current ratings for:
"Bring your own device" to work tech trend helps nurses provide improved patient care

Not long ago, hospital IT departments supplied and maintained the hardware and software that nurses used to perform work-related tasks. Then came the mobile revolution, when consumers increasingly began carrying smartphones and tablets to assist them in their personal lives as well as in business. As a direct result, many nurses today are following the trend known as BYOD - bring your own device.

"RNs have greater familiarity with their own devices and the more familiar they are, the greater the tendency there is for nurses to optimize the use of the device to its fullest capacity for improved patient care," says Judith Church, DHA, MSN, faculty member in the health care and health care informatics programs at American Sentinel University.

A recent survey by Fierce Mobile Healthcare found that 61 percent of hospitals and health systems responding said that half their employees use personal mobile devices for work. Fifty percent said this use was limited to email and calendar applications, but 36 percent said that employees were accessing patient data.

Another report, Point of Care Computing for Nursing 2012, examined the BYOD patterns of nurses and found that 69 percent of hospitals say their nursing staff is using personal devices at work.

The Pros and Cons of BYOD in Nursing
Church says that BYOD can increase productivity or job performance because people are more comfortable with their own device, have more control over the computing environment and enjoy an enhanced sense of work-life balance, to name a few benefits.

The nurses surveyed in the report specifically stated they use their own mobile devices to improve patient safety and reduce the risk of medical errors. They believe their personal devices enable them to fill in critical communication gaps with the technologies provided by the hospital - for example, allowing them to easily access clinical reference materials at the point of care or quickly communicate with other clinicians to coordinate care.

Yet, BYOD can put IT departments in the difficult position of having to provide support for all these personal devices.

For example, IT might have to build a platform that will ensure hospital software works on all four mobile operating systems (Apple, Android, Microsoft Windows and Blackberry). These diverse devices also create security and HIPAA issues associated with mobile technology.

"The drawback to BYOD in nursing is that it contributes to a non-standardization of a work arena's equipment," says Church. "Nurses should realize that IT policies exist for a reason to protect data integrity and security and should adhere to them at all times when participating in a BYOD initiative."

Using BYOD to Improve Nursing Workflows
Integrating BYOD with nursing call systems can improve both staff and patient satisfaction. Call systems based on overhead paging or lights that can only be seen from the nursing station may soon become obsolete in favor of newer systems that can wirelessly transmit alerts right to a nurse's smartphone when the patient pushes a button.

Alerts can take the form of text messages, emails, pages or phone calls. In some cases, patients may be able to send a specific type of alert - a request for bathroom assistance or pain medicine, for example - that are then routed to the appropriate staff person.

"BYOD can play a significant role in nursing to improve workflows," says Church. "The individual device and user prowess will contribute to optimal standardization of devices across the physical and electronic work environment."

Church points out that BYOD is a trend that will continue in health care because of its financial implications.

"The BYOD trend will thrive in nursing because health care organizations save money when the employee purchases the device. Since nurses are most familiar with their own devices, they will work more effectively and efficiently. Equipment - no matter what it is - is only as effective as its setup and use," adds Church.

It's clear that health care must find ways to reap the benefits of mobile technologies, while reducing the risks and protecting patient data.

"BYOD initiatives should be expanded to include nurses as well as physicians in order to increase nurse productivity and improve patient care and satisfaction," adds Church.

For more information about American Sentinel University's MSN, nursing informatics specialization, please visit http://www.americansentinel.edu/health-care/m-s-nursing/m-s-nursing-nursing-informatics.

Article adapted by Medical News Today from original press release. Source:

American Sentinel University

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Most ward nurses say time pressures force them to "ration" care, UK

Main Category: Nursing / Midwifery
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
Most ward nurses say time pressures force them to "ration" care, UK

Most ward nurses say they are forced to ration care, and not do or complete certain aspects of it - including adequate monitoring of patients - because they don't have enough time, indicates research published online in BMJ Quality & Safety.

The lower the nurse headcount, the greater the risk, the study shows, prompting the researchers to suggest that hospitals could use episodes of missed care as an early warning sign that nurse staffing levels are too low to provide safe, high quality care.

They base their findings on a survey of almost 3000 registered nurses working in 401 general medical/surgical wards in 46 acute care NHS hospitals across England between January and September 2010.

The questions, which covered five different domains, were designed to gauge the prevalence of missed care - care that nurses deemed necessary, but which they were unable to do or complete because of insufficient time.

Thirteen different aspects of nursing care were included in the survey, ranging from adequate patient monitoring, through to adequate documentation of care, and pain management.

The researchers wanted to find out if there was any association between nurse staffing levels and the number of these episodes, and whether these were linked to overall perceptions of the quality of nursing care and patient safety in a ward.

So they asked nurses to rate the quality of care on their ward, and to indicate how many patients needed assistance with routine activities and frequent monitoring. The researchers also assessed the quality of the working environment using a validated scoring system - the Practice Environment Scale (PES).

The results showed that 86% of the 2917 respondents said that at least one of the 13 care activities on their last shift had been needed, but not done, because of lack of time. On average, nurses were unable to do or complete four activities.

The most commonly rationed of these were comforting and talking to patients, reported by 66% of participating nurses; educating patients (52%); and developing or updating care plans (47%).

Pain management and treatment/procedures were the activities least likely to be missed, reported as not being done by only 7% and 11%, respectively.

Higher numbers of patients requiring assistance with routine daily living or frequent monitoring were linked to higher numbers of missed care activities.

Staffing levels varied considerably across wards, but the average number of patients per nurse was 7.8 on day shifts and 10.9 at night.

The fewer patients a nurse looked after, the less likely was care to be missed or rationed, and the lower was the volume of these episodes. Staffing levels were significantly associated with rationing eight of the 13 care activities.

Nurses looking after the most (in excess of 11) patients were twice as likely to say they rationed patient monitoring as those looking after the fewest (six or fewer). Adequate documentation and comforting/talking with patients also suffered the most.

Staffing levels of healthcare assistants had no bearing on rationing of care. But the quality of the work environment did, with the average number of care activities significantly lower (2.82) in the best than in the worst (5.61).

Around eight care activities were left undone on wards nurses rated as "failing" on patient safety, compared with around 2.5 on wards rated as "excellent."

"Our findings raise difficult questions for hospitals in a climate where many are looking to reduce - not increase - their expenditure on nurse staffing," comment the authors, who go on to say that hospitals would have to reduce the number of patients to seven or fewer per registered nurse to significantly reduce the amount of care left undone.

But they suggest: "Hospitals could use a nurse-rated assessment of "missed care" as an early warning measure to identify wards with inadequate nurse staffing."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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'Most ward nurses say time pressures force them to "ration" care, UK'

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