Work in action

Published: 29 July 2010

Orthopaedic and trauma practitioners competencies – do we need a review?
SOTN Committee Project Lead Mary Drozd reports on why we should have a new set of competencies.

The proposal

The committee has put forward a proposal to develop further competencies, building on those produced five years ago (RCN, 2005). The first-phase objectives are to agree a project plan and identify a methodology, key stakeholders and the costs of the entire project, together with a timeframe. Although it had been hoped that some news would be forthcoming, at the time of going to press, the bid has been delayed by the RCN Forum Group until its July meeting.

The aim of the proposal is to bring together an interdisciplinary group to explore potential approaches for review and development of orthopaedic and trauma practitioner and assistant practitioner competencies. It is acknowledged that the competency framework will need to be congruent with the NHS Knowledge and Skills Framework (KSF). Alongside this, Skills for Health offers a comprehensive range of competency based framework templates that this project could utilise.

We also hope to engage with other parts of the RCN, for example: Learning & Development and other forums, such as the Emergency Care Association, Advanced Nurse Practitioners Forum, Perioperative Forum, Rheumatology Nursing Forum and the Children and Young People forums.

Why do we need a review?

Public protection and patient safety issues are increasingly of paramount importance and directly relevant at the current time. There has been a heightened awareness of serious omissions in these areas since the Francis Report (DH, 2010), an inquiry into the state of care at the Mid-Staffordshire NHS Foundation Trust. Indeed, it has been recommended that high-quality care for all is essential as well as the development of flexible roles and career structures to enable nurses to move easily between health-care settings and posts. (Please see the Prime Minister’s Commission on the Future of Nursing & Midwifery in England, 2010.)

There is also a range of longer-term trends shaping the health-care sector. These include the demographic changes in the population, innovations in health-care provision, the rising incidence and prevalence of people with long-term musculoskeletal conditions and the growing expectations of the patients themselves (Skills for Health, 2009).

A shifting focus

Quality of care remains at the forefront of health care, despite the economic crisis and subsequent public sector deficit. And across the UK, the key themes in Government policy include a greater focus on personalised care, delivery of care closer to home and an emphasis on public health and on a reduction of health inequalities; there is also a focus on improved skills utilisation, productivity and quality, and better-integrated working across sectors. By bringing together an interdisciplinary team of musculoskeletal specialists, it is anticipated that a sound, evidence-based competency framework could be produced that would safeguard standards of care for trauma and orthopaedic patients.

Skills for Health reinforces this by stating that there is a need for a skilled, flexible, and effective workforce while maintaining high-quality and safe care for patients (2009). It goes on to state that competencies are a key vehicle to achieve a more flexible workforce. The proposed project to develop orthopaedic and trauma competencies could assist with future solutions that maximise skills utilisation as well as create opportunities to develop existing – as well as new – employees.

Working together

There are differing levels of practice, from 1–9, which require evidence-based standards in order for practitioners to work safely and competently with trauma and orthopaedic patients in and across different settings. Alongside this, an interdisciplinary approach to developing the competencies is now advocated rather than the pre-existing uni-professional nursing perspective. It is hoped that this work will provide for joint working with other internal and external stakeholder groups such as the British Orthopaedic Association (BOA) and the National Association of Theatre Nurses as well as musculoskeletal special interest groups, such as physiotherapists and occupational therapists, in addition to the RCN forums previously identified.

This UK-wide project, with representatives from Northern Ireland, Scotland, England and Wales, and with representation from paediatric, orthopaedic and trauma nursing, aims to provide a sound foundation of evidence-based practice for all levels of practitioners (1–9) who work with patients who have orthopaedic and/or musculoskeletal traumatic conditions in primary, secondary and tertiary care settings.