Item 13: Leading change for nurse leaders
Resolution submitted by the RCN Cumbria Branch
That this meeting of RCN Congress asks RCN Council to develop a strategy that supports directors of nursing with executive responsibility in commissioning
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That this meeting of RCN Congress asks RCN Council to develop a strategy that supports directors of nursing with executive responsibility in commissioning
What does it mean to be a nurse leader in the NHS today? This how Maria Hannah opened Thursday's debate around nurse leaders.
She stated that these were challenging times for delivering high quality care before asking what were the nursing directors doing in the lead up to some of the recent health care scandals, including Mid Staffs.
She agreed that it's no easy job being a director of nursing but said that you go into it with your eyes open. You need to champion nursing and standards of patient care and have full voting rights on the executive board to achieve this.
Philip McCaffrey stated that as a nursing director in the mid-80s he felt very isolated. In a time when he believes the RCN was more focussed on its junior members, he felt that he had no one to turn to for advice. However staff would regularly come to him and expect him to have the answers. He welcomed the proposal of the college moving to provide even more support for nursing directors.
David Dawes also welcomed the idea of offering more support, but suggested that this could be widened. He pointed to the benefits of mentoring - using the advice and guidance of his more experienced colleagues to help him improve his knowledge - suggesting that this is something nurse leaders could give back as part of the support network.
Susan Adams, a nurse at Mid Staffs, spoke emotionally in response to the proposer's question about the situation at Mid-Staffs explaining some of the background. She also explained that more nurses had now been recruited and stated that she could say with a clear conscience that she and her team had provided the best care they could with the resources available. Susan's words were met with a standing ovation.
Jennifer Luchoomun, a nursing student, stated that negotiating, lobbying and politics were all an integral part of her course and that nurse leaders had spent time with her sharing their vision for patient care.
Following a right to reply from Maria Hannah, Congress voted overwhelmingly in favour of the resolution.
For: 389 96.29%
Against: 15 3.17%
Abstain: 15
PASSED
Background
The term 'commissioning' is only used in England and Northern Ireland. Current English health policy, as enshrined in the NHS next stage review (2007) and more recently in the Transforming community services (2008) programme, demands that primary care trusts (PCTs) develop into world class commissioners. The Department of Health (England) wants all PCTs to demonstrate they are planning to separate their commissioning and provider functions by April 2009. Longer term, the objective is to entirely separate PCT commissioning organisations and community health services provider organisations. In Northern Ireland, new arrangements for the commissioning of health and social care — based upon a new regional health and social care board and a network of local commissioning groups — are to be in place by April 2009.
Since 1999, NHS community health organisations in England have been subjected to frequent reorganisation and on each occasion the issue of nurse leadership, and the position of senior nurses at executive level, has arisen. Experience has demonstrated that NHS reorganisations threaten nurse leadership and that the post of nurse executive is never assured.
Lord Darzi has called for investment in clinical leadership, development and engagement, and the Department of Health (England) recently released £1.5 million for investment in nurse leadership. However, in relation to the latest initiative in England, there is no statutory requirement for PCT commissioning organisations to employ either an executive nurse or a director of nursing.
The RCN position is clear and has been in place for many years. Since nursing represents 70% of health care delivery, it has a huge impact on the standards and quality of care provided to patients. Health care organisations must have visible nurse leadership in place which has significant authority and influence. On numerous occasions the RCN has lobbied ministers, chief nursing officers and civil servants for senior nurses to hold executive positions within health care settings. RCN Northern Ireland has worked successfully to influence the nursing input to, and representation on, the various new bodies, and to provide support to nurses in commissioning roles. Although there is no commissioning role in the NHS Scotland, senior nurses continue to need support to maintain their work in strategic planning and leadership roles, for example on NHS Scotland Boards, while nurse directors in Wales equally need support in their planning and leadership roles.
References and further reading
Lord Darzi of Denham KBE (2008) High quality care for all: NHS next stage review final report, London: DH.
Royal College of Nursing Transforming community services resources area on the RCN website.
Scottish Executive (2006) Delivering care, enabling health: harnessing the nursing, midwifery and allied health professions' contribution to implementing Delivery for health in Scotland, Edinburgh: SE.