Staffing for Safe and Effective Care
The ‘Staffing for Safe and Effective Care’ programme is the Committee’s highest priority in our policy work and is of particular importance given the unsustainable pressures our members are facing in all sectors of health and care, and the risks to both patient safety, and staff safety and wellbeing. The work to advocate and lobby for the sustainable expansion of the nursing workforce, for demand led workforce planning, and for accountability for that workforce to be enshrined in legislation continues across all four countries of the United Kingdom Throughout 2021 we have had detailed reports from all four countries on the policy position, and the progress towards a legislative framework (or lack of progress in the case of England and Northern Ireland).
In May we launched the ‘Nursing Workforce Standards
’ which apply across all health and care settings – wherever there is a nursing workforce. The standards set out our expectations as the Royal College of Nursing in relation to the planning and provision of the nursing workforce. They are central to the campaign for staffing for safe and effective care. PNC members have presented the standards, alongside RCN staff colleagues from the nursing department, and regional teams in a wide range of settings. We have collaborated on the development of resources for RCN members and their representatives; we are determined to use the standards to advocate for positive change at the policy, regulatory, and organisational level – in all settings.
The nursing workforce crisis has deepened as the year moved towards its close. Whilst ensuring that resources and support are available to members on the website, and through RCN Direct, we recognised the need to campaign more actively and effectively on the central demand for staffing for safe and effective care, recognising the need for greater public engagement, and to ensure that we demonstrate how we can, and should, be part of the solution in addressing this long standing, but increasingly acute, crisis. This will remain central to our work plan, and we agreed that a separate ‘think tank’ event would be convened, early in the new year, to include expert members from across the UK to further test and develop our position. This will be followed by the PNC strategy day in January when we will further review this critical area of our policy and professional advocacy work.
Protecting and valuing the role of the Registered Nurse
One of the products of the current nursing workforce crisis has been the increased evidence of role substitution; this includes the substitution of Registered Nurse roles with nursing associates, and opening nursing roles to other registered health professionals, including nurse leadership roles. In June of 2021 we published the position statement on ‘preserving safety and preventing harm – valuing the role of the registered nurse
’. This statement called for all employers working within health and social care to ensure that where a vacancy exists for a registered nurse, this is open to registered nurse applicants only. It set out our expectation that all employers, regardless of sector, should develop robust workforce plans, in line with our Nursing Workforce Standards, and taking into account the nature of the role, service demand and skill mix. It highlighted the impact and critical importance of strong nurse leadership. We identified an item which had been accepted on to the 2021 Congress agenda on ‘the erosion of the role of the registered nurse’ (a matter for discussion from the General Practice Nursing Forum) which would align to this position. At the end of 2021 we recognised the need to strengthen this position as well as supporting increased lobbying and influencing activity in this space, and this will be taken forward early in 2022. The Committee supports the current petition calling for the protection of the title nurse in law and the question of nursing roles and titles will be taken forward through our work on a Royal College of Nursing Professional Framework.
This significant piece of work is underway under a programme board whose leaders include PNC member Professor Alison Leary and RCN Fellow Felicia Cox. It will build on and update existing resources and guidance to co-create our Royal College professional framework for nursing today. It has three defined workstreams: ‘What is Nursing’, essential to articulating the value of nursing; ‘Levels of Practice’ and a ‘Career Framework’.
One element of the Career Framework looks at routes into nursing including the Prince of Wales Cadet Scheme which launched in England in 2021. Many cadets have gone on to careers in health and care settings and interest in this scheme is considerable.
Education Learning and Development Strategy
The new strategy was launched at the RCN Education Forum conference in April 2021. It was a critical piece of work for the committee, as both a requirement of our Royal Charter, and because we know that education and professional development is one of the top priorities for our members in all sectors. Dr Sue Haines was co-chair of the Task and Finish Group which oversaw the detailed development of the strategy and included members from key committees, the professional forums, and the RCN Fellows. Sue is now co-chair of the joint programme board, which is overseeing its implementation, with continued membership input from an inclusive expert reference group.
The first year of the strategy has focussed on ‘making good’ current provision and laying the path for implementation and delivery. A quality assurance framework has been agreed for all educational resources, which are mostly found on the professional development and ‘clinical pages of our website, as well as through our library. Whilst there is a huge amount of great content available, this may not always be visible or easily accessible to our members. One of the key deliverables for the strategy is the development of a new ‘portal’ or doorway to enhance and improve access.
During 2021 PNC Committee members Professor Julie Green and Professor Alison Leary supported the RCN response to the NMC’s proposals on post registration standards, and our position that Specialist Practitioner Qualifications should be retained, highlighting their particular importance in community settings.
In England the merger of HEE into NHSE raises a very real concern that the loss of the independence of HEE could raise the risk of students continuing to be used by service without the focus on quality of education. We will be watching this carefully alongside our colleagues on the RCN Student Committee. We have also agreed to the development of an RCN position on the increased use of simulation in learning.
Education and Research are closely linked and both key responsibilities for the Committee. In 2021 we agreed with the Research Society on the need to develop a Research Strategy for the RCN. Unfortunately, although some early work got underway during the year, this work has not progressed in recent months due to competing priorities. A Deputy Director of Nursing with responsibility for Education Research and Ethics will be appointed to the RCN in early 2022 who will lead this work, alongside the Research Society and others from our expert membership.
Forums and Networks Review
The 35 professional forums make an important contribution to the professional work of the RCN. Their work is not always visible to the wider membership or aligned with the strategic objectives of the College. An array of networks has developed over the years and are not all formally identified within the governance framework of the organisation. There are varying models of their development and ways in which they function; some are linked to a forum, while others may report to a regional board or country. Both forums and networks both provide an opportunity for members to network, share best practice and lead the development of knowledge within specialist areas of interest.
A task and finish group was established by PNC early in 2021 to undertake a review of the forums and networks. The group was comprised of members, including forum chairs, and staff from the nursing department. The review was completed at the end of August 2021, with the final report received and agreed by PNC in December.
The aim of the review was to look at how the work of forums and networks, underpinned and supported by a robust governance framework, could be optimised and the professional profile raised to greater effect. The review was undertaken through four main workstreams, supported by a communications and engagement working group:
- Purpose and role
- Governance processes and functions
- Effective ways of working
- Support to forums and networks
The report made 27 recommendations, which having been agreed by PNC will be taken forward through RCN Council and the Executive team in early 2022. The report and recommendations will then be published to the wider membership.
The strength of the RCN is in its twin functions, as professional body and Royal College, and special Trade Union. As one of the two principal committees of the RCN, accountable to our governing Council, we work closely with colleagues on the Trade Union Committee and the two committees met together formally for the first time in 2021. We will be continuing joint working in key areas as we move into the new year. The complexity of nursing as a safety critical, knowledge intensive profession has been central to the RCN’s campaign for fair pay, terms, and conditions, and PNC is represented on the UK Pay Programme Board to strengthen the professional case.
RCN members are everywhere, and we know that many work outside the NHS, in social care, in independent health services and in the voluntary sector. As the RCN continues to develop its strategy for the independent health and social care sector, PNC is represented on the joint programme board by Mary Codling. The Nursing Workforce Standards, which apply in all settings, are being taken forward through this work too.
As the RCN develops an organising model to support members looking to make positive change in the workplace, I have represented PNC on the interim board, to ensure that this approach incorporates the breadth of professional issues that matter most to our members, and our identity as a professional body as well as a trade union.
Ways of working
We are determined to find better ways of communicating our work to RCN members, and externally. After each meeting we send out ‘key messages’ to members, which are posted on our pages of the RCN website, but we recognise the need to find more and different ways of talking about what we do and will be working more on this in 2022. We will continue with our ‘Nursing Matters’ Podcasts, where we talk about a range of professional issues, and we always welcome suggestions for topics and guests.
Underpinning our work as a committee is a recognition of the need to ensure that we follow and promote within the RCN core principles of equity, diversity, and inclusion. Committee development sessions this year focussed on how we bring the principles and practice of inclusive leadership to our governance role within the RCN.