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Crisis, confusion and change

 Doreen Crawford 17 Feb 2017 CYP - Acute Care Forum

Many years ago I remember reading about how confused the public were about children’s nurse uniforms and nursing titles.

About the same time there was also a debate about who was entitled to be called a nurse.

Opinions were polarised: there was a view that only registrants should have the title. This was set against the view that it did not matter what you were called: it was what you did and how you did it that was important. So dental nurses and nursery nurses kept their titles and wore them proudly as a badge of honour, but auxiliary nurses in children’s departments lost theirs and became health care assistants, care assistants, maternity support workers, baby care assistants – forgive me if I have missed a few. So if confusion reigned before – it continued. The job did not change, only the person’s name-tag, and it was a blessing that if a child or parent shouted for a nurse, these staff still responded.

Workforce planning has never been a strong point in the NHS and the profession has experienced boom and burst causing various degrees of crisis. Periodically we have robbed other nations of their valuable health care workforce, reduced NHS-commissioned numbers, expanded NHS-commissioned numbers and, during one particularly deplorable cycle, students once qualified had no post.

Now we face one of the biggest changes in the history on the NHS: the loss of the student bursary. This has put a question mark over nurse recruitment into higher education programmes. Some experts have expressed confidence that the removal of the student number cap is a positive strategy, others are more cautious and unsure what the impact will be. The cynic might think that this has not been a well-thought-out strategy, because if there is no appetite to incur £9,000 debt each year to join one of the most poorly paid professions, who will be left, as the aged workforce retires, to look after the children?

So out of the hat the Government has produced the apprentice track into nursing. The associate practitioner initiative continues and there is now a nursing associate career path. The pilot sites for these have been announced and Great Ormond Street Children’s Hospital is to have a children’s cohort.

It might be an accident that these newish titles all begin with an A. At some point these new contributors to care might contribute to better care for children and better outcomes for children but they’re unlikely to experience better pay. Because you can bet your bottom dollar the real drivers behind these changes is cash.

Doreen Crawford

Doreen Crawford

RCN CYP Acute Care Forum committee member

Independent Consultant

Doreen is a now a retired nurse, but regularly reviews nursing books for a variety of publishing houses and has experience of the NMC professional conduct panels. She has supported the RCN educational accreditation department for a number of years and has held a number of external examiner appointments.