In Northern Ireland, the RCN states that the Northern Ireland Executive’s Transforming your Care reform and modernisation agenda will not succeed without appropriate investment in the nursing workforce that will deliver an effective and comprehensive 24/7 health service.
Nurses are key to the success of seven day care, particularly senior decision-making nurses such as ward sisters, specialist nurses and those working in advanced roles, and nurse and midwife consultants.
Experienced district nurses can deliver complex care, help patients to live with long-term conditions to avoid hospital admissions, arrange prompt discharge from hospital, treat minor injuries, prescribe medication and refer patients for other treatments. Perhaps most importantly of all, they supervise, mentor and train newer staff so that they can take on these roles in the future.
The RCN supports moves to ensure patient safety and outcomes are as good for a patient admitted at the weekend as they are during the week. Without opportunities to develop the necessary skills and experience, we will be failing the next generation and adversely affecting the success of the seven day care plans. The right skill mix and the right working conditions will be crucial.
RCN Chief Executive & General Secretary Dr Peter Carter said: "Nursing staff feel passionately that patient safety and high quality care are the key priorities for the NHS of the future. Nursing staff, and above all senior expert nurses, are a huge part of the solution to delivering seven day care. Many nurses working as ward sisters or clinical experts are able to make decisions, supervise teams and educate and mentor their junior colleagues.
"The importance of these roles can sometimes be overlooked when the NHS rushes to recruit nurses to fill long standing gaps. But the gap risks getting bigger. Not only do we have too few of these staff to supervise and support care at the moment, those we do have can be stretched so thinly that they cannot do their vital work in developing the next generation of staff. We must invest in getting the right skill mix, the right pay, terms and conditions, and the right training to ensure that we can recruit and retain the staff we need.
"There is strong evidence for better patient outcomes with an expert, qualified workforce and enough staff for proper supervision to take place. If the NHS tries to deliver a true seven day service only by stretching the staff it has for weekdays, the loss will be felt by patients as the level of expertise is progressively diluted. Nursing roles will be at the heart of a seven day NHS, but we can’t fall into the trap of thinking that by stretching the roles we have more thinly that it can be delivered to the standard patients need."
RCN Northern Ireland Director Janice Smyth said: "Nursing occupies a unique role within the HSC as the link between different patient and client services. Nurses provide the 24/7 care in terms of assisting patients with meeting their fundamental needs. This means that, in many cases, nurses have little control over their workload and often find themselves in positions where staffing levels do not facilitate attendance even at mandatory training activity.
"Patient needs in the community cannot be met within the constraints of a 9am-5pm Monday to Friday service. This is evidenced, for example, by relocating to the community the care of patients with complex needs, who may then promptly require accident and emergency admission during the evening or at weekends.
"It is nursing that holds the key to building and sustaining the 24/7 services that will meet patient needs. The RCN recognises and supports the general strategic shift towards 24/7 care outlined in Transforming your Care but believes that the DHSSPS and commissioners must ensure that it is appropriately managed and sustainability resourced, particularly in relation to the nursing workforce."