MS nursing: more of the same or maintaining the best?
Vicki Matthews
MS Specialist Nurse Advisor, MS Trust
Way Ahead 2009;13(1):2-3
Nursing debate often risks polarisation when discussing future workforce numbers and supply sources, or the skill demands for future nurses. It is important to move beyond just the numbers game and balance the equation and relationship between supply of, and demands upon, the future nursing workforce. What is certain is that the current nursing status quo is unsustainable and this includes MS specialist nursing.
The majority of nurses who will deliver care in the next twenty years are already within the system. How we invest in them will shape the future of nursing and its career pathways. If we do not take control and lead on how, and by whom, MS specialist care will be delivered in the future, someone else will.
There are a number of issues to consider.
- After a period of growth and investment we are entering a time of fiscal uncertainty that will mean workforce planning and skill needs are at risk of being sidelined or ignored. It has already been demonstrated how easily education and training budgets have been 'raided' to meet other financial deficits.
- Nursing, and other healthcare professionals, must change to meet the demographic explosion of the next two decades. The UK would need to recruit every 18 year old to meet nursing needs if we continue with current methods of nursing recruitment and practice. The population of over 65's in the developed world will have increased by 50% by 2025 and the population of over 85's will have increased by 75%.
- More than 50% of all over 65's will have one or more chronic conditions, with the second leading long-term condition being clinical depression. The need for expert nursing intervention to maximise self-management and independence, reduce symptoms, unplanned admissions and enhance quality of life will be greater than ever before.
- Models of care will change to enable more localised pathways of care, provide timely, responsive and technically supported care interventions, allow plurality of care provision and the mandate to purchase health care from any provider who successfully demonstrates they can provide evidence based, quality, cost effective care that meets the local need and integrates social care and health.
- Workforce projections suggest that a shortfall of nurses will drive a reshaping of the nursing workforce, including the specialist role, and the current 'territories' of medical, health and social care professionals. Projections for 2006/07 to 2015 suggest a 5% increase in the nursing workforce, at best, and a 12% decrease at worst, with the shortfall occurring in 2011/12. Some reasons for this are the lack of reinvestment, continuing attrition of skilled professionals, retirement of 50 years plus nurses, and a generally ageing workforce.
- These issues are incompatible with the 50% required increase in registered nurses to sustain current shape of a workforce that has already raised concerns about dilution of skills, public perception and confidence.
One strategy might be to 'raise the bar' and redefine what it is to be a state registered nurse and to create new pathways for gaining both qualification and experience (within nursing). This is good for the status of nursing, but could result in more 'associates' and fewer registered nurses.
The 'State Registered Nurse' would have a new definition; a five-star professional having similar status to medical colleagues. This would bring a higher level of expectation, and skills, in clinical assessment, history taking and caseload management, developing care pathways, having a full referral system, advocacy and negotiation skills, authority and accountability.
Health and social care workers who are practising at National Vocational Qualification (NVQ) level 2 and 3 may be enabled to complete formal study, specific to the chosen field of practice, alongside acquisition of experience/expertise. This could allow entry for higher qualification following a period of mentorship. For example, an NVQ level 2/3 leading to a two year foundation course, registering as associate nurse, completing graduate studies (if desired), followed by qualification as a registered nurse.
This career pathway would allow for a faster trajectory of growth with an increase in nurses of more than 10% in the next ten years. It would also facilitate development of the role of the associate nurse who would be qualified and responsible for delivering high quality protocol led care, for supervising health care assistants and lay carers and working under the supervision/mentorship of a registered nurse. The development of such a pathway would be to encourage career progression defined by level of practice not just role title, and training routes that are linked to broader domains of practice. It could result in a smaller but more stable registered nurse group with degree status, leading groups/teams of qualified staff. It may have the potential to 'talent spot' and 'knit your own' for succession training, but support those who remain fulfilled/motivated at associate level to deliver protocol led care under the continued leadership of registered nurses.
The challenge for MS specialists will be to focus beyond immediate awareness of the changes ahead and scan the further horizon for what can be done to encourage and embrace the potential new workforce into our current structure, how we are to control and lead the workforce and set the standards for the future. This must include new invitations to integrate into our networks, academic and experiential learning opportunities, representative organisations and strong culture of sharing expertise and experience.
MS specialists are uniquely ahead of the game.
- We have two professional organisations sharing interest and goals and working across professional boundaries and territories; UKMSSNA and Therapists in MS (TiMS).
- We have a set of comprehensive competencies that make explicit the pathway to becoming a specialist, have already 'raised the bar' on what it is to be a specialist, and guide the aspiring on how to become the five star professional.
- We have a commissioning pathway that sets out clearly what MS specialist care must be regardless of location or organisation, that is aligned to the competencies required to deliver that care and is already receiving widespread approval and acknowledgement.
- We have a community that is informed and knowing of each other, with a culture of sharing and rich educational opportunities. This is much more than many others enjoy and can be capitalised so we can lead on maintaining the best rather than futile attempts to control more of the same.
If we don't do it; someone else will.
Further reading
- Buchan J.
Nursing Futures, Future Nurses. Commissioned by the Royal College of Nursing Great Britain.
London: RCN; 2008. - Centre for the Development of Healthcare Policy and Practice.
Towards a framework for post registration nursing careers: report of the outcomes from the National consultation.
London: DH; 2008. - Department of Health.
Modernising nursing careers - setting the direction.
London: DH; 2007. - Department of Health.
Trust, Assurance and Safety - the regulation of health professionals in the 21st century.
London: DH; 2007. - McLeod-Clark J.
Ensuring a fit for purpose future nursing workforce.
London: Royal College of Nursing 2007; Policy Discussion Paper 13/2007. - National Nursing Research Unit King's College.
High quality nursing care - what is it and how can we best ensure its delivery?
London: Kings College; 2008.
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