Commission visits US Initiative on the Future of Nursing

September 28th, 2009

The Commission has exchanged news and views with colleagues from the United States, on a visit to Washington DC hosted by the US Initiative on the Future of Nursing.

Commission chair Ann Keen and support office joint lead Jane Salvage addressed the Initiative’s second expert committee meeting on 14 September, joined by Commissioner Anne Marie Rafferty via a videolink from London. They described the Commission’s work and debated issues of shared concern with US experts. Hundreds of people across the US and worldwide also tuned into a live webcast of the event.

The US Initiative on the Future of Nursing was launched on 14 July in a move that in many ways echoes the Prime Minister’s Commission. It is supported by the Robert Wood Johnson Foundation, a leading philanthropic organization in the US, and hosted by the prestigious Institute of Medicine.

Its expert committee is developing a blueprint for action on the future of nursing in the US, and identifying how nurses can contribute to the design and implementation of health reform. It has set out a ‘nursing prescription’ to guide President Obama and Congress as they seek to transform the US health system.

Health reform was the hottest issue in town during the Commission’s visit, with demonstrations on Capitol Hill and feverish media coverage. During site visits to see examples of best practice, and meetings with healthcare leaders and policymakers, Ms Keen rectified some of the misleading information about the NHS that has been circulating in the US.

The US committee chair Donna Shalala, a former Secretary for Health and Human Services, said the goals of US health reform efforts were not only health insurance, which dominated much of the current discussion, but also making quality healthcare affordable. ‘I share wholeheartedly Ann Keen’s belief that you can deliver quality care cheaper if you get it right the first time,’ she said. ‘Nurses have the expertise to make that happen.’

Read Donna Shalala’s blog

Commission shares ideas down under

September 23rd, 2009

Commission down underThe Commission has gone down under to share ideas and experiences with overseas colleagues. Commissioner Anne Marie Rafferty and support office joint lead Jane Salvage outlined the Commission’s aims and work to nursing and healthcare leaders from Australia, Canada and the USA, at an international policy and research round table in Sydney, Australia.

Their visit was fully funded by the Worldwide Universities Network, a global research collaboration between 16 universities. Jill White, dean of the University of Sydney’s faculty of nursing and midwifery, hosted the four-day event in September to explore and develop health policy education and research priorities and strategies. She met Commission chair Ann Keen during an earlier visit to London.

Nurses and midwives needed to build closer alliances with patient and community groups, the group concluded. They should become ‘policy entrepreneurs’ who could influence health policy to create higher quality, innovative services.

The group aims to develop further its international nursing policy network and meet again next year. Among other things, it hopes to discuss the Commission’s report, due out by next March.

Jane also discussed the Commission’s work with researchers and nursing leaders from service and academia in Adelaide. She was leading a symposium organised by the Joanna Briggs Institute for Evidence Based Healthcare.

Re-examining the role of nurses in the US healthcare system

September 23rd, 2009

Donna_ShalalaDonna E Shalala, Ph.D, is a former Secretary of the US Department of Health and Human Services; president of the University of Miami; chair of the, Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, and is the inaugural post for the Initiative on the Future of Nursing.

Here in the United States, our healthcare system is on the cusp of major change. As in the UK, efforts are underway to ensure that the expertise of nurses and the value that the nursing profession brings to healthcare is used to inform how our future is shaped.

The Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine, which I chair along with Linda Burnes Bolton, chief nursing officer at Cedars-Sinai Medical Center, will take on some of the most pressing and systemic problems facing the nursing field. Our end goal is nothing short of transforming the way Americans receive health care services, and determining the most effective ways to apply the skills of nurses is at the center of our process.

The goals of health reform efforts in the US are not only health insurance, which seems to dominate much of our current national discussion, but also how we make quality healthcare affordable. I share wholeheartedly the belief of your Commission chair Ann Keen, which she shared with us at our recent Initiative meeting in Washington, DC, that “you can deliver quality care cheaper if you get it right the first time.” Nurses have the expertise to make that happen.

As a function of their jobs, and by the very nature of nursing, these men and women are on the front lines of patient care; they spend the most time with patients and their families, and the knowledge they bring to the table prevents costly medical errors, unneeded tests, expensive hospital stays, and avoidable hospital readmissions through effective chronic care management. As the largest group of health professionals, the experience of nurses is key to the effective design and implementation of health system change. To reform our system without gleaning from their expertise would be a fool’s errand.

One of the tasks of the Initiative on the Future of Nursing is to determine how to ensure this critical part of the workforce is adequately staffed and prepared to meet the changing needs of our society. A significant hurdle is the continuing shortage of nurses across the US. If left unaddressed, the US faces a shortage of 500,000 nurses by the year 2025, and this number is only expected to rise as our population ages and faces the enormous challenges of managing chronic disease.

The Initiative will address these challenges and examine the optimal utilization of nursing care through a series of technical workshops and forums which have already begun. Each forum will focus on particular challenges facing the nursing profession; one will address nursing in acute care settings, another will deal with nursing issues in community and public health care settings, and the third will examine the changes needed in nursing education. All of the forums will follow a town hall format to provide an avenue for input from healthcare professionals at all levels from all healthcare settings.

Similar efforts underway in the UK are both enlightening and encouraging to us. We have much to learn from one another in our parallel efforts to ensure that patients receive the right care, at the right time, in the right place, and by the most appropriate members of the healthcare team.

Fridays with a difference

September 10th, 2009

eileen_sillsProfessor Eileen Sills, Chief Nurse and Chief Operating Officer at St Guy’s & St Thomas NHS Foundation Trust, is known for strong, visible, clinical leadership. Her drive to take senior nurses back to the bedside earned her a national reputation for her Clinical Fridays initiative.

A unique experiment was started at Guy’s & St Thomas NHS Foundation Trust in May 2006, taking all senior nurses back into clinical practice one day a week. This sees over 100 nurses, including the Chief Nurse, working together clinically every Friday. Three years on, this is now well embedded, a part of routine practice and has received national recognition.

It is very important that senior nurses are clinically credible and up-to-date just like our senior doctors. It is also important to our patients and the public – who valued the role of the Matron – to see senior nurses on the wards. After losing this aspect over many years, this initiative has regained much of that ground.

Every Friday, all our senior nurses leave their offices: no emails are answered and no meetings attended. They work together across the Trust to support staff, monitor standards of care and attempt to resolve problems staff are experiencing by enabling and facilitating them to take action and to think creatively to resolve problems.

A meeting is held each Friday afternoon at which senior nurses and other staff discuss the previous week’s clinical indicators and share best practice.

This way of working has made an enormous difference. The patient is returned to the heart of the organisation, staff feel supported and we are able to respond to any problems around standards of care very proactively.

Effective relationships have been built with other staff groups, such as our facilities staff, who participate in the initiative. We also now run major change programmes and undertake audits of practice.

This has been the most rewarding thing I have ever done. The difference we have made is enormous and I am very proud of our nursing and midwifery workforce. This is not about compression five working days into four; it’s about working differently and smartly on a Friday. After all this is why we are here.

Students’ Day

September 2nd, 2009

The Prime Minister’s Commission on the Future of Nursing and Midwifery recently held a Students’ Day to learn how people starting out as nurses and midwives viewed their future and how they hope to see it grow. The event was organised in conjunction with the Royal College of Nursing.

Working with disadvantaged mothers

September 2nd, 2009

Kuldip BharjDr Kuldip Bharj is a senior lecturer in midwifery and lead midwife for education at the University of Leeds and has 10 years of board level experience in the NHS. She writes:

Complex and multiple factors disadvantage mothers. Many policy initiatives acknowledge ‘disadvantage’ as an area of priority and focus on providing adequate and appropriate services, often harnessing a ‘woman-centred’ approach to care.

Like other mothers, disadvantaged mothers, consistently call for kind and approachable healthcare professionals with whom they can develop trusting relationships. They want to be treated with respect and dignity. They desire accurate and timely information to enable them to negotiate their way through their childbirth journeys and choose the kind of care they want. Some mothers do receive this but many do not.

Many healthcare professionals assert that they draw upon fundamental caring skills when delivering individualised care, confirming their competency to deliver culturally-sensitive and anti-discriminatory care.

Disappointingly, despite policy initiatives and competent healthcare professionals, there remains a variation in disadvantaged mothers’ experiences and outcomes. Evidence confirms that there are inequalities in health outcomes for disadvantaged mothers and their babies – they have a poorer experience and poorer access to services.

This raises many questions:
• What are the issues hindering translation of policy to practice?
• Do diverse policies lead to fragmentation?
• Would a summary of key directives leading to a care pathway be a way forward?
• What support do practitioners need to deliver woman-centred care to disadvantaged mothers?
• Are service models provided on ‘ad hoc’ bases or should they be mainstreamed?