Last Sunday I had the privilege of taking part in the Royal College of Nursing 100th anniversary Congress which was held in Glasgow for the first time.
Together with the Director of the RCN in Scotland, Theresa Fyfe, and Scotland’s Chief Nursing Officer, Prof Fiona McQueen I was invited to debate the contribution of third and independent sector nurses to care and health in Scotland.
My contribution was to reflect on the question ‘What needs to change for the independent and third sectors to be seen as equal partners in delivering health and care?’
To answer that question perhaps we need to ask something even more basic – What does it mean to be a nurse?
I’m probably not the right person to be answering that but it’s a question I can remember asking from an early age because every summer holiday I spent time with my aunt who was a district nurse in an island community… The archetypal navy-uniformed, Mini-driving, doctor-repelling, straight-talking Highland district nurse!
I remember asking her probably at a precocious ten years of age why she wasn’t a nurse in a hospital and amongst all her responses one thing stuck in the memory –
I can get to know people, when they are ill and when they are well, I get to know them all, their sons and daughters, their neighbours and friends… And here I have time… I didn’t have that in a hospital.
Maybe that’s a romanticised recollection of a ten year old but I remembered those words when recently I spoke to a nurse in a care home I was visiting. I was asking her what was different about nursing in a care home compared to a hospital. She said:
Here I have time to get to know people, to sometimes become a friend, to nurse to the whole of the person and their family… It’s especially important at the end of life to be able to have known the person whose hand you are holding and who is spending their last moments with you.”
Time, relationship, being with, are some of the characteristics which mark out the especial circumstances of nursing in social care, whether in a care home or in someone’s own home. That’s not to say that they are alien to an acute environment but they are just more possible in non-hospital settings.
As we increasingly hear of the importance of people remaining at home or in a homely setting for as long as possible; as we read new policy initiatives such as the National Clinical Strategy or the Review of Out of Hours Provision, the potential and role of social care in achieving better health outcomes for people becomes a real one. In that regard nursing in social care settings becomes all the more important. There is real potential for those who want to nurse in care homes and in community locations to become a key ally in achieving the outcomes that people want for their lives. But to get there things need to change.
What needs to change for the independent and third sectors to be seen as equal partners in delivering health and care?
Perhaps not a lot for the person who is cared for at home and in a nursing home… but for the nurses themselves – the answer is that equality seems so very far away…
Do we really have equality when nurses in a care home setting are worse off (in terms and conditions) to the degree of around £6,500? Do we really have equality when nurses aren’t given the same opportunities for shared learning and development that colleagues in the NHS have? Do we have equality when countless nurses have told me about how lecturers in college dismissed care of the elderly as not ‘real’ nursing? Do we have equality when frontline nurses feel they have to justify working in a care home or in social care to their fellow professionals?
We need to give value to those who work in non-traditional settings, we need to honour and celebrate nursing staff in care homes and in the community as an essential contributor to the care and support of our communities. And yes value is in part by financial reward but its much more than that. It is about respect, being given a place, being listened to, being heard, having your contribution noticed and indeed celebrated.
The more nurses I have the privilege to speak to the more I know that despite the suffocating amount of paperwork and procedure that gets in the way- I might say unnecessarily so – it is the ability to form relationship, to nurture contact and to be with people that marks out nursing in an independent sector care home or care at home organisation as something which attracts.
In some essential truth nursing in the independent sector is authentic – it is genuine, honest, hard graft but at its best it is relational, human and valuable
What needs to change? – we all do, society does, Scotland does. We need to change into a country that values those who have been labelled and limited by being described as old; we need to recognise contribution beyond location and value beyond number… Only then will nursing our older citizens be truly celebrated for the critical art it is.
About the Author
Dr Donald Macaskill is Chief Executive of Scottish Care, a membership organisation and the representative body for over 400 independent social care services in Scotland. Donald has a background in learning disabilities and older people’s work; with a particular focus on issues related to bereavement, palliative care and individual rights.
Donald was writing the first blog on the brand new Scottish Care website. You can follow this blog here: http://www.scottishcare.org/category/scottish-care-news/blogs/