June 25, 2021, by sbzaj1

30 at 30: ‘The best way to predict your future is to create it’

a group of NHS staffDuring my career as a nurse, I have encountered numerous registered nurses working both on and off the wards who believe that nurses do not require a degree to be what they define as a ‘good’ nurse. On the contrary, they believe changing nursing into a Higher Education course will produce the opposite.

The move of nursing qualifications from a Diploma to a Bachelor of Science (BSc) caused a feeling of unease within some qualified nurses on the wards. This mainly manifested from the concern that Universities were changing nursing into a more academic profession, resulting in nurses qualifying without the practical skills or life experience it takes to be a ‘good’ nurse. Some nurses believed that the BSc would not add any value to nursing practice and result in nurses qualifying without the interpersonal skills to effectively communicate with and care for their patient.

I frequently encountered these concerns throughout my nursing training and once I had qualified. Having completed my Bachelor of Arts Degree in Religion and Theology, I joined the first Child Graduate Entry Nursing (GEN) cohort to run at the University of Nottingham. The GEN course gives students the opportunity to complete their nursing training in two years, whilst completing the same placement hours as the BSc students and initially graduating with a PGDiP and then an MSc. However, the introduction of the GEN course only exacerbated concerns, with continuing scepticism from nursing staff towards students like myself, stating that ‘good’ nurses cannot be trained in two years.

Therefore, what do these nurses believe makes a ‘good’ nurse? When faced with this question, one immediately refers to the ingrained nursing values and behaviours, compassionate, caring, kind and so on. However, I believe that the fear of the introduction of the Nursing BSc was that it would detract from patient-centred care. Throughout the Nursing Diploma the majority of nursing training occurred on the wards, focusing on practical care of the patient and it is the skills and the confidence of the hands-on care which makes a ‘good’ nurse. BSc Nursing students are encouraged to become critical thinkers, which is identified as the level which distinguished the BSc from the Diploma education. These students are encouraged to question nursing practice, to look at different perspectives and consider whether there was any opportunity for improvement. This meant that students were spending less time on the wards and more time within the University developing their academia and research skills. However, research such as a self-reported cross-sectional survey by Clinton, Murrells and Robinson (2005) and a literature review by Girot (2000) found no evidence that graduates and diplomates in England differ in their level of nursing competence. Plus, I can’t think of any paediatric nurse that I have worked with who wouldn’t be happy to chat, sing and dance with their patient, regardless of their nursing qualifications.

In addition, encouraging critical thinking results in the instigation of change. Much of ward-based nursing defaults to the top-down management strategy in which nursing leaders have the responsibility to influence practice and promote change. This top-down management strategy ensures that, despite any opposition voiced by nursing staff, the change is instigated. Other areas of nursing, however, do not operate under the top-down management strategies and changes need to be introduced, negotiated and trialled using the bottom-up process. However, if you are the only person who believes in the new ideas and resources, regardless of the time and patience given to team members, such as step-by-step support guides that have been painstakingly written to cover all basis, they will still be dismissed, deleted or thrown in the bin, as I know all too well. In this instance, plus many others, the adversity to change was based on the saying “this is how we have always

done it”. This resulted in new innovations, such as printing less in order to save money and promote an eco-friendly office, being dismissed or suggested as a practice that just I can do, whilst they continued as they were.

Why is there an adversity to change with some nurses and how can this be managed? We all find reassurance in the knowledge of the process and outcome. Yet, with the introduction of innovation, that knowledge is lost resulting in anxiety. Lagarde (2020), however, quoted Abraham Lincoln when stating that ‘the best way to predict your future is to create it’. Therefore, whilst considering instigating change, it is important to involve those nurses who are fearful of change and foster a sense of control and confidence, as demonstrated by the Dancing Guy, the first to follow is just as important as the one who is leading.

Since moving to the School of Health Sciences, I have been actively encouraged to look at new innovations which can improve teaching and nursing practice, an attitude which needs to be extended into frontline nursing, to enable nurses who wish to innovate to do so, and foster confidence in all nurses to follow. Nursing staff need to empower one another to consider, research and develop innovation within nursing, rather than dismissing their colleagues, causing them to become dejected and demotivated. The development of BSc Nursing empowers nursing staff to develop research skills which will enable them to instigate and embrace change, therefore moving away from the ‘this is how we have always done it’ culture.

Rebecca Cooper. MSc, BA (hons), RCN

Posted in 30 Years of Nursing