A radical blueprint to reshape the nursing workforce calls for nurses to follow a medical style model of training and the creation of a new ‘advanced healthcare assistant’ role.
Lord Willis, who led the Shape of Caring Review for Health Education England and the Nursing and Midwifery Council, told HSJ the current £5bn education and training budget for the healthcare workforce should be reviewed to allocate more money towards multiprofessional training.
Currently, the majority of funding (more than £3bn) is spent solely on medical training.
He also said HEE should support trusts with funding for the postgraduate training recommended by the report.
Lord Willis said it was time for the nursing profession to find its voice. He outlined a string of proposals for a structured career path for nurses and healthcare assistants. He said this would help boost the aspirations of the whole care workforce.
Proposals from the review, published today, include:
- a review of education funding by HEE to secure a multiprofessional approach to training;
- a one year formal preceptorship for newly qualified nurses in their chosen specialty;
- more general training in the first two years of a nursing degree, including mental health;
- the creation of a clinical membership and fellowship model for nurses as they progress in their careers;
- creation of doctoral training centres to encourage more academic nursing research;
- a review of the four branches of nursing and the creation of a new “community nursing” field;
- making the care certificate a mandatory requirement for all HCAs;
- a new advanced HCA role at pay band 3 with a nationally recognised and standardised curriculum based on NMC standards;
- changes to make it easier for advanced HCAs to access undergraduate nurse training; and
- an annual student nurse survey and exit interviews for those leaving to help identify and tackle high attrition rates.
Lord Willis said: “The nursing profession itself has all too often acquiesced to what society’s view of it should be. It lacks aspiration and Florence Nightingale did not lack aspiration.
“Nurses were the handmaidens of the medics and that must not be the case anymore. Where you have top class patient care it is through the co-production of care not the result of hierarchical structures.”
He said he feared that without the changes nursing did not have a future, and without a proper career structure it was “a profession in name only”.
Lord Willis said his proposals for a 12 month preceptorship, which usually lasts less than six months, was “akin to the foundation year in medicine”. He added that during this year nurses would undertake specialist study to achieve honours or credits towards future post-graduate qualifications.
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They would then go on to study for membership and fellowship exams to organisations linked to their specialty, which could include organisations such as the Florence Nightingale School, the Royal College of Nursing and medical royal colleges.
He said HEE should support trusts with funding for postgraduate training, adding: “There is a sense that when nurses graduate that somehow they become a commodity to be used. There should be a continued investment.
“Nurses are the key linchpin of good patient care.
“If we don’t have them well motivated, better invested in and well educated then we will plateau in terms of healthcare. Simply saying ‘we cannot afford to invest in you’ is not an option.”
Arguing for a more generalist approach to university training, he said there was a “major flaw” in the current system with adult nurses not having enough knowledge of mental health and vice versa.
The Liberal Democrat peer said he was “utterly and totally opposed” to recreating the position of a state enrolled nurse, which had less training than degree nurses, stressing that the new advanced HCA would need to meet “all requirements of being a graduate nurse - full stop”.
He said his aim was to create an “aspirational post” for HCAs at pay band 3, saying: “You are building up, from the most humble of souls who do a lot of the work, recognition that what they do is very important.”
Accepting the changes would take years to implement, he warned, and demographic challenges would not go away. He urged the NHS to be “bold and imaginative.”
HEE and the NMC have accepted the recommendations but will launch a three month consultation following the report’s publication.