Making My Vote Count

No one could not have notice that there is a general election on the 8^th June. Not many of us saw this election coming, and it can be argued that many of us don’t even want this election, but it is happening. 23.59, on 22 May is the last day we can register to vote (1), but we can register on line here. 

Already Brexit is already dominating the media coverage of this election but an election should never be about one subject. An election should be about the whole of a Government’s policies and how they have behaved in government. This government’s record on the NHS has been anything but high quality.

We have just come out of another winter crisis, the third winter crisis the NHS has suffered in a row (2), even though the past three winters have all been mild, without any long cold spells (3, 4. 5). And this is only one of the many problems facing the NHS.

As nurses we have a voice and we need to make our voices heard in this election. We must stop the agenda just being about Brexit and what the politicians want us to hear. Health unions have already called for this election to be about the state of the NHS (6), unions including the RCN, BMA, Unite, UNISON and the Royal College of Midwives. The Royal College of Nursing (RCN) has already launched its “Nursing Counts” campaign (7), to ensure healthcare priorities are at the heart of all the political parties’ manifestos. 

But what can we do as individuals? In reality we don’t elect a Prime Minister at an election, we don’t vote for a specific political leader, what we do is elect our local MP, who then has the responsibility of representing us in parliament. Therefore shouldn’t we ensure that the candidate we vote for has our best interest at heart?

At the last election I emailed all my local candidates asking them how they would support the NHS, their responses were certainly a mixed bag and often not what I wanted to hear (You can read my blogs about it all here, here, here and here). But this hasn’t deterred me. At this election I am going to do exactly the same. This time I will also blog about it and the experience, we need to engage with candidates or how else will they know our concerns. At the end of this blog I’ve pasted the email I’ve sent to my local candidates, complete with reference links. Feel free to use any or all of it if you want to email your local candidates too (Details of your local candidates can be found here).

Wouldn’t it be wonderful if every nurse in the country emailed their local candidates and quizzed them on how they were going to support the NHS? Those candidates wouldn’t be able to ignore the problems facing us and the NHS. Wouldn’t it be wonderful if everyone who reads this blog emails their local candidates? We need to make our voices heard, we need the candidates to listen to our concerns, otherwise the media will make all the running and all we will hear about is Brexit. Nursing and the NHS deserves better.

Drew Payne

Why Should I Vote For You? email

Dear ______,

I live in the ______ constituency and I intend voting at this coming election, but my vote is very precious to me, I only get one vote, and I want to make my vote count. As a candidate, you want to represent me in parliament, I want to know that you will support my concerns and worries if you were elected.

I am a nurse, working in the NHS, and I am very worried about the state of nursing today. Nursing is under threat from the following factors:

•         Last year there were 23,443 empty nursing posts in the NHS, 9% of the nursing workforce (a1).
•      93% of NHS Trusts reported shortages of registered nurses and 78 per cent reported difficulty in finding nurses for hard-to-fill nursing vacancies (jobs vacant for three months and longer) (a2).
•         Last year 5% of nurses did not renew their Nursing and Midwifery Council (NMC) membership (a3), they effectively left nursing because you cannot practice as a Registered Nurse unless you are registered with the NMC.
•         There also has been a 92% fall in EU nurses coming to work here since the Brexit Referendum (a4).
• ·       Since 2009 there has been a 28% fall in District Nurses numbers and the Community Nurse workforce has shrunk by 8%, putting a huge strain on this important service (a5).
• ·         Since 2010, there has been a 15% fall in the number of student nurse training places (a6).
•         This year saw a 23% fall in people applying to train as a Register Nurse, after the scrapping of student nurse bursaries (a7, a8, a9, a10).
•          Nurses’ pay has fallen in real terms by 14% since 2010 (a11).
•          There has been a 50% increase in nurses applying for hardship grants since 2010 (a12), last year alone £250,000 was paid out in hardship grants (a13).
•          Last year there was a 3% increase in emergency admissions to hospital via A&E (a14), yet last year NHS funding only increased by 0.9%, as it has done year on year since 2010 (a15).

Nurses are the glue of healthcare, without us so much patient care just would not happen, yet our profession is being eroded. What would you do, if you were elected my MP, to reverse this erosion and to protect and value nursing? 

As I said, my vote is very important to me, as a voter and also as a nurse. Why should I vote for you in this coming election?

Yours,

Drew Payne (Mr),

(Email address) – to make sure they can reply to me

(Postal address) – to show that I live in their constituency

And Things Change

This year marks the 50^th anniversary of the Sexual Offences Act 1967 (a). This was the act of parliament that partly decriminalised male homosexuality (the law never acknowledged lesbian sex), it opened a crack in the wall and was the first step towards change in our society.

I came out when I was eighteen, more than thirty years ago, and overnight I lost almost all of my friends, I was ostracised just for being gay. It was a shocking experience that has left a lasting impact on me.

Today I am married to my husband Martin and work as a Community Nurse in North London. Everyone at work knows my husband and no one has a problem with him, I have almost forgotten the last time I experienced homophobia at work, certainly not in this job.

So much has changed since I was a teenager, changes I would never have believed back then. We have marriage equality, we have protections against discrimination at work and when we use businesses or services, the Equality Act (b). Lesbian and gay characters can be found on so many different television programs. We have won so many protections and rights under the law in this century that it makes our world almost unrecognisable from the one I first came out into.

So we can just relax and sit back, all the work has been done. Unfortunately no. Homophobia is still alive, it is just not as blatant as it used to be, and the NHS is still not an open and welcoming place to everyone.

In 2016 a BMA study found that over 70 percent of LGBT NHS doctors have experienced homophobia at work, and three quarters had not reported it because they feared it would not be taken seriously or they feared reprisals (1). “I don’t think the NHS is an LGBT-friendly environment”, said Dominic, one of the doctors contributing to the study. This type of homophobia isn’t restricted to doctors only.

Last year also saw the unsightly sceptical of NHS England going to court so they would not have to fund PrEP, the HIV prevention medication (2). If used correctly PrEP is 86% effective (3), far higher than most vaccines. If PrEP prevented heart disease or diabetes we would be welcoming it and there would be no question the NHS would provide it. But PrEP prevents HIV and NHS England felt it could justify not funding it, tapping into the homophobia around HIV.  A Nursing Standard Twitter poll at the time found that 54% thought PrEP should be self-funded and not provided by the NHS (4), and it was mostly nurses taking part in that poll.

There was a shocking spike in hate crimes following the referendum result last summer (6). Less publicised was the 147% rise in homophobic crimes in this period (7). Homophobia hasn’t gone away and the Brexit climate seems to be giving it oxygen again.

Brexit also raises another challenge for LGBT people. When Britain leaves the EU all the EU laws that are also part of our laws will be reviewed and we might lose many of them. EU Article 10 offers protect from discrimination, including on grounds of sexuality (8). Employment Framework Directive 2000/78 (9) protects people against discrimination at work on grounds of sexuality.

Many in the Conservative party have openly called for the repeal of the Human Rights Act and the Equality Act (9a 9b 9c), Theresa May has previously spoken of her dislike of the Human Rights Act (10). What laws, what protections will we lose as Britain separates from the EU? The government has given us no re-assurances, they barely seem to know what they want from Brexit itself.

In America, Donald Trump’s Government has taken a shocking turn. Almost all of his cabinet have previously gone on the record with their anti LGBT views (11). Within only a few hours of Trump becoming 54th president the LGBT section of the White House website disappeared (12a). Trump’s plans to slash federal funding for AIDS have been leaked (12b), and in only the last few days Trump has signed a “religious liberty” executive order (12c). Many LGBT American’s fear this will be only the beginning of the weakening of LGBTI rights in the United States, allowing discrimination against LGBT people in the name of “religious freedom”.

It is no longer true that what American does today we in Britain do tomorrow, but many people here still look to America. People, who have been campaigning for the repeal of marriage equality and LGBT protections, will be looking very keenly at Trump’s administration, especially as they roll back LGBT equality.

Peter Tatchell once said that LGBT people are the litmus test of how a society respects human rights (13). If a society doesn’t value diversity how will it value anyone? But why should nurses worry about human rights? Because if we don’t how can we nurse anyone with dignity.

(This was originally published as part of the Nursing Standard magazine’s LGBT History Month special, it was also published on the RCNi website here. Unfortunately you have to be registered with RCNi to view it. Therefore I have re-published it here, on my blog, after updating it.)

Drew Payne

Super Nurse Is Entering the Building

I’ll never forget my first year as a staff nurse, even all these years later, it was when I really learnt how to nurse and what was required of me as a nurse. My nurse training had been hard, I was expected to learn so much and cram in so much information in what felt like such a short period of time. But during this time I was also sheltered from responsibility, “Student Nurses can’t do that,” “Student Nurses aren’t allowed to do that,” “Just sit there and watch me do this, you’re only a Student Nurse.”

Then, suddenly, I was a qualified Staff Nurse and all that sheltering was gone. I was a Staff Nurse, I was expected to know what I was doing, I was given the ward’s drug keys, I was solely responsible for the patients allocated to me, I was responsible for all my own actions. In that first year after qualifying I learnt so much, so many different things in such a short time. I learnt how to really use my nursing skills and understand what is required of being a nurse. It was a very important time for me, and for many nurses I have spoken to.

As my first year of qualifying ended, as I settled down into my role then I learnt new skills, such as giving intravenous drugs, managing central lines (intravenous lines going a major artery of the heart), and later still taking blood and cannulising patients. It was the confidence and experience I had gained in that first year that enabled me to learn these new skills and safely practice them.

 

The Nursing and Midwifery Council (NMC), the regulatory body for nursing in Britain, are looking at changing nurse education, again. They haven’t formally announced it, there is no consultation open on the NMC website, but the Nursing Standard had access to the unpublished plans, Standards for Registered Nurse Education, reported on them (1). These proposals would see student nurses having to learn a whole new set of skills before they qualified, skills that nurses learn now after they have qualified.

The NMC wants newly qualified nurses to be able to:

• Prescribe from a “limited” formulary, a selection of drugs and dressings; 
• Cannulation; 
• Venepuncture, take blood, 
• Management of continuous infusion of intravenous drugs and fluids and safe use of infusion pumps, safely giving IV fluids; 
•  Injection (bolus or push) of intravenous drugs, giving IV injections 
• Intermittent infusion of intravenous drugs and safe use of infusion pumps, pumps with variable dosages such as insulin pumps; 
• Subcutaneous administration and safe use of syringe pumps, such as syringe drivers; 
• Subcutaneous infusion of fluids.

Nurses already do all of these clinical skills but these are all skills that are learnt after qualification. They are all complicated clinical skills, if carried out wrong they could be very seriously harmful to a patient.

If the NMC wants student nurses to learn these skills they will need to provide the resources and time for them to learn them and have their competencies certified. You can’t just learn these skills in a classroom and then go out and practice them on patients, you need a skilled and experienced nurse to sign you off as competent.

This requires a large number of suitably trained nurse mentors, who also regularly practice the skills the students are learning, with the time to teach and access the students. But mentoring student nurses at present is proving difficult. 9% of NHS nursing posts are vacant (2), and nurses’ workload have hugely increased (3), which has had a detrimental effect on student nurse placements (4). Mentors are not getting enough time to teach students (5), students aren’t getting enough practice time, mentors have to do mentorship duties in their own time, and some departments/placements are no longer having student placements because they are too busy and short staffed (4). This before any changes to student nurse training are made, changes that would require even more mentorship involvement.

Also, will student nurses even get the chance to learn these skills in practice? I mentor second year student nurses, in my job. They spend four weeks with our team on their community placement. Many of them have had little or no experience of wound care and administering injections. This is not their fault, this is due to the nature of their placements, many of them are not getting the experience for their learning requirements now.

Working on Medical and Surgical wards student nurses could get experience of intravenous infusions and injections, they are certainly used a lot, they may even get experience of intermittent infusions, but subcutaneous infusions and pumps are used rarely, if ever in hospital. They are more often to be used in end of life care, which is happening more and more in patients’ homes. I often set up and manage subcutaneous pumps, but it is not something I can guarantee every student nurse I mentor, we do not always have an end of patient life on our caseload.

Nurse prescribers are out there and are making a difference but nursing prescribing is still a skill the profession is only just learning to use. Are there enough nurse prescribers to mentor nurse students in prescribing? Currently there about 55,000 nurse prescribers (6). This may sound a lot but, as of November last year, there were 340,384 nurses and midwifes employed by the NHS (7), this means only 16% of nurses are nurse prescribers, and I would be concern that not all of them are also mentors, and many of them will be specialist nurses who students rarely have placements with. So again, who will mentor student nurses in prescribing?

The first cohort of Associate Nurses have started their training (8), and this does feel as if the NMC is hurriedly trying to draw a difference between Registered Nurses and Associate Nurses, without understanding what is involved in clinical nursing. Associate Nurses are designed as much more hands-on nurses, they are not being training in the assessment, planning and evaluation side of nursing that Registered Nurses are expected to do. Put bluntly, Associate Nurses will implement what the care plan says, but Registered Nurses will still be needed to assessment what care is needed, plan that care (The care plan) and evaluate that the care is meeting the patient’s needs.

Instead of purely focusing on clinical tasks, why isn’t the NMC looking at what is required for each role at qualifying?

In my opinion, based on my own experience of being a Registered Nurse (both a newly qualified Registered Nurse and as a Nurse Mentor supporting newly qualified Registered Nurses) at qualification as Registered Nurse should be able to:

•  Safely administer medication (whether Drugs Rounds in a hospital or in patient’s own home),
•   Safely administer medication via injection, either subcutaneous or intramuscular.
• Safely discharge a patient from hospital (know when a patient needs support at home, whom to refer that patient to and how to do it),
• How to carry out a patient assessment, whether on admission or during their episode of care
• How to plan and evaluate a patient’s care,
• How to prioritise patient care during a shift,
• How to coordinate a shift,
• How to prepare and recover a patient from surgery safely,
• How to safely administer a unit of blood to a patient
• How to assessment a wound, and to know when a wound is caused by pressure damage.

These are skills much more to do with managing care and assessing a patient’s needs, but these are skills that are essential to newly qualified Registered Nurses, I did not have all of these skills when I qualified, and had to quickly learn them in that first year after qualifying.

I have a low opinion of the NMC (Read my blog about Pauline Cafferkey and my two blogs about Donna Wood to see my full opinion) but this latest “radical” change to nurse education (1) is just another example of what a poor organisation they are. The problem at the heart of this plan seems to be a lack of understanding of the role of the Registered Nurse, and this seems to be because so many people employed by the NMC have little or no nursing background. The prime example is Jackie Smith, the NMC’s Chief Executive and Registrar. She has no background in nursing, her background is the law (9).

When are we going to get people regulating nursing who have a background in nursing and who understand what is involved in nursing? Then maybe we would get less of these “radical” changes that do not reflect what is needed in nursing, and more policies and regulation that moves nursing forward into the modern healthcare profession that it needs to be.

Drew Payne