Modernising Nursing Careers: Setting the Direction

4 Nursing and nursing careers today

By taking on new and enhanced roles and responsibilities, nursing has been instrumental in delivering the improvements in patient care in recent years. Nurses have already played a vital part in reducing waiting times, making services more accessible and improving the quality of care.

Since 1997 there has been major investment and change in nursing.

• There are 85,305 more nurses in the NHS in England, 4,295 more in Scotland and 8,228 more in Wales.
• The number of student nurses in training across the UK has increased since 1996.
• Over 18,000 nurses have returned to the NHS in England since 1999.
• 50,000 nurses in the UK can prescribe for their patients, with over 7,000 being able to prescribe from the whole British National Formulary.
• New senior clinical roles such as clinical nurse specialists, nurse consultants, and modern matrons and community matrons in England ensure experienced and highly skilled nurses stay close to patient care.
• The Chief Nursing Officer's 'ten key roles' for nurses in England has given them the legitimacy and authority needed to assume new responsibilities, like the freedom to admit and discharge patients.
• Changes in the law enable nurses in primary care to become partners in general practices or run nurse-led primary care practices and the white paper, Our Health, Our Care, Our Say ( DH, 2006) signals new options for nurses to be entrepreneurial.
• Scotland are developing a set of clinical quality indicators that will enable clinical leaders to demonstrate the impact of the nursing team on the delivery of safe and effective care.
• Tools like Essence of Care and Fundamentals of Care have been introduced to support nurses caring for patients.
• Over 30,000 nurses in the UK have benefited from leadership programmes since 1997.
• In Scotland a review of the role of the senior charge nurse will assist in the creation of modern charge nurse roles to enable frontline clinical leaders to maximise their contribution to delivering safe and effective care.

Nursing has been supported in this by radical workforce reforms that have increased capacity, capability and flexibility and introduced new roles and freedoms. Working conditions have improved to help people achieve a better work-life balance and through pay modernisation, Agenda for Change has harmonised conditions of service and provided a more transparent system of reward and staff development.

A feature of workforce reform has been the move towards a competency-based work system to drive service and role redesign. Through Agenda for Change we now have a national NHS careers framework that provides the opportunity to break down traditional occupational boundaries, enables greater movement and transferability of skills and provides better career opportunities for all staff. Key to these changes will be effective mentoring arrangements.

Modern nursing career
Craig's career in psychiatric nursing found him specialising in the care of older people. However, after a few years he was ready for a new challenge but remained committed to improving care for older people. The solution? Craig works part-time as assistant manager in a care home for older people and part-time in a drug detoxification unit mainly for young people.

Modern nursing career
Megan started her career as a care assistant in the community and gradually took on a small caseload of families working with the health visitor. During that time, she gained more knowledge and skills in the field. She has recently taken up a new role with the community children's nurse supporting children with asthma and their families.

Modern nursing career
Lancia is a nurse clinician with a masters degree. She works as part of a multiprofessional community nursing team and has a caseload of people with acute and chronic problems. Her focus is to improve holistic care while keeping people out of hospital. She is an independent prescriber and refers direct for admission and consultant opinion. She is becoming involved in commissioning and in how advanced nursing practice can contribute to modern health care services.

Modern nursing career
Patricia started her nursing career in mental health, followed by general nursing. She then became involved in HIV and AIDS work, which took her to Oxford, Los Angeles and Johannesburg. She became interested in end of life care and moved into palliative care, and now has a role which combines lecturing in the undergraduate programme with leading the palliative care team in a district general hospital. She continues to have a combined career linking education with hands-on clinical care while maintaining her interest in mental health and uses those skills in her work with patients with breathlessness, for example brief interventions and cognitive behavioural therapy.

Modern nursing career
Charlie spent four years in the army, owned a building company and ran a market stall before working as an NHS volunteer. After working as a healthcare assistant he joined the local cadet scheme, went to university at 50 years of age and is now staff nurse on a stroke unit. He values the effective mentoring arrangements that are available and his aim is to make the unit a place of excellence for stroke care.