Modernising Nursing Careers: Setting the Direction

6 Towards modern nursing careers: priorities and action

Four key priority areas have been identified that need to be addressed. To create modern nursing careers that are fit for purpose we need to:

• Develop a competent and flexible nursing workforce
• Update career pathways and career choices
• Prepare nurses to lead in a changed health care system
• Modernise the image of nursing and nursing careers.

The Department of Health in England and the devolved administrations ² of Northern Ireland, Scotland and Wales will now engage stakeholders on these priorities making links to existing initiatives wherever possible.

Where appropriate actions will be taken forward across the four countries. In some instances the action will be country specific. Discussion is underway across the four countries to set out the details of implementation for each action.

Priority: Develop a competent and flexible nursing workforce

Rationale: Nurses should be prepared for different patterns of care, in particular, caring for older people, working with the whole family, meeting mental health needs, supporting self care, rehabilitation, integration across the health and social care system and working outside hospitals. They need to be competent to deliver high standards of nursing care as well as new and advanced clinical interventions. They need to be able to provide high quality services and value for money. Pre- and post-registration learning needs should therefore be planned and funded to take account of patient needs and the changes identified in this report.

Nurses will take responsibility for care co-ordination, standards of care and leading the nursing workforce as part of multidisciplinary teams.

There will be a need to manage changes in supply and demand and to plan for advanced level and specialist roles, balancing local provision and access with plurality, diversity and choice. Investment in 'growing' senior and advanced nurses from within the existing workforce will be important.

We also need to address the current inflexibilities and barriers in nursing that get in the way of integrated care for patients, restrict the ability to redeploy resources to shortage areas and limit career opportunities for staff. These currently exist between the branches, different parts of the register, education, research and service, and the public and independent sector.

Nurses also need a sense of identity and confidence in their specific contribution to multidisciplinary teams. Pre- and post-registration education will need to increase the flexibility and responsiveness of the nursing workforce to health service changes.

Action
The Health Departments will work with others to explore whether changes are needed to the content and level of the pre-registration programme. Initially we will scope the changes that have already been made to support new patterns of care, and flexible careers.
The Health Departments will work with stakeholders to map nursing roles and competencies to the national NHS careers framework with proposals for a competency passport scheme.
The Health Departments will work with stakeholders to review the career pathways and educational preparation required for specialist and advanced roles.
These are major pieces of work so more detailed information on process and timescales will be published in 2006/7.

Priority: Update career pathways and career choices

Rationale: Nursing careers in the future will be shaped by the needs of patients and clients. They will encompass the wide range of new and advanced roles, clarify the contribution of specialist and generalist roles and show how they fit with the wider workforce. Nursing careers in the community are a priority area for development.

Nurses should all feel confident to work with a wider range of providers and new organisational models. Careers will need to take account of the global nature of the nursing workforce. Renewed effort will be needed to ensure a critical mass of high quality educators supporting academic and practical learning.

Action
The Health Departments will work with key stakeholders to review the career pathways and educational preparation required for nursing in the community, focusing on public health, long term conditions and acute care ³. This will include supporting acute nurses to follow services from hospital to community ⁴, and in Scotland reviewing nursing in the community.
The Health Departments will initiate a review of educator roles and career paths spanning service and education. More detailed information on the scope and timing to emerge 2006/7. It will draw on the UK Clinical Research Collaborative work on clinical academic careers and recommendations from the Strategic Learning and Research Advisory Group (StLaR).
Tools to support career choices, such as career navigation aids, will be produced ⁵.
The UK chief nursing officers will work with the new and existing independent sector providers on supporting modern careers for nurses.

Priority: Prepare nurses to lead in a changed health care system

Rationale: Nurse leaders of the future will need to deliver ever- improving quality and productivity and have business and entrepreneurial skills. Nurses need to have greater confidence to engage in strategic decision-making and business issues and to achieve the maximum gain from nursing skills and better health outcomes for the public. If frontline leaders, including modern matrons and nurse consultants, have these skills it will build leadership capacity and provide this group of nurses with alternative career options.

Nurses will play a central role in patient choice and developing a quality driven service. This is an area where nursing is already active but where we need to be pro-active to ensure there is leadership development in this area. Nurturing ability, fast tracking and career development opportunities for key leaders at board level will be important.

Nurses will also continue to lead ever-changing skill mixed teams. They will need to know how to maximise the contribution of individuals and the team so that they are patient focused and quality orientated.

Developing leaders in education and research will need to overcome the current divisions between service based and academic careers, with their separate career paths and employment arrangements.

Action
The Health Departments will work with key stakeholders to provide information for the profession on the nursing responsibilities of leading and co-ordinating care.
The Health Departments will work with stakeholders to nurture ability and develop fast track schemes for future nurse leaders.
Work on these actions will commence in 2006/7.

Priority: Modernise the image of nursing and nursing careers

Rationale: We need to attract the best and most suitable people into nursing, promote a more accurate view of what nursing involves and reflect the different motivations and career choices of today. Nurses should be encouraged to consider a wider range of employment options for their career in health. Everyone in the profession needs to promote a public image that reflects the constant values of nursing with its caring role, along with opportunities for the complex and varied roles of nursing today.

Action
The Health Departments will work with stakeholders to agree and communicate key messages about nursing and nursing careers ⁶, including information for the public on 'what nurses can do these days'. To be available by early 2007.