Editor's note: Ian Peate, the Editor-in-Chief of the British Journal of Nursing, contacted me with an idea for a transcultural editorial exchange. In response to this excellent opportunity, I invited Ian to author a guest editorial for us, and I'll contribute an editorial to his journal. We gave each other "freedom of the pen" to write about issues that confront nurses in our respective corners of the globe. Though we're an ocean apart, I'm sure you'll relate to the challenges that impact nursing practice in the United Kingdom (UK). I've enjoyed working with Ian and look forward to your feedback.
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The state of nursing globally continues to change and evolve; it has done so for centuries and no doubt will continue to do so for centuries to come. Most of the changes have added to the quality of care to the benefit of our patients. Many nurse-initiated interventions have contributed to an increase in life expectancy. Our care is effective; the evidence is there.
Here in the UK, however, hardly a day goes by when I don't read in a newspaper or hear a news summary referring to poor standards of nursing care-particularly regarding care of the elderly, but not exclusively. The media is replete with graphic descriptions.
I wince when I read reports that detail how we abuse the people we have the privilege to care for, how we have failed to feed them, how we neglect them, how we ignore their right to dignified care, how we have violated the human rights of those who trust us. Our profession has been subjected to attack, with condemnation coming from all quarters. Recommendations for improvement come from various institutions, all external to the profession.
For example, the Prime Minister has dictated that nurses initiate hourly patient checks (also known as intentional rounding). This edict imposed on us by the office of the Prime Minister has the potential to reduce, not enhance, the quality of care. The danger is that it may become a checklist that signals the return to task-orientated nursing, in which care is routine and ritualized and engagement with patients is fleeting instead of therapeutically meaningful.
The persistently negative press reporting becomes especially disheartening when coverage reveals the most appalling maltreatment of the most vulnerable in our society-the old and infirm, those with mental health problems, and those with a learning disability. The ongoing onslaught is doing nothing for morale and could potentially impair the profession's ability to recruit new candidates to study nursing and become tomorrow's great nurses.
Those people we care for and their families are rightly anxious and apprehensive about the care they might receive. What has not been reported, and this is such a pity, is the fact that most nurses are providing a service that is second to none. They are selfless, committed, and above all professional.
The nursing response has been lukewarm. We need to determine who is committing abuses when they occur. Is it the RN (regulated by the Nursing and Midwifery Council) or is it those who work closely with nurses offering care under the supervision (allegedly) of the RN-the Health Care Assistant (unregulated)? It is imperative we investigate this so we can put our house in order and call to account, professionally and criminally, the abusers.
In the UK, funding for our health and care system (the National Health Service) derives from taxation and is managed centrally by government. Nurses in the UK have just been subjected to a 2-year pay freeze in light of the government's management of the current economic crisis. (It's interesting to note that other public services, such as the police, have not had any such pay freeze.) Because nurses' pensions are also being changed, many nurses will have to work well into their late 60s in a physically demanding profession to receive a decent pension.
I concede that indeed this has not been nursing's finest hour; it has been what Her Majesty the Queen might call an annus horribilis. Now is the time for nurses to reclaim nursing. The public deserves only the best nursing care from RNs and Health Care Assistants who are regulated and called to account for their actions and omissions. Now is the time to make known exactly how our contribution to the health of the nation has an impact. We need to promote the profession and publicize the myriad of advances being made in nursing by nurses. In doing this, we can demonstrate our commitment to the sick and distressed; we can reinforce that we value them as members of society and will defend their right to dignified nursing care. We can also say collectively that we value nurses and nursing.
-Linda Laskowski-Jones, MS, RN, ACNS-BC CEN, FAWM
-Ian Peate, RN
Visiting Professor of Nursing, University of West London
Editor-in-Chief, British Journal of Nursing