Category Archives: Nursing

Wednesday’s budget delivered grim news of poor economic growth over the next few years, compounded by even grimmer jokes. However amongst the cautiously delivered statement seemed to appear one pearl of  policy that should of set every NHS employees heart a flutter. The announcement that funding would be provided to facilitate pay rises for some staff, but this was not the monumental announcement abolishing the pay cap or a U-turn on austerity that some may have hoped for. This announcement came as more of a carrot on a very long string with a few hoops to jump through along the way and it would appear the devil was in the detail. The Chancellor confirmed that this increase in pay would be linked to productivity and pay reform, something that has been mooted before without being fully explained. So the question of whether or not there would be a pay rise has left many nurses, midwives and paramedics scratching their heads.

Union bosses criticised Mr Hammond’s announcement. Unison’s Dave Prentis showed concern that the chancellor was raising the hopes of nurses without putting any extra money on the table, where as the RCN’s Janet Davies warned that any pay rise should not be linked to staff working harder highlighting the fact that nurses have had their pay frozen for the past 7 years and that any increase would only deliver what had been lost. So what could this announcement mean for nurses ?

It is no secret that the NHS faces a funding black hole despite receiving an extra 2.8 billion this budget, with the government hoping the restructuring of services will help plug the gap. Many NHS staff are paid via an agreement called Agenda For Change which allows for universal pay across the NHS as well as providing incremental pay increases linked to progression.

2016 saw Health Secretary Jeremy Hunt embroiled in a row with doctor’s over contracts that many labeled unfair but the government said were necessary to modernise the health service. It is thought that the same will happen again with Mr Hunt setting his eyes on aspects of the Agenda For Change agreement particularly surrounding enhanced unsociable hours payments given for night shifts and weekends when he submits evidence to the NHS Pay review body in the next few weeks. It is  also felt that the Government will attempt to redefine the working day in line with their 7 day service strategy. This could see unsociable hours pay kicking in much later in the evening and being abolished at weekends. Other possible changes could include smaller incremental progression pay rises as well as getting rid of any overlapping pay structures between bands. meaning those nurses who reach the top of their band, don’t progress or rely on extra hours payments may see the long term pay drop further despite any pay increase.

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The pace of change in health visiting over the past few years has been hectic, traumatic at times and stressful, but have the rewards promised been delivered?
Health visitors welcomed standards and national recognition but the next phase is not certain at all. We, as with our School nurse colleagues transferred to Local Authority Commissioning this year. We have worked hard to ensure commissioners were ready for us and know what we do, how we respond to populations and need. Lots of good standards have been written down but sadly this is where I fear the wheels fall off.
 Government cuts have hit Local Authorities. Hard. The honeymoon period has been short for our school nurses who now find themselves an expensive service that no one wants. Commissioning is looking at getting a complex professional service but finds there is not the money to pay for dedicated, well educated  professional SCPHNs.

Is this the future also for Health Visiting?

Currently many health visiting services are finding that managers are looking at how they deliver the service that is being “paid for” and “counted” rather than the comprehensive complex relationship building, nurturing service that health visitors are trained to do. Yes I celebrated the enshrinement of the 5 mandated contacts and the 4,5,6 model but this is a bare minimum, what if a provider interprets that as a set service delivery standard? Do we continue to anticipate need? A core principle of health visiting is the search for health needs

I’m a Health Visitor in the NHS. My job is to provide a universal service to children until they go to school that will monitor their health and well being and safeguard them

The safeguarding of children depends on so many factors. But it’s not just the job of health visitors to protect children, it’s the role of families and families currently are under massive pressure.  Cameron’s government talked about Troubled Families but those of us working day to day are finding families in trouble, they have more stress than ever before. Mums and dads are working 2/3 part time jobs. We are there to support them.
 These children and their parents have little expectation of us. They become lost to services and when, as we have heard so much recently, they are living in fear there is no one to trust, no one to support them. Safeguarding children does not start with social workers, it’s about visible children supported in their communities but we need commitment to maintain universal services from Health Visitors and School Nurses to ensure our children are never unseen or unheard.

No one else will

So, we move forwards to the here and now.
health visitor
Is this is it? I’m in consultation phase and I’m at risk of being down banded or made redundant. So too are my colleagues across England.  So have we lost the fight? Do we give up now, go back to our areas and tough it out, having our own individual battles? When it’s done do we reflect on when things were good, what we could have done who’s at fault?
Just the sound of this is too awful to imagine.
So what do we do?  We look for inspiration. Whether it be current or past. The Practice teacher that inspired you, the mum that fought against the odds for her child, women like Marie Stopes, the women that started us off in 1862, those that went on to do their bit for women’s suffrage.  We take their example and adapt, we owe it to our children and communities to stand up and fight these cuts to a service we built for them.
It’s not just a job. It’s a service that will disappear unless we shout out. We are the invisible support. There’s a presumption we will always be there from our colleagues in Health and Social care and by the public.
In Worcestershire recently we raised the “What if” question and were bombarded by mums and families asking what if their health visitor had not been there, asked, enquired? They showed how much health visiting affects families.
Last week I heard stated that we shouldn’t worry about the lack of follow ups a and chasing contacts. She cited the example that “no one else does, a GP wouldn’t call to see why an appointment is missed”. But that’s exactly the point. No One else does. The under 5s are too easily invisible and we have seen again and again the tragedy of invisible children, lost from the eyes of their neighbours.  Women with post-natal depression are not wont to shout for help, we know that often unless the health visitor asks no one else does. The Domestic Abuse question, so vital to women and children, if no health visitor who will ask? No one.
I could go on, but I think I’m preaching to the converted.  I know you get the importance and significance of the job. So how do we go forward?
The only way I know is by raising awareness, sharing experiences and campaigning.  We are not reinventing the wheel. So many nurses have had to fight for services in the past.  Health visitors fight daily for housing, safeguarding, GPs to listen to concerns they raise. This should be simple for us. Why so careful?
We have leaders who have given us inspiration, Professor Dame Sarah Cowley spelled it out for us and continues to do so, Dame Elizabeth Anionwu coins the phrase the Radical Health Visitor. It’s my belief that if we aren’t radical we aren’t fulfilling the job description!  They weren’t Dames when they did their work, they were you and me, turning up, doing their best. Use the resources you have, your voices and your Union as so many before have done. No one does this alone.
Support each other, speak out, speak up, challenge, organise and don’t give up. It’s a nothing to lose moment, were in good company with the rest of our NHS and Local Authority colleagues.
So, I’m at the March in London on March 4, I want a block of red ❤️YourHealthVisitors up front – indulge me!  If we don’t fight this No One will.
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Students applying for nursing or midwifery courses in 2017 will already be aware that they are no longer eligible for government bursaries, which have been scrapped by the Tories in a bid to save £800m of public spending. While this change will result in financial uncertainty for many students, the removal of bursaries could spell even greater uncertainty for the National Health Service in the next few years.

Under the bursary system, Health Education England funded a fixed number of places based upon local ‘workforce plans’, designed to fulfil the needs of the NHS locally. The government argues that by removing a cap on the number of funded places, the removal of bursaries could result in an increase of 10,000 places by 2020. Yet some experts disagree. Estimates by London Economics suggest that because of the removal of bursaries, nursing admissions could fall by 6-7 percent in the first year alone, leading to “a significant increase in staff shortages in the medium term”.

There is a distinct shortage of nurses and assistant health practitioners within our health service – a shortage of 15,000 to be precise – so it seems counter-productive to be cutting investment at a time when we should be attracting applicants to study nursing. It is hard to see the logic in shifting the financial burden from the taxpayer to individual students, considering that, on average, 70 percent of students never fully repay their loans, meaning that the taxpayer ultimately foots the bill anyway.

But even if the government’s forecasts turn out to be correct, there is no telling what types of nurses and allied health professionals are likely to be trained under the new system. Without the financial guarantee which bursaries provide, universities may be tempted to cut the numbers of less popular, specialised courses like child psychology, while expanding upon popular courses such as physiotherapy. HEE warns that,

If the commissioning of education is not efficient and effective, then attrition potentially goes up, people leave the courses or graduate with the wrong attitude…this impacts on the tax payer in a number of ways.”

By replacing workforce plans designed to meet the needs of the NHS with a system driven by market values, it is possible that an unfunded system could result in a shortage of highly valued and specialised nurses and AHPs, while unneeded specialities become flooded with new graduates. As none of this training will have occurred with specific vacancies in mind some graduates may find themselves struggling to find a job, despite having incurred thousands of pounds of student debt.

The political choice to detach recruitment from the needs of the NHS runs the risk that many graduates may end up taking jobs elsewhere. One particular weakness of government-funded places was that graduates could take up jobs within the private sector or abroad, with absolutely no obligation to work within the NHS after they graduated. But whilst the bursary system was far from perfect, the new system does even less to incentivise people to study nursing in the first place and to pursue careers within the health service.

What is particularly uncertain is who exactly will be responsible for meeting the workforce needs of the NHS once funded places have been completely abolished. If HEE remains ultimately accountable for NHS staffing, it will have to look at other non-financial incentives and soft ‘nudging’ to convince people to take up nursing in spite of the associated debts.

While the rest of the NHS is supposedly getting to grips with Sustainability and Transformation Plans and the devolution of healthcare, the removal of nursing bursaries seems to relinquish some of the control which would make local workforce plans easier to plan and carry out. The full effect of these bursary cuts will not be felt until 2020, when the first cohort of students who enrolled in 2017 will finish their courses. If Labour were to win the next general election, therefore, they could find themselves having to explain an NHS workforce crisis conceived under the Tories.

This was first published by the Fabian Society in Anticipations winter 2016

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In its early days, the NHS was an institution that valued and worked in accordance with a strict hierarchy. Consultants and other doctors occupied the top positions, with nurses taking their much lowlier place close to the bottom of the pile. The gender of those who staffed our hospitals and surgeries also reflected a wider societal gender divide, with almost exclusively female nurses existing primarily to enact the wishes of almost exclusively male doctors. Decision-making rights were concentrated amongst the males, at the top of the NHS power structure.

Nursing today is a very different proposition and, rather than being ‘trained on the job’ in a piecemeal way, the vast majority of nurses today either hold a degree or are studying towards one. Additionally, many of the qualifications nurses are achieving are in specialist medical areas. Nurses are no longer auxiliaries to the main medical prowess of doctors- they are experts in their own right, holding valuable knowledge and insight in areas like diabetes, obesity, obstetrics, pharmacology, pain control… the list is endless. With their new expertise, these nurses have achieved higher pay scales, with many reaching the earning power of their doctor colleagues.

So, why are these changes taking place?

There are a number of reasons, both societal and scientific. In society more broadly the lines between traditionally ‘male’ and ‘female’ roles have become very blurred. Although nursing as a profession remains dominated by women, that too is gradually changing. There are far more male nurses today than there were even a few decades ago, and there are also a much greater number of female doctors. In fact, today more women go to medical school than men. In the UK, in 2013, some 55% of first year medical students were female. As the old-fashioned division between male / female, doctor /nurse breaks down, so to does the way we, as patients and colleagues, perceive the roles. However, changes to the nursing profession don’t only reflect a shift in gender roles; the way the role is changing is also down to major technological and scientific advances.

New nursing methods, innovative machines and better research have freed nurses from many of the labour-intensive chores that once defined their working lives. Like housewives of old, a nurse’s daily life was once full of cleaning; a constant fight against infection and filth. Today, with machinery bearing the brunt of this work, nurses are more likely to be found processing illuminating data or contributing to important research than they are scrubbing floors.

A hierarchy of nursing still exists, as anyone observing a nursing teams’ colour-coded uniforms (which correspond to different band roles) will attest. However, nurses today have opportunities to climb a pay scale ladder and / or to branch off into interesting and rewarding specialisms; something simply not possible 100 or even 50 years ago. Inarguably, these are positive developments, for nurses of either gender, but also for the patients who rely on them.

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There may come a time in your life where you and your family can no longer provide the quality of care for your parent, grandparent or partner. You may not have the skill, experience or the facilities to properly care for your loved one in their older years and need help making sure they are cared for in the best way possible. At times like this you may want to consider making use of a residential care home in your area. West Sussex care homes can have a number of benefits for you, your family and your loved one, such as:

  • An Experienced Staff – A residential home is going to have the staff on hand that knows how to deal well with your loved one. The staff will have the education, training and experience in dealing with seniors and know how to provide the best care possible. They can see that all of the needs are met of their residents so that people are able to live happily and comfortably each day. This can include helping with any of the daily needs that may need to be met.

Ashtonleigh Residential Care Home

  • The Right Atmosphere – You will find that a quality care home is going to have all of the best facilities so that your loved one will be as relaxed and comfortable as possible. Rooms will be furnished nicely so that they will feel right at home and they can bring their own items to give the room a familiar touch. There will also be activity areas that provide entertainment and activities regularly. Many homes also have nice gardens and grounds that are available to the residents to enjoy.  A well run home should smell good.
  • Meet New People – A care home can be the ideal place for your loved one to meet new people of his or her age to interact with. This can provide the perfect opportunity for them to be social and be with people that they have something in common with throughout the day. This type of atmosphere can help them to feel happier and much more relaxed.
  • Still Near Home – Take a look at a care home nearby to your own home so you can be sure that you and your family can visit anytime and always be nearby. This will help to provide you with peace of mind and help your loved one know that you will visit often and are there for them.

A residential home can be the perfect solution for everyone involved. You want to be sure to choose a place that has a quality reputation and goes the extra mile to make the home as safe and comfortable as possible. When you are looking for care homes in Crawley you want to be sure to take a look at Ashtonleigh Residential Care Home. Ashtonleigh is a residential home that will provide the best care possible for your family member so that they will feel right at home there and benefit from the care, attention and surroundings.

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nursing home

It is never an easy decision to put a parent, grandparent, spouse or relative into a nursing care facility. Unfortunately, a time may arise where the medical circumstances involved mean that you can no longer provide the level of care at home for this person and you may need professional help. This is particularly true of those that may experience issues with senility, Alzheimer’s disease or dementia. You need to know that there are quality places that you can turn to that can provide you with the type of help you are looking for so your family member or loved one can get the help and treatment they need. You will find that nursing homes can be just the right place to assist you if you find one that provides the high level of care to make sure your loved one is happy and healthy.

Knowing the Right Place

There are a few important characteristics you want to look for in a nursing home facility so you can be sure it is the right place for your family member. First, you want to be sure that there is an experienced and quality medical staff available at all times. This means that nursing care is available around the clock should it be necessary and that other medical personnel can be called if needed or steps can be taken so that medical treatment is seen to. Outside of the trained medical staff, you also want the staff to have experienced caregivers that help to support the nursing staff. This means there is staff available to help your loved one with daily care and activities to see that all of their needs are being met.

Activities and Interaction

A good nursing care facility is going to be able to provide many different activities for the residents to keep them engaged and entertained. This can mean everything from providing organized activities and outings in groups to individual options that your loved one may enjoy and benefit from. You also want there to be opportunities for interaction both with the staff and with other residents. Your loved one will benefit from the opportunity of meeting and being with others so they can forge new friendships and be more comfortable in their surroundings each day. This can help to make them feel happier and transition easier to their new home.

You want to be sure that your family member’s needs are all going to be met at whatever facility you choose. Take the time to look over and visit different facilities among the Horsham dementia nursing homes available today. You will find that of the Crawley nursing homes you look at that the Ashton Grange Nursing Home is going to be the best option for you. Ashton Grange offers a high quality facility with the level of care you want for your loved one so you can be sure that they have the quality life that is so important to you.

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Nursing roles have always played a large part in all aspects of healthcare and today the diversity of the work involved means that those who choose a career in nursing have more opportunities than ever before.

Of course, across the spectrum of nursing jobs for both women and men there are certain skills needed to cover every discipline. For example, having a high degree of empathy means someone can place themselves in another person’s shoes and have an idea of what they are going through. This can be an essential element in learning how to treat everyone with respect and keep his or her best interests at all times.


Nursing is a career that offers something for everyone when it comes to how far it can be taken. For ambitious people who feel they have something to offer in a leadership role, there is plenty of room for advancement. For those who are happier dealing only with their own responsibilities at work rather than looking after a team of people under them, the day-to-day duties can be rewarding and bring great personal satisfaction.


Of course, the wide range of nursing jobs available covers everything from theatre positions, general hospital ward duties, GP practise nurses and a wealth of opportunities to work in the wider social care sector. All of these services are becoming increasingly vital as the population of the UK gets older and lives longer, and the demand for nurses continues to grow each year.

Of course, the stories about how both the NHS and the social care sector are being hit by cut backs and financial resource challenges during this ‘age of austerity’ are never far from the headlines. However, an Employment Management Company will be able to offer good rates of pay and plenty of opportunities for work, both on long-term placements and short-term contracts. Not only that, but using this kind of service means that getting the right job becomes far more straightforward and simple.

Entry requirements and training

The entry requirements and training needed to start and continue on a career path in nursing vary greatly depending on what direction someone wants to take. Some jobs, such as those in Occupational therapy involve having to be registered with the Health and Care Professions Council (HCPC), while others in the social care sector need zero formal qualifications and can offer ‘on the job’ training programmes. There are plenty of part-time and in-service courses available and two or three A-levels will usually help get a foot in the door for further education courses.

However ambitious someone might be or whichever particularly aspect of nursing work is attractive to them, anyone who chooses to build a successful career in nursing knows that they are helping some of the most vulnerable members of society everyday in the course of their work.

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In 1987 Brian Turner wrote a seminal text detailing the sociology of the para-medical professions. Whilst some of his work would be contested in a contemporary context (e.g. Nursing may no longer associate itself as para-medical), some of his work still applies. Namely, his assertion that the non-medical health workforce undergoes a process of professionalization. One modern day exemplar of this may be the role of the Ambulance service Paramedics.

Arguably this has been a quiet revolution. One generation of workers has seen the shift from the traditional ‘ambulance man,’ promoted from driving council vehicles, to the graduate profession who now have a place in primary care to assess, prescribe (legislation pending), treat and maintain a patient in their own home. This places them on a par with Nurse Practitioners and other professional such as Physiotherapists and Pharmacists who define themselves as Advanced Practitioners.

There is little to critique in term in terms of the efficacy of these roles. There is widespread consensus that many clients can and should be treated at the right place and right time, rather than taken into a hospital environment. However, there is the wider question of how these roles have emerged and in whose interest do they serve?

A benefit of health policy from 1997 was the principle that each area of the UK can seek to review its own specific health needs and meet these through local health service specifications. This included workforce planning. However, there is a need to undertake this with a view to the longer term and not, as we assert, to fill a void perpetuated by the current Governments Neo-liberal approach to health policy.

There is a notable lack of regulation for all roles that describe themselves as ‘Advanced’. Nurse Practitioners in both secondary and primary care have been arguing for their roles to be recognised through regulatory frameworks for well over a decade.

Without nationally agreed regulation of Advanced Practice (as we do see in Scotland and Wales), Governance will not keep pace with changes in practice. Without Governance, organisational structures will continue to struggle to understand the distinction between roles that specialise and those that are advanced. This debate is not one of semantics, but a very real and distinct method of health care practice.

Whilst the neo-liberal approach to policy in this field (ie a lack of), then there will continue to be a plethora of health professional titles across the sector. To again use Ambulance Paramedics as an example, a quick review of literature finds that Paramedics use the same ‘Advanced’ title if they specialise in trauma and intubation or if they practice in a primary care setting seeking to see, treat and maintain a person in their own home.

Not only is this true in the context of Advanced Practice, there is an emergence of new professional roles such as Physicians Assistants and Primary Care Pharmacists which is adding to the confusion around roles and responsibilities. This crowded primary care environment with a plethora of illegible titles, professions and roles is hard enough for those working within the profession to keep pace with. How then should the wider public, let alone those who are unwell and their families and carers understand this picture? Whilst there may be more areas and professions to seek care from, it may be suggested that there are more professions who may turn clients away for ‘not meeting their criteria’.

The more crowded and confused the landscape becomes, then the more professions may lose sight of their primary purpose. Turner (1987) commented that with the process of professionalization also comes the ‘rise and fall’ of competing professions. Clearly a neo-liberal landscape may be a catalyst for this. We would argue that this is counterproductive and not in the public’s interest. We would seek for professions to focus on their primary aim, the delivery of care for their clients and wider community and not have to be in a position whereby they have to compete for professional space. This competition not only detracts from our professional imperative, but also leads to short term planning through a race to be the first to meet the next policy agenda.

This is not a call for nurses and paramedics etc. to ‘know their place’; we do assert that all health professions should be involved in the wider political context. But rather an argument to seek an end to the competition between professions and to plan for practice in the longer term, practice that is carefully underpinned by socially just principles.

See Turner B, 1987, Medical power and social knowledge, Sage London

Paul Mackreth is a District Nurse and Senior Lecture in Community Nursing at Leeds Beckett University

Fiona Needham – who also contributed –  is a Senior Lecture at Leeds Beckett University and Course Leads a Programme for Advanced Practitioners

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Buurtzorg (“care in the community”) is what would be called in the UK a social enterprise which was established in Holland in 2006 as all parties involved started to realise that the demand of providing care by nurses/carers in the community,  caring for the clients in their own home environment, was significantly  increasing. This created a situation in which the nature of providing care  subsequently started to change too.

“Buurtzorg” is in essence a home care organisation working with small and flexible teams; a community nurse and community carers providing care to the clients within their own living environment or house. E.g.  clients being subject to ill health, clients returning home from hospital  or on behalf of their GP; injecting insulin, caring for surgery wounds and dealing with pain relief. Supporting in palliative care is also possible. Each client is allocated a personal nurse/carer. The nature of this “Buurtzorg” is to promote the client’s independence and to increase the opportunity to remain living in their own home as long as possible.

The fully autonomous teams work throughout the Netherlands and all have the authority to take any decision for whatever issue that may arise during their daily involvement with their clients. They therefore have the ability to organise the job without too much management involvement and unnecessary bureaucracy.  Decisions are taken by the nurses/carers working closely with the clients. Although there is one office only within the organisation dealing with administrative issues for the whole of all the teams throughout the Netherlands.  The staff are well-qualified and undertake activity personally which is in other systems are often delegated to unqualified people. This reduces the number of different staff involved in the care of an individual.

The consequence is that the nurses are challenged to have the courage to take the responsibility in taking tough decisions and that working hours are irregular. The nurse/carer is in a direct contact to the client’s GP, (hospital) specialist, or social worker; whoever as professional is involved.

Clients do not pay for “Buurtzorg”. This is funded by general funds within the Dutch healthcare system.  A study by KPMG in 2015 showed that care provided in this way was not more expensive. Care appeared to be higher quality and much more satisfying for staff.

Differences with regular care and general characteristics of “Buurtzorg”;

  • Nurse/carer and client actively work on creating the best possible solutions within their own (professional) support network that results in increasing the client’s independence and quality of life.
  • Providing care is the responsibility of the carer/nurse.
  • Professional care is based on professional standards and is all evidence based and  monitored.
  • Providing care is based on achieving the maximum of effectiveness; care delivered within the exact the time needed; not more and not less time spent and custom made and custom offered care based on the client’s wishes.
  • Hardly any overhead costs.
  • Nature of the care provided is often practical by nature, therefore the provided care is “transparent, visible and measurable”.
  • Aim-purpose “Buurtzorg”: to create the opportunity for clients to live in their own home as long as possible and to avoid that they have to be cared for in elderly homes or hospitals.
  • “Buurtzorg” is highly focused on the client’s availability of (professional) network in the community.




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Just as with the role of alternative and complementary medicine in modern healthcare, there are many misconceptions that are associated with the nursing profession. We have to realize the fact that nursing is not properly understood. This is such a shame since the stereotypes make the entire job of the professionals a lot tougher than it already is. While we are quite sure that you already know that not all the nurses are sexy and you do not believe this myth anymore, those that are highlighted below may still be reality for a lot of people.

Nurses Just Help Doctors

This is one myth that has been around for such a long time now and there is no sign that it will go away soon. The nurses actually treat and diagnose patients every single day. They are in charge of patient education and do work so many hours with not that much time available for them. The nurse is definitely not the doctor’s secretary. The nurse is a true professional.

Nurses Just Wanted To Be Doctors But Failed

This is completely incorrect. The nurses are not medical college drop-outs or individuals that did not manage to become doctors. This is a separate profession and most of the nurses are really passionate about the careers that they are going through. The doctors are trained in order to treat symptoms and diagnoses diseases while nurses are usually trained to offer holistic healthcare. You will see that nurses visit you while in the hospital just for chatting while doctors do not actually stay a lot in the room.

All Nurses Are Women

It is a shame to see so many that look at male nurses and see them as failures since not all nurses are women. This is just a really common myth. Around 6 percent of all the nurses are male and the men are really good at the job that they do. A big reason why this myth still exists is the influence of the media, with many shows still using only female nurses. Do not think about the gender of the nurse since it is completely irrelevant.

Nurses Are Stupid Or Not As Smart As A Doctor

The registered nurse spends over 4 years in medical school and can go through even more education. Nurses need to go through a lot of schooling, go through clinical trials and need to react really fast. The nurse is basically just as intelligent and competent as the physician you trust at the moment. The nurse techs even perform research or publish papers, treat illnesses, administer medication and diagnose patients. Never underestimate the IQ of a nurse. Every single one went through a complex training program that is needed for the license to be obtained.

All Nurses Are The Same

This is another myth that way too many believe. Just as there are differences between cardiologists and gynecologists, different nurses can have different career paths to take. As a simple example, the pediatric nurse is highly skilled in the treatment and care of children. Nurses do specialize, just like the doctors do!

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Traditionally, the best watches for nurses are those who don’t get in the way of the job, can be easily read and are simple to use when in a stressful environment. The best, most hygienic and practical watche, are those that can be attached to a uniform for easy access when working, but nurses – like anyone – can also appreciate beautiful wrist watches. For the times when the hospital rounds can wait, places – such as – have some beautiful timepieces on offer: here are just a few of our favourites.

Mark Maddox Rose Gold and Salmon Pink Watch

This watch is simple and beautiful, perfect for any woman who appreciates the finer things in life but doesn’t want to spend too much on a watch that’s going to be worn to work. This watch is the perfect statement of feminine class, it’s a great choice for anyone who wants to show off their style without breaking the bank.

Braun Men’s Digital Watch

This simple and elegant watch is perfect for anyone who appreciates the latest technology. This is a great watch for a nurse – male or female – because the large face makes it easy to tell the time. Perfect for when you’re in a rush or need to see in a dimly lit room.

The face is scratch resistant too and the whole watch is waterproof up to 5m.

Link Black Breo Watch

This is a fantastically affordable watch for anyone who isn’t too precious about their timepieces and just needs something with which to tell the time. For the price, it’s a surprisingly attractive watch with a very simple face and chunky black strap.

Kennet Gent’s Red and White Watch

If you’re looking for a large face and distinct hands, this is the perfect watch for you. It’s easy to read and the colour scheme is rather striking too. The time adjust button at the side is easily accessible too, for those of you who hate the frustration of fiddling with small parts.

Daniel Wellington Nato Oxford Gent’s Watch

Sometimes a leather, plastic or metal strap can become uncomfortable. The ultimate in watch comfort – at least at the more affordable end of the market – is a fabric strap. This Daniel Wellington watch is simple but it has an attractive red and blue strap. The hands are thin but on the plain white watch face, they really do stand out.

Police Tripod Chronograph Watch

If you need more information than just the time in your day-to-day work then a chronograph might be helpful. This one features multiple different dials and while it may bit a little confusing to look at, this is the kind of watch that can make your day easier as well as much more stylish.

Ladies Chronograph White Ceramic Watch

This watch is the epitome of luxury and if you want to make a statement at work, this is a great choice. There’s a good amount of glitz as well as attractive sub-dials and a ceramic bracelet. While this might not be appropriate for every day work wear, it’s definitely good for those days when something a bit smarter is required.

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The response of the Socialist Health Association (SHA) Cymru Wales

1. Purpose

This deliberately short paper responds to the invitation to submit comments on the forthcoming Bill proposed by Kirsty Williams AM to ensure safe nurse staffing levels within Wales. It draws upon consultation with the membership of SHA Cymru Wales which culminated with a meeting of members on September 3rd 2014 at which four speakers from different perspectives explained in detail some of the issues that need to be considered.

2. The SHA

SHA Cymru Wales is part of the UK Socialist Health Association which has over 700 individual members (and many affiliated organisations). Many members have some expertise in, or knowledge of, health care. It is affiliated to the Labour Party. It believes that health care systems should operate on the basis of meeting the needs of the population through a national, publicly owned, planned and delivered, system of care. SHA Cymru Wales has about 40 individual members, and several affiliated bodies that share its aims.

The response has two parts. The first offers comments upon aspects of the Bill. The second raises queries that arise from a reading of the Bill which it is hoped will be addressed as the Assembly undertakes its work upon the Bill.


3.1. SHA Cymru Wales understands the motivation for the Bill and has much sympathy with its aims. The best defence that the NHS can have against its detractors is that of offering consistently high quality care to its patients and their families who would be expected to be in the front line of defending the NHS from those who see it as an impediment to the relentless march of the alleged efficiency of profit- driven insurers and deliverers of health care. However, SHA Cymru Wales is not entirely clear how the precise legal vehicle chosen to ensure defined staffing levels will operate in practice.

3.2. Safe staffing levels must be a pre-requisite in ensuring that standards of care at all times meet all legal and professional requirements. Nurse staffing levels in particular have received much attention as a result of recent enquiries – notably the Francis Enquiry related to Mid Staffs. However, SHA Cymru Wales would see the need for safe levels of staff to apply across a range of care professionals. In this regard we would wish the Bill to be so crafted that other care professionals would be brought within it purview as evidence to underpin required staff ratios / levels becomes available.

3.3. Even if the Bill is confined to nursing levels, determining what a safe nurse staffing level is at any point in time in different care settings (an acute “on take” medical ward or award caring for elective surgery) has to take into account the severity of the patient load and the needs of those patients. Thus the nursing staff that ought to be available for a given setting have to be adequate both in quantity and in quality (skill). As ward setting become increasingly specialised it is important that staff have detailed knowledge of the care needs that arise from the precise clinical work being done. Nurses that have great experience of nursing patients recovering from major surgery may not be fully au fait with the needs of, say, elderly patients recovering from a stroke.

3.4. It is understood that there is some evidence base for different ratios of staff to patients in different settings, but some of that evidence is from outside the UK. It is not clear whether the evidence base being cited is totally transferable to the UK / Welsh context. If the research that underpins specific ratios comes from non UK care settings, these may, or may not, generate similar care needs and nursing requirements for similar numbers of patients. It It is requested that great care is taken to understand the extent of the transferability of research data from any overseas settings.

It is less clear whether the evidence base in regard to skill levels is sufficiently well developed in all nurse settings but it would be hoped that the Bill would prompt urgent research to identify appropriate levels across all hospital and community settings.

3.5. It is noted that the safe level would apply on a shift by shift basis. It is not clear how sudden surges in workloads are to be accommodated within this legislation. Three very different approaches might be intended.
a) Is it intended that such surges would be met by deploying a “reserve” of trained staff (with the inevitable implication that current total levels of staff would need to be increased to maintain such a reserve?
b) Is it intended that “manageable” workloads would be adjusted to allow for the surge in unmanageable demand – with the result that elective work would act as the safety valve in the system?
c) Is it intended that calculated “safe levels” would be explicitly relaxed when high levels of sudden demand are placed upon one part of the hospital system – and if so how would this be permitted?.

We would expect the Bill to recognise the possible reactions that the service would need to take.

3.6. The Bill is silent with regard to the financial implications. SHA has received some views that the measure may be “self funding” in that any higher staff costs arising from the Bill will be covered by shorter lengths of stay and better outcomes. SHA Cymru Wales would have major concerns if this is indeed the expectation for it is reported that the Welsh average nurse: patient staffing ratio is currently 1:10 and the intended ratio is 1:8. This represents an increase in staffing of about 20% and thus an increase in cost of about the same percentage for a large part of the total nursing budget. Worse, were the predicted reduced lengths of stay to occur, far from releasing funds to pay for the higher staffing levels, there is every probability that this would lead to an increase in workload, rather than a reduction in cost unless very tight controls over admissions were introduced and the “spare capacity” gathered together in such as way as to allow it to be closed.

3.7. Following on from 3.6. a major concern of SHA Cymru Wales is that the Bill will lead to unintended consequences if NHS funding remains tight. If legally binding staffing levels are established, these will be high on the agenda of Boards, professionals and managers. Such staffing levels will be protected at all costs. In straightened times, staff cost centres that are not so protected will inevitably become prey to cost reductions. Medical staffing levels have some protection – as do the services that are outsourced and are protected by commercial legally binding agreements.

There is thus concern that other staffing levels that are not well protected – for example ambulance services, community staff, rehabilitationists, and diagnostic staff – will bear the brunt of providing funding to support nursing areas to which legally binding levels of staff apply. This may, perversely, drain staff from the very support services that assist nursing staff, so that nurses then find themselves undertaking tasks that were once the preserve of others.

3.8. It has been noted that the evidence that links safe nurse staffing levels to good care (using reduced mortality and other measures as evidence of such care) has been interpreted as emphasising the staff : patient ratio as being the main feature. It is accepted that if good staff levels are maintained, then staff might feel more secure and settled, leading in turn to lower staff turnover and high team spirit.

However, members believe that great importance should be attached to the continuity of care that a settled ward staff can deliver. Merely ensuring a defined staff : patient ratio in itself will not automatically provide for the same nurses to care for patients throughout their stay. Indeed, if the impulse becomes one of staffing wards to a given level, then there is a risk that the use of transient agency staff and staff re-deployed from other areas will be increase.

We would wish further work to be undertaken to understand what impact continuity of staffing has on care outcomes.

4. Questions

4.1. The Bill is clearly titled so as to refer to “nurse” staffing levels. SHA Cymru Wales assumes that this wording intends specifically to apply to registered nurses only and not to staff sometimes seen as part of the nursing workforce at ward level, but who are not professionally qualified.

Is this understanding correct and if so, could this be made explicit within the Bill?

4.2. Again, in relation to the wording used, SHA Cymru Wales assumes that the Bill does not seek to bring midwifery staffing levels within the scope of the legislation. If so, SHA Cymru Wales is not persuaded that the omission of midwifery for any length of time can be justified. First, it is felt that the adequacy of staffing levels in this field can be predicted and assessed to a level similar to the (wider) range of nurse settings using an evidence base of comparable utility. Second, safe levels in this care area are just as important as in general nursing – especially given the nature of the care that is to be given to both mother and baby, the tragedies that arise from poor care, and the extremely high costs and that fall to be met by the NHS when avoidable harm arises from inadequate care. Third, workload in midwifery has some element of predictability that should aid the service in arranging adequate staff levels.

Could the Bill please allow for the inclusion of this service within its scope?

4.3. SHA Cymru Wales understands that much of the debate around the Bill has focussed on nursing care in acute hospital settings. SHA Cymru Wales however, would wish to see any “safe” level applying in all psychiatric care settings and would wish to be assured that this is so. In respect of 3.7. above SHA Cymru Wales would wish to see firm safeguards that protect investment in psychiatric settings and ensure that nursing levels here are set using appropriate metrics.

4.4. It is not clear whether the Bill intends that the safe staffing regime is to be applied to:
• NHS facilities operating in Wales only
• All health care facilities operating in Wales – public and private
• All health care facilities which provide services to Welsh patients as commissioned by the Welsh NHS.

SHA Cymru’s reading of the Bill as drafted is that Welsh health bodies would need to apply the provisions of the Bill both as providers of NHS care and as commissioners of NHS funded care. Further, the logic of the Bill should also apply to ensure that all privately provided nursing care operating in Wales is “safe”.

Clearly, if the Bill passes, NHS Wales should operate its own services in line with the Bill’s requirements. However, NHS Wales as a commissioner of services (whether from the English NHS or the private sector) will then be expected to ensure that any services it acquires for its patients also operate to safe standards. Further, for privately funded nursing care, it would seem unwise to allow a two tier level of staffing to operate within the public and private sector; if safe levels are required, they must be required in both.

Could the Bill please make clear the application of its provisions to health providers serving Welsh patients – whether publicly or privately funded?

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