Government Influence on Nursing Development

Introduction

Nursing is an important profession as the nurses by consulting with the health professionals uses best healthcare products for the patients as well as refine the process of support towards the patients to improve their health condition. In this assignment, the developments of nursing over the years are to be discussed. Further, the government policies and legislations that have influenced the development of nursing associate role and contemporary nursing activities are to be identified and explained.

History of Nursing

In the nineteenth century, before the rise of nursing training it was regarded as casual and low paid profession. The voluntary hospitals established in the era in London only paid 6-9 shillings to nurses for six days in a week with some lodging and boarding. Moreover, outside London, the pay much lower and the performance of the nurses in taking care of the patients was also poor and inefficient (Thomas, 2016). In 1866, only 53 nurses were found to be appointed in 11 metropolitan workhouses that are run under Poor Law infirmaries offer average of £20 to the nurses for their services (Abbott, 2014).

In the nineteenth century, there was no nursing training school until in 1846 the first nursing training school was established in Germany from which Florence Nightingale got training to nurse patients. The training led Nightingale to become a competent nurse and with practice the person developed effective capability. In 1854, Florence Nightingale along with 10 nurses and nun was sent in the military hospitals in Turkey to assist the doctors but the physicians refused to take their assistance (Steele, 2017). However, the fresh causalities from the Battle of Inkermann lead the nurses and Nightingale to be involved in care. In 1860, St Thomas Hospital was in London by Nightingale. This was the first nursing training school that was solely developed to offer education and training regarding nursing services to individuals to make them have professional ability to nurse the patients (Steele, 2017). Thus, it indicates that the nursing profession from being poor and low paid got its exposure with the help of Nightingale. Moreover, Florence Nightingale was the main individual who developed proper training and education of the nurses as seen in the modern era to provide care services to the patients.

In 1893, the Nightingale Pledge was created which was the modified version of Hippocratic Oath in which nurses are to recite the pledge that is a statement of principle and ethics to be followed by nurses while involved in the nursing profession (Fatima and Erlinda, 2016). This informs that the development of the pledge led the nurses to remain concern regarding their ethics and value at work like the physicians to ensure effective care is provided to patients. The early nurses before Nightingale did not have idea regarding the way compassionate and competent care is to be provided. They also did not have clear ideas regarding the way hygiene is to be managed for benefiting the patients (Epstein and Turner, 2015). However, with Nightingale way to provide diligent, compassionate and competent care for the patients are established through her works.

The period from 1890-1910 the image regarding asylum nursing was poor as allegations of brutality was continued despite claims by nurses and physicians that such general concept is to be avoided. In the Three Counties Asylum which was present in Southern England, it was found that majority of the nurses in the asylum were unskilled and offered services for a brief time. The disciple of nursing in asylum was found to hard and long hours that often lead nurses to leave their position (Fealy et al. 2013). However, by the end of the 19th century in Britain, it was seen that many government systems are already established to develop better nursing care for the mentally ill. This is evident as by 1946 it was seen that the National Asylum Workers Union has merged with the Hospital and Welfare Service Union to frame the Confederation of Health Service Employees to include increased majority of skilled nurses to offer care to the mentally-ill (mrc-catalogue.warwick.ac.uk, 1946).

In 1950, the inclusion of tranquilisers transformed the scenario of mental health nursing (Colaizzi, 2016). Moreover, in 1951, the male nurses were first allowed to join the nursing register who were previously only regarded as asylum nurses. The Mental Health Act 1959 abolished separation of mental hospitals allowing mentally-ill people to get admitted and receive nursing services from any hospital (legislation.gov.uk, 1959). This indicates that with the progressing years the asylum nursing changed with introduction of more skilled workers with vast majority. In the 1940s, the nurses at the first during training were not allowed to execute any technical work and only helped in passing things to doctors and in the kitchen. After nine months of initial training in the 1940s, the nurses were sent to Preliminary Training School where they are made to learn about way to give bed baths, take temperature, do wound dressing and make poultices. In the time, the nurses were trained to sterilise things such as apron, syringes and others and they were not provided any gloves to wear expect in the operation theatre (theguardian, 2018). This informs that the early nurses were trained in executing basic activities and were forced to work long hours without proper protection.

The development of the NHS took place in 1948 but before it, the healthcare of the UK was managed in an unsystematic way. The treatment has to be personally paid by all the individuals making healthcare to be accessible to the wealthy only (theguardian, 2018). This is because the common people were found to be financially poor and unable to bear the extensive expenses required for availing healthcare. However, with the introduction of the NHS, the treatment of all nature was made free for the UK individuals allowing people of all social class have equal ability to avail healthcare services (nursingtimes, 2018). The NHS in the 1950s also led may skilled nurses from over the Caribbean to join nursing to offer care to the patients (nursingtimes, 2018). This indicates that NHS led to include more nurses per patients in the UK ensuring better care is received by each individual.

The progressing work of NHS led to the development of Salmon Report in 1967 which dictated the nursing staffs about the structure and status in the hospital management is to be followed for maintaining effective professional standards (nursingtimes, 2018). In the 1980s, the Bridges report was framed which informed that nurses are to be provided training ion clinical settings. In 2015, the Nursing and Midwifery Council which was established in 2002 developed the Code of Practice for the nurses that were again modified in 2018 which guides the nurses about the way professional nursing care is to be provided for the well-being of the patients (nursingtimes, 2018; datadictionary.nhs.uk, 2019). Thus, it informs that after the development of NHS the contemporary workforce which is currently seen in the nursing field was established. This is because the NHS led to the formation of various reports and policies who with the involvement of the Nursing Council develop guidelines for the nurses regarding the way they can offer high-quality care to the services users and promote professionalism.

Government policies influencing the nursing associate role

The nurses in the current era are seen trying to offer effective care and support to the service users for improving their health. However, the Mid Staffordshire Hospital scandal changed the view regarding the efficiency of the nurses to offer care. This is because in the scandal it was mentioned that from January 2005 to March 2009 nearly 400-1200 patients died as a result of poor quality care (theguardian, 2013). The Mid Staffordshire Hospital is mainly found to be operated by the NHS Hospital Trust but in 2008 the hospital-acquired their foundation trust status which led it to become semi-independent of the Department of Health Control in the UK (theguardian, 2013). The Francis Report was published first in 2010 and then in 2013 which informed the public queries regarding the Mid Staffordshire scandal. The report mentions that there was failure of care due to the lack of presence of skilled staffs, improper working by tiers of management and lack of presence of systematic regulations. The planned actions mentioned by the report include that improvement in joint working and information sharing arrangement is to be established as well as appropriate referrals are to be made for the patients so that prompt actions can be taken to deliver immediate care to the service users. Moreover, the report mentions that they are willing to recognise the workforce development planned by Health Education England (NMC, 2015). This indicates that the report suggested development of better workforce development and collaborative working in resolving the gaps in care which led to the scandal in Mid Staffordshire Hospital.

The Francis Report led to the development of 6 C’s in nursing which are the core values and behaviour to be abided for showing compassionate care to the service users. The 6 C’s include care, competence, compassion, commitment, courage and communication (NMC, 2015). The effectiveness of following the 6 C’s is that the nurses would be able to provide efficient as well as effective care to the patients ensuring their safety and steady recovery. The Cavendish Review was developed in 2013 with the intention to examine the activities to be done so that patients and public using healthcare from professionals are treated with compassion and effective care support. The Review mentioned that new healthcare associates to be known as “nursing aides” are to be recruited who would have three months induction training before they are to be made to attend patients (assets.publishing.service.gov.uk, 2013). This indicates that the review mentioned addition of new role in the nursing profession who are able to support the registered nurses in offering appropriate care to the service users to ensure good health.

The Keogh Report by assessing the Mid Staffordshire scandal informs that immediately the operating theatres in the hospitals are to be closed and most patients have died in the emergency indicating there is low-quality service being provided in the ward. In addition, the changes in staffing levels are to be made and backlogs of complaints made by the patients regarding care services are to be dealt (NHS, 2013). Thus, the report demands that new staffing levels are to be developed so that new roles can be included in dealing with the necessary care to offer prompt support to the service users. This is evident as changes in staffing levels are suggested to be done by the report informing new role or defragmentation of existing staffing levels are to be done.

The Keogh Report along with the Francis Report suggested that changes in staffing levels and new role in nursing are to be achieved to access proper care. The Shape of Caring Review developed by the Health Education England (HEE) in 2015 also determined that a skill gap and lack of knowledge is present between the registered nurses and the healthcare practitioners. In order to resolve the gaps, the UK government thought of introducing a new role in England so that changing needs of the patients as well as the public can be easily met (hee.nhs.uk, 2015). The new role announced was nursing associate and under the role, the individuals are to work in supporting patients of all age groups in different setting in healthcare as well as contribute in key work of nurses to help the registered nurses have time and opportunity to focus on complex medical care (NMC, 2019).

The HEE to discuss the role arrange a six-week public consultation. In the process, many individuals were found to show positive response towards HEE as well as mentioned that effective regulation for the nursing associate role is to be established to ensure it is properly regulated (NMC, 2019). As mentioned by Heale and Rieck Buckley (2015), the presence of proper regulation in healthcare provides information regarding the way actions are to be made to ensure lack of error in care and performing the role. This is because regulations informs about the guidelines and policies to be abided to execute specific role in healthcare. Therefore, the development of regulations for nursing associate role was done so that the people involved in performing the role have proper knowledge regarding the way the standards in work are to be maintained to offer effective quality care to the servicers under the role.

Conclusion

The above discussion informs that in the 1940s when the NHS was not developed the nurses did not have a proper approach to offer care. However, with the introduction of NHS, various new regulations and policies are developed which helped the nurses to offer better care. The history of nursing in the UK mentions that modern nursing ways were first established with the intervention by Florence Nightingale who taught the nurses the way compassion and diligent care can be provided. The Francis Report, Keogh Report and Cavendish Review inform that collaborative working and changes in staffing levels are to be made. The Shape of Caring Review in relation to all other reports mentions that to resolve knowledge and training gaps created between registered nurses and health professional a new role known as nursing associate is to be developed.

References

Abbott, A., 2014. The system of professions: An essay on the division of expert labor. University of Chicago press.

Colaizzi, J., 2016. Seclusion & restraint: a historical perspective. Journal of psychosocial nursing and mental health services, 43(2), pp.31-37.

Epstein, B. and Turner, M., 2015. The nursing code of ethics: Its value, its history. OJIN: The Online Journal of Issues in Nursing, 20(2), pp.1-10.

Fatima, A.C. and Erlinda, C.P., 2016. Nursing, nightingale and beyond: Voices, dialogues and talks of the future. Philippine Journal of Nursing, 86(2), pp.11-23.

Fealy, G., Kelly, J. and Watson, R., 2013. Legitimacy in legacy: a discussion paper of historical scholarship published in the J ournal of A dvanced N ursing, 1976–2011. Journal of advanced nursing, 69(8), pp.1881-1894.

Heale, R. and Rieck Buckley, C., 2015. An international perspective of advanced practice nursing regulation. International nursing review, 62(3), pp.421-429.