In our last article we wrote about nurses at the beginning of their careers and the need for high-quality placements in adult social care for student nurses.
In this article, we focus on what happens next: How might we attract nurses already qualified and show them that a high-quality career in adult social care is a real and tangible option?
In our opening article, we spoke about the perception that there is no career pathway for nurses working in the sector and that adult social care nursing is often seen as the ‘cosy-cardigan’1 of the profession. We suggested the experience shows that this is not the case and that in reality the careers pathways do exist, but that they are just not visible or well articulated by providers or the sector more broadly.
In the new edition of Ross and Redfern’s Nursing Older People2, in the chapter on care home nursing, Richard Adams (one of the authors of this article) and Karen Spilsbury argue that care home nursing is, in fact, ‘maxi-nursing’ and that care home nurses need the skills required to meet and represent wide-ranging and highly complex needs of people living in care homes at both local and national level.
Back in time
Adams and Spilsbury suggest that in order to understand the present, there is a need to understand the past. The history of care homes and care home nursing casts a long shadow, that still informs people’s views and opinions today. Our healthcare system is predominately set up around a hospital model focused on the ability of doctors and medicine to cure people of their illnesses. Hospitals as we know them today, start their history in the 1800s and were set up as places where students of medicine could train for their profession and practice the art and science of treating acutely ill patients. At the same time as these hospitals were becoming mainstream and the ‘cult of cure’ took hold, the old and those who could not be cured were cast aside, destined for the workhouses and their infirmaries. These workhouse infirmaries became the place of refuge for those rejected by the new hospitals and became, over time, long stay institutions for people viewed as ‘incurables’, marginalised by the medical professions3.
An assumption that was validated by studies from the 1980s to 1990s (representing nurses working in older people’s care) was that nurses were tasked with work that no-one else wanted to do. As hospitals became more successful in the treatment of conditions and their ability to cure people, a medical elite was established, focused on the cult of cure and the dominance of the hospital in the UK’s healthcare model. This dominance persists today with nursing careers based in the community reportedly seen as having less value than those based in the hospital setting.
A role of opportunity
Our sector therefore has been dealt a double blow: Nursing in the community is seen as having less value than working in a hospital, and those who nurse older people are doing the work no-one else wants to do. It would seem that this view continues to persist. Yet, we know that these assumptions are not true. Community nursing offers a rich and varied setting of clinical practice and caring for older people is challenging, rewarding and professionally fulfilling. What’s more is the fact that the sector is large and made up of many different organisations. It also has a whole range of roles to offer registered nurses looking for a career. There are three times as many care home beds as there are NHS hospital beds in England4. There are approximately 33,000 registered nurses in the sector, and 42,000 staff employed in managerial roles, some of whom will also be registered nurses5. This makes adult social care a sector with serious ‘skin in the game’ when it comes to nursing.
It is not our aim to list all the different types of roles available to nurses in the sector – that is the job of the provider. However, our aim is to highlight the breadth of the skill and knowledge set required, recognising that nurses work at every level in care organisations from the shop floor to the executive. We also wish to challenge the narrative that is so heavily informed by the past. All of these roles are important, and yet, they remain so hidden to the outside world. We need to talk more about these roles and opportunities and the people delivering them. It is only by telling people about these opportunities that we can start to challenge the view that social care nursing has little value.
In 2021 the Queen’s Nursing Institute (QNI), working with Skills for Care, published a set of Standards of Education and practice for nurses new to care home nursing, which set out four key domains of practice: Clinical care; Leadership and management; Facilitation of learning; Evidence, research and development6. This publication explores the work of care home nurses in great detail and provides excellent examples of areas of specialism within care home nursing such as independent prescribing, neurological conditions and pain management to name a few. Providers should be (and are) developing these roles and specialisms as a key part of their own workforce strategies – but they need to be publishing these opportunities for learning and development to the outside world, inviting nursing to step in and find out more. At the moment, there is a risk that too many of these opportunities are hidden and only known to those already in the sector, or sometimes even just in the organisation.
Looking further up the ladder to management roles, nurses need to become subject matter experts in issues away from clinical knowledge, in key areas such as safeguarding, clinical governance and professional and practice development. In larger organisations this knowledge becomes more visible in organisational structures as corporate nursing teams, lead by heads and directors of nursing. These departments are vital in monitoring care and developing professional practice, as well supporting the performance of the business.
Challenging the narrative
Clearly, there is, as in all areas of health and social care, a recruitment challenge. Our response to this is understandably focused on filling the roles closest to those we care for. However, you cannot be what you cannot see and it is only by showing people what their own professional futures might look like that we will be able to attract those who see a future for themselves in the sector. This is opposed to people feeling that they are simply going to be doing the work that others do not want to do. It is our stories that will show that there is true human and professional value in the work we do as nursing in adult social care. We need to find ways where we can showcase our stories to the profession and broader public, to show how we make a difference and what we are capable of. We would challenge readers of this article to tell their stories, through social media, through local media and through the professional press.
How many times have you been told: ‘You should write a book’, when talking about the work you have done? The ‘We are Social Care Nursing’ campaign, run by Skills for Care, is a great starting point for nurses to tell their stories and share them with a large audience. Visit the Skills for Care website and search ‘We are Social Care Nursing’ for more information. Tell your story and help us change the narrative to one that represents modern care home nursing. Now is the time – go for it!
Later in this series we will look at the leadership challenge of the role of adult social care nursing in changing and shaping the broader healthcare agenda, including the dominance of the hospital in the healthcare landscape. In the meantime, consider this a call for all nurses in this wonderful sector to get out there and share their stories and showcase their careers. Only then can we show the true value of nursing is not on caring for ‘incurables’ but in helping all people to live their lives well, and on their terms, not ours.
References
- Re previous CMM article with Andrea Sutcliff, JB and RA. Available online at: www.caremanagementmatters.co.uk/feature/the-role-of-social-care-nursing/
- Adams, R., and Spilsbury, K. (2023) Care Home Nursing is ‘Maxi Nursing’: The Value and Contribution of Nursing Older People in Long-Term Care Settings. In Ross, F, M., Harris, R., Fitzpatrick, J,M., and Abley, C (Eds) Redfern’s Nursing Older People. London, Elsevier
- Nolan, M., Brown, J., Davies, S., Nolan, J., and Keady, J. (2006) The Senses Framework: Improving Care for Older People Through a Relationship Centred Approach. Getting Research into Practice. The University of Sheffield, Sheffield. Available online at: http://shura.shu.ac.uk/280/
- OECD. (2015) Health at a Glance 2015: Long-term care beds in institutions and hospitals. Available online at: OECD iLibrary | Long-term care beds in institutions and hospitals (oecd-ilibrary.org) [accessed 20/07/2023]
- Skills for Care. (2020) The state of the adult social care sector and workforce in England. Skills for Care, Leeds. Available online at: https://www.skillsforcare.org.uk/Adult-Social-Care-Workforce-Data/Workforce-intelligence/publications/national-information/The-state-of-the-adult-social-care-sector-and-workforce-in-England.aspx
- Queens Nursing Institute (2021) Standards of Education and Practice for nurses new to care home nursing (2021)