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Holding up a mirror to social care nursing

With the new role of Chief Nurse for Social Care in England and the World Health Organisation’s announcement that the Year of the Nurse and Midwife will be extended into 2021, we asked three influential voices in the sector to share their views on COVID-19, the barriers that must be overcome, and the work that needs doing to improve the role of nursing in social care.

Richard Adams is Chief Executive Officer at Sears Healthcare Ltd

COVID-19 has transformed the landscape of care in many ways for all of us working in social and health care. Providers have been collaborating and sharing information in a way that was simply not the case previously. A spotlight has been shone on social care and the value of the work carried out in the sector. There have been some brilliant pieces of work connecting social care with health at a local level, and some fabulous examples of mutual support across the social and health care system.

The past few months have thrown into sharp relief the complexity and fragility of the people that we look after in social care. The next few months will test the strength and resilience of these changes for better or worse. We have had to innovate like never before, but we have also, I think, found ourselves lonely and isolated from our healthcare colleagues at times due to the perceptions that many nurses hold of social care nursing.

 

It is time for social care nursing to cast off its image as the cosy cardigan of nursing – a place where nurses go when they are ready to retire. Social care nurses have been working with autonomy and leading the care interventions. Even before this pandemic, social care nursing was about more than simply pushing a drug trolley around giving out paracetamol and simvastatin. Social care nurses are true advocates for the people they care for. They are experts in really understanding and delivering complex, person-centred care; of keeping people connected to their families; and of developing the skills and capabilities of the people around them.

 

The starting point for this is to establish mutual respect between those nurses working in hospital settings (and other acute services) and those working in community and care home settings. Too often, I have heard care home nurses recount their experiences of nurses in hospitals not being able, or prepared, to discuss a resident who is currently an inpatient. We have had cases where there has been no conversation between the ward and care home nurses, and the only ‘handover’ has been the discharge summary sent to the resident’s GP.  Whilst I understand the issues around data protection and the need to protect individuals, there is a very basic need for one nurse to be able to hand over to another.

I cannot help but think that this is due to the perception that many in the profession have of nurses working in social care, and care homes in particular. Continuity of care is a fundamental tenet of a positive experience of care. If this cannot be achieved because of the perceptions held by one field of nursing of another, then nursing is failing on a very basic level.

Now, more than ever, there is a need for better understanding and acknowledgement of the skilled and complex nature of social care nursing. Only from the foundations of mutual respect for one another’s expertise can the profession come together to meet the challenge ahead.

Joanne Bosanquet is a Registered Adult Nurse, a Public Health Nurse and Chief Executive at the Foundation of Nursing Studies

I remember when, back in March 2020, we were being thrown into action – literally. I felt an enormous pull to drop everything and go and support my colleagues at my local hospital. We were told to increase ITU capacity and learn how to be an ITU nurse overnight. What I don’t remember is a similar call to rush into our care sector and support teams who were starting to buckle under the pressure to admit residents from hospitals.

I don’t profess to be competent in either of these specialisms and, to be honest, I was relieved that I wasn’t needed on my local ITU. I was left feeling angry and useless. I could see that colleagues in our care sector were struggling, with multiple policy decisions being made weekly and the associated guidance often confusing matters.

I was invited to join a small group of concerned front line social care professionals and academics who set up a support WhatsApp group (this group has since been shortlisted for a national award). We quickly grew to over 250 members and, immediately, I felt the power of collaboration. We shared practical solutions, discussed risks, workarounds and made plans. The word was spread and very soon we had commissioners and local authority social care leads asking to join us. This collaboration continues even now and we very often exchange 25-30 messages per day.

In England, we are venturing into our very first serious partnership between health and care. Integrated Care Systems and associated partnerships are already sprouting up around the country. We have thousands of registered adult nurses, children’s nurses, mental health nurses and learning disability nurses in roles across the sector, working at a place-based level.

We have a Director of Nursing in every clinical commissioning group in the country, and we are developing nursing leadership within Primary Care Networks. In some areas, such as Croydon and Torbay & South Devon, we even have System Directors of Nursing who tie everything together and create networks. These collaborations are natural to nurses. We know our communities and advocate for individuals, families, communities and populations.

We need to share successes and challenges in order to learn and grow. We need to profile these roles to undergraduate nurses to ensure we grow a sustainable workforce. We also need to ensure we develop a long-term plan to develop a range of opportunities for nurses to come into social care as a career of choice and stay there.

There’s an enduring challenge though. The culture and language in health and social care is different. Relationship-centred approaches to care are the norm in social care and we are a long way off this in health. We strive for this I hope, but we are not there yet.

Unfortunately, I have been informed on multiple occasions that there is a lack of understanding and professional respect between nurses in the health and care sector. If we took a serious look at ourselves and focused on culture and person-centred care, we wouldn’t repeat historical behaviours.

Diversity, inclusion, equality and celebration of difference is a societal-level movement for change.

As a member of a 500,000-strong nursing profession in England alone, I am determined to do what I can to establish joint working and understanding amongst my peers. We have to try to walk in each others’ shoes to understand the peculiarities of our roles. What we don’t have to do is establish a common set of professional behaviours and values. These are set by the Nursing & Midwifery Council. Holding one another to these values and providing touch points to establish reflective practice is one way we can grow together. Let’s start there, at a local level. Bit by bit.

Andrea Sutcliffe CBE is Chief Executive and Registrar at Nursing & Midwifery Council (NMC)

It took a while initially, but the COVID-19 pandemic has brought social care out of the shadow of the NHS and into full public view. More people now realise the vital role social care plays in our communities, caring for and supporting older people, people with learning disabilities, physical disabilities and those living with mental health issues.

We’ve seen nurses at the heart of the social care response to COVID-19 – coping with unprecedented challenges and using their skills and expertise to provide the best care possible. Some of them even moved in to their services to sustain the care their residents needed. Going ‘above and beyond’ doesn’t even begin to describe it.

But we’ve also seen problems we knew already existed laid bare. The disproportionate impact of COVID-19 on people from black, Asian and minority ethnic backgrounds has exposed deep-seated inequalities in our society, not least for those working in social care. The lack of focus on the needs of social care and the fragmentation of the sector caused problems with PPE, testing, communications and co-ordination with health. Nurses feel all these pressures and their resilience and patience have been sorely tested.

Frankly – the fix is simple. We need social care to be recognised for its vital community role; a comprehensive, coherent plan established to deliver that role; and, key to that plan, we need enough nurses to provide the skilled care and support people using social care services have every right to expect.

However, if it really were that simple, it would have been sorted by now, so obviously we’ve got some barriers to overcome.

Rich Adams puts it brilliantly when he describes the outdated ‘cosy cardigan’ image of social care nursing, ‘a place where nurses go when they are ready to retire’. We know that’s not true, as the recent brilliant film commissioned by Health Education England shows.

You use all of your skills in social care nursing, you practice truly person-centred care, you manage difficult situations, you cope with emotional as well as physical distress, you’re part of – or lead – a team but you often have to stand on your own two feet, the NMC Code and standards apply to you just as much as they do to anyone else on our register. Does that sound like retirement to you? No, me neither.

So why does this image persist? I suggest prejudice and ignorance are the answer.

The people social care supports are often disregarded by the rest of society – they’re old, they’ve got dementia, they’re disabled…the list goes on. When we don’t value the people using a service, how likely are we to value the people providing it?

Often, people who disparage social care nurses have no idea what they do, the skills they need, the challenges they face. It’s harder to take the time to find out and so much easier to accept the stereotypes.

Prejudice and ignorance are twin evils we have to challenge.

It’s great to know we’ll have a new Chief Nurse for Adult Social Care in England – they’re going to have their work cut out. But their ‘To-Do List’ won’t get done working in isolation – we’ve all got to join together to:

  • Promote social care nursing as a wonderful career option and make sure students get experience in social care placements.
  • Strengthen relationships between the NHS and social care – learning from each other and building mutual respect.
  • Celebrate the role of social care nurses at the heart of their communities.
  • Use the NMC statement we developed last year to recognise the contribution of nurses working in social care.

Together, we can make a difference.


Richard Adams is Chief Executive Officer at Sears Healthcare Ltd. Email: richard.adams@searshealthcare.co.uk Twitter: @RichAdams_RN
Joanne Bosanquet is Chief Executive at the Foundation of Nursing Studies. Email: joanne.bosanquet@fons.org Twitter: @FoNSCharity
Andrea Sutcliffe CBE is Chief Executive and Registrar at Nursing & Midwifery Council. Email: Andrea.Sutcliffe@nmc-uk.org Twitter: @nmcnews

What are your experiences of nursing in social care? What is needed in your view? Leave a comment below to share your thoughts on this article.

 

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