Change is undoubtedly the current buzz word in the health service and, indeed, the wider economy. If a person, or a system, or an organisation is not changing then, in the eyes of those who know everything, that person, system or organisation is going backwards and is wasteful.
So, for example, these people put forward the view that a nurse is a nurse is a nurse. She/he should be able to work in any area, specialism or department at any time and, even more alarmingly, that healthcare assistants, or other unqualified staff, can perform direct patient care in the same manner, and in the same quality assured way, as a registered regulated nurse/midwife.
These people have absolutely no concept of the volume of specialised knowledge necessary to work in any given area. They have no understanding of the body of evidence that exists across the globe, confirming that the presence of a registered nurse/midwife, competent in that specialism, has a demonstrable positive impact on the patient’s journey and the speed of recovery to full health.
I am reminded of all this in the context of the decision of the Public Services Committee of the ICTU to accept the proposals on public service and reform - 2010-2014, otherwise known as the Croke Park Agreement. As you will know the INMO voted against these proposals.
I have no doubt that public sector employers, regrettably particularly the HSE, will now accelerate their demand for change, dressed up in the language of reform/reconfiguration/ new service delivery models but, in reality, purely because it is short money and must make savings regardless of the human cost.
It is against this stark background that over the coming weeks we will focus very significantly on policies and directives, to members that will constantly remind them to safeguard their practice, safeguard their registration, and, in doing so, safeguard their patients.
Recent decisions of the fitness to practise committee, of An Bord Altranais, have quite clearly reaffirmed that the duty of care, of each individual nurse or midwife, for their scope of practice, lies with that individual registered nurse/midwife and cannot be delegated, under any circumstances, to another person.
So, regardless of the pressure for change and regardless of the dictatorial attitude of any employer the individual nurse or midwife must assess everything they are asked to do, and everywhere they are asked to work with reference to their scope of practice. They must take into account their own skills and competence and they must not allow themselves to be intimidated, in to working in any clinical area, where they do not feel competent and enabled to deliver satisfactory assured care. This is a stance that must be taken by each individual nurse/midwife in their own interest, in terms of their long term registration and in the interests of the patients.
This Organisation, beginning in this journal, will issue a number of guidance/ advice notes to all members. These will provide them with an effective checklist that will help the individual carry out an assessment of whether it would be safe for them to move to another area of the service or whether they require an adequate opportunity for orientation, re-skilling or professional updates before they accept any request, or directive, to work in a new, unfamiliar, clinical area.
Our healthcare system must change and we must continue to strive for new models of care which meet the patients needs and enhance their journey back to good health. However, for this to happen, we must not accept change, for the wrong reasons, and we must never accept management imposing decisions that compromise your practice, compromise your patients and ignore the realities of being a regulated professional.
The coming weeks and months will undoubtedly test us in this regard. We must not be found wanting in the interests of our patients and of the long-term livelihood of every registered nurse/midwife in this country.
General Secretary, INMO
|Editorial - Safeguarding your practice|