By Jo Stephenson, Nursing Times, 5 July 2019
The head one of nursing’s most influential leadership bodies has revealed plans to set up a policy unit to help ensure nurses have “a stronger voice”, while also highlighting the challenges currently facing the profession.
In an exclusive interview with Nursing Times, Dame Yvonne Moores, executive chair of the Florence Nightingale Foundation and a former chief nursing officer, hoped the new unit would give the profession some extra clout when it came to influencing government policy on healthcare.
She also highlighted key challenges for the UK nursing profession including the need to boost staff retention, improve support and succession planning for nurse leadership roles, and address widespread shortages of nurses across the UK.
In particular, she said there was an urgent need to tackle the drop-off in applications to nursing degrees following the scrapping of the bursary in England, which she claimed had “completely cut off” people aged 25 or over from applying.
At the same time, she called for an end to the “awful” practice of recruiting nurses to fill UK vacancies from less well-off and developing countries who were struggling with their own shortages of nursing staff.
She was speaking ahead of a landmark year for the charity, which is gearing up to celebrate Florence Nightingale’s 200th birthday in 2020 – now designated Year of the Nurse and Midwife by the World Health Organization in honour of the bicentenary.
Dame Yvonne, the only person to have ever served as CNO of England, Scotland and Wales, said joining the foundation at such a hugely important time was “a challenge I could not resist”.
She has spent her first few months as chair meeting nurse leaders, as well as visiting hospitals and universities to get “some sort of reality check” on the current state of nursing and midwifery on the frontline.
Dame Yvonne started as chair of the foundation in January but stepped up to become executive chair when chief executive Ursula Ward left the organisation in March.
She told Nursing Times she was in the process of appointing a new chief executive and hoped to make an appointment at the start of July, after which she plans to resume her original role.
In the meantime, she said she was keen to build on and expand the work of the organisation nationally and internationally, and was discussing various plans with the charity’s board, including the creation of a policy unit within the foundation.
“I believe that the voice of nursing and midwifery is not as influential as it should be and, therefore, I am going to be setting up a piece of work and an area of our portfolio which is about influencing policy,” she said.
The new policy unit would “pick up key topics of great interest – not just to the nursing and midwifery profession but to our deliverers of healthcare and our politicians,” she said.
“We will gather evidence – as you do in developing policy – sift it, test it and then publish it. When I have explored this idea with leaders of nursing, it has received really warm support.”
She said the unit built on the call from the current CNO for England, Dr Ruth May, for “one voice” for nursing.
“This is about developing one voice but a louder voice, an informed voice on key issues,” she said. “Policy, influence and a stronger voice – so we can get evidence-based policy-making by our policy makers – is now something this organisation is going to be involved in.”
She said she was in the process of considering the first two or three issues for the unit to focus on and had already been “inundated” with ideas.
An “obvious one” would be mental health, said Dame Yvonne who recently met with NHS England chief executive Simon Stevens to discuss challenges and priorities for the health service, including mental health, learning disabilities, and primary and community care.
“There is a feeling that the voice of mental health nursing has really not been listened to,” she said. “I don’t think the contribution that nurses can make in this field is being maximised and step one is about listening to what our mental health nurses are saying and feeling at the moment.”
This year, learning disability nursing has celebrated its 100th anniversary and much attention has also been given to severe shortages of nurses in the field.
Dame Yvonne revealed that Mr Stevens was planning to meet some of those who had undertaken a Florence Nightingale Foundation leadership programme specifically for learning disability nurses. “He was going to meet some of these nurses and listen to them to see what more we need to do to support and enable them,” she said.
Other examples of issues the unit could look at include a dire shortage of clinical nurse specialists for continence, which was causing delayed discharge from hospital, hampering people’s ability to live independently at home, and meant GP surgeries were struggling to deal with huge numbers of people with continence problems, said Dame Yvonne.
Nurses’ role in tackling an “explosion of people with type 2 diabetes” was also an issue that could be explored. “In one part of England a group of GPs funded two diabetes nurse specialists and it has taken the pressure off that practice by having nearly a thousand people not needing to see a GP,” she said.
“This kind of thing really has got to be brought to the fore and properly presented with the costs and benefits, which will help in every way.”
Other areas where she hoped the foundation could make a difference included further work to bridge the gap between clinical practice and nurse education and academia.
“There is still a gap between academic and clinical nursing. Our teachers and educators in the main are not clinicians,” she said. “Some of it is the movement of the education of nurses into universities, which I completely applaud and agree with, and it’s partly because the money for funding higher education and funding the health service are in different pockets.”
She said the Florence Nightingale Foundation’s clinical professors of nursing, who work across universities and health services, were helping to bridge that gap but more work was needed to “ensure the validity and excellence of our education system”.
When it came to attracting new people into nursing, she said it was clear more had to be done to address a drop-off in applications to nursing courses in England since the scrapping of the bursary.
“We need to look at what on earth we are going to do now we don’t have the bursaries,” she said. “Obviously there has been a drop-off in numbers. We have completely cut off people from about 25 and above from applying for nursing – they cannot possibly afford to come back in and have that extraordinary debt.
“Something has to be done to relook at how we’re going to do it,” she said. “People have different ideas – do we provide some supporting finance and so on? So maybe politicians can’t do U-turns but there has got to be answer to recruitment into our training programmes.”
She said she had recently met education and health service leaders in Hertfordshire, who told her many potential nurses could not currently afford to do the training.
“They have so many people in their workforce who would love to go into their undergraduate programme,” she said. “Our new nursing associates are waiting to go and would love to, but they are older in the main and cannot possibly afford it with all their family commitments – and the fact they are often the breadwinner. So there is a very big piece of work to be done there.”
Meanwhile, she said she was completely against taking nurses from countries that could ill-afford to lose them.
The long-term plan for the NHS in England set an ambition to recruit 5,000 overseas nurses per year to fill vacancies in the short to medium term. However, the target did not feature in the recently published Interim NHS People Plan that accompanies the NHS Long Term Plan.
“I am absolutely adamant that we must not recruit from the developing world. It’s awful that we say we’ll take nurses from countries that can least afford to lose the few skills they have,” said Dame Yvonne.
“The whole strategy of international recruitment has to be carefully managed and it has to be those countries that have over-produced for their own use and health service delivery.”
She recalled attended a meeting of Commonwealth health ministers in the late 1990s that was attended by the then health secretary Frank Dobson, and which followed a major recruitment drive for international nurses by the UK.
“We were absolutely surrounded by these Commonwealth health ministers saying ‘Keep out of our country’. It was horrendous but quite rightly so,” she said.
Meanwhile, she stressed that boosting retention rates was a key element when it came to tackling shortages of nurses and ensuring there were enough to meet ambitions for the NHS in England and elsewhere.
She said there was a need to invest in continuing professional development and highlighted a lack of clear clinical pathways for nurses as one reason why some people dropped out.
“Our newly graduated nurses don’t know what the possible career opportunities are in different roles, nor do they know what educational preparation is needed,” she said.
“Newly qualified nurses definitely want proper career pathways, they want to prepare themselves and want to be supported but there isn’t clarity, so it could be that the foundation works with others in getting that clarity and helping in that preparation – maybe indicating some of the clinical areas we see as a priority,” she noted.
Dame Yvonne also talked about the need to promote “excellence in leadership” and support nurses in the most senior roles.
“Sometimes what can happen is a nurse director is appointed to a board level position and they’re left – they have no mentors, no coaches and are left to sink or swim. There has got to be proper mentorship and coaching,” she said.
More effort also needed to be devoted to succession planning, which is something she had witnessed in the world of business, with up to 30% of chief executives’ time was spent on nurturing talent.
“This is what our top people should be doing – succession planning, identifying talent, preparing, mentoring,” she said.
When it came to promoting excellence in nurse leadership, she stressed the need to ensure nurses from black and minority ethnic backgrounds were given equal opportunities to develop their careers.
Her comments follow a row over her appointment as chair of the Florence Nightingale Foundation, which saw one trustee resign because they felt an internal candidate from a BME background should have been given the job.
Dame Yvonne, who said she was aware of the controversy, told Nursing Times she was committed to supporting increased diversity in senior nursing roles.
“When you look at the data – at the percentage of BME nurses in the most senior roles – there is something wrong,” she said.
“We have about 35 BME nurses on our Windrush programme and to sit in a room and listen to their experiences and see their potential is both amazing and sad.”
She said inspirational BME nurse leaders included Joan Myers OBE, who was due to become a full trustee of the foundation from September.
“When I was CNO of England I set up one of the first coming togethers of BME nurse leaders and potential nurse leaders,” she said. “I met them, supported them and helped their development but I absolutely agree more has to be done.”
Reflecting on her different experiences as CNO of three out of the four UK nations, Dame Yvonne said she was “amazed she did it”.
“I didn’t think I was that ambitious but I loved making an impact on patient but my ultimate vision was to be a ward sister and just run a terrific ward. But then I went into management positions and got the bug of having wider influence,” she said.
She said she had been thrilled to be appointed CNO in Wales, where she helped implement the first ever nursing strategy for the country and said it was “a phenomenal experience and part of my life”.
Being appointed CNO Scotland was an “interesting challenge”, given she was the first senior civil servant in what was then the Scottish Office to come from south of the border but “she absolutely loved it”.
Meanwhile, she highlighted that the main challenge of moving into the chief nursing role in England was the bigger scale and “connecting with somewhere that was 10 times the size of the patch you had just been in”.
She said she had been determined to find ways to keep in touch with nursing on the ground, including setting up a practice advisory group and regular meetings with all trust nursing directors.
“It is a phenomenal challenge to keep in touch and as CNO of England you also have a big international role as well. You really are a leadership person for nursing across the world and you can make an enormous impact,” she said.
She said the current set of CNOs faced an “incredible challenge”. “They are in very prominent roles and are doing amazing jobs in the most challenging situations with the workforce issues and maintaining quality standards,” she said.
Her key piece of advice was to work with others including organisations like the Florence Nightingale Foundation.
“It is so great we have these posts and they can be enormously powerful, even though there are lots of unknowns such as Brexit. It is very unique and I think it is an amazing opportunity to be a CNO at the moment with everything that is on the horizon,” she said.
Dame Yvonne said 2019 represented a huge opportunity to raise the profile of nursing and “make nursing and midwifery so much more visible, respected and listened to”.
Her vision comes amid fresh concern about the outdated image of nursing after Guinness World Records initially refused to award the record for the fastest marathon run by a nurse in uniform to a female nurse, because she was dressed in scrubs instead of a dress.
Meanwhile, The Guardian newspaper was recently forced to issue an apology after describing nurses as doctors’ assistants in a guide on university courses.
Dame Yvonne said she was not surprised such stereotypes continued to be perpetuated and admitted there “was always debate” about the Florence Nightingale Foundation’s annual service at Westminster Abbey, which featured nurses in more traditional garb.
“We have a group of usually student nurses from somewhere in the country in their nurses’ uniform and we do give them a hat to wear, because this is seen as part of the tradition,” she said.
“This year we had three of the St Thomas’ nurses with their long caps and their original uniform. People love to see it.”
She said the public’s idea of nurses’ continued to be informed by old films and other old-fashioned representations of the profession.
But she added: “Alongside that there are tens of thousands of people that experience a nurse intervention – a relationship – which is different from that. For example, one of our Marie Curie nurses, nurses in the local community or a health visitor seeing a mother and child.
“Many people do have this different experience and understand that, while a nurse may have a badge, they very often don’t wear uniform.”
Dame Yvonne, who is also chair of the 2020 Steering Group made up of leading UK nursing bodies, said her key goal for next year was to ensure “the potential of nurses and midwives to impact on the health and wellbeing of the population is maximised”.
Much focus will be on a major international conference to be staged in London at the end of October 2020, which is expected to attract more than 5,000 delegates from around the world.
She said the idea was the conference’s four main themes would be inspired by Florence Nightingale’s work and interests.
The event would highlight the work of the global Nursing Now programme to develop nurses around the world. She expected a key topic for debate would be the findings of a WHO-commissioned report on nursing around the globe, which will be published at next year’s World Health Assembly.
Other exciting projects include plans for a Florence Nightingale garden to be included in next year’s prestigious Chelsea Flower Show. Dame Yvonne also revealed she was meeting with the director of the English National Ballet, who is keen to stage an adaptation of a well-known ballet – but with a Florence Nightingale theme – and hopes to get funding from the Arts Council.
She said next year would be “amazing for nursing”. Pondering what Florence Nightingale herself would make of it all, she said: “I met a relative of hers and she thought she would be reticent but at the same time would really want us nurses to be influential and powerful for people.”