The evolution of professional

nursing

History of Medicine

• Medical practice can be dated as far back as the ancient Egyptians

• Imphotep was the physician to King Zozer and lived in about 2600 BC

History of the non-medical professions

• Nursing has existed in various forms in every culture over millennia, e.g. wet nurses

• America’s first trained nurse graduated in 1873

• The most significant development was during war time when Florence Nightingale laid the foundation stone for professional nursing

History of other professions• Physiotherapy practice dates back

to BC times, for example in ancient Greece and the practice of hydrotherapy

• In 1894 the UK recognised physiotherapy as a specialised branch of nursing

• The polio epidemic was a turning point for the physiotherapy profession and its establishment in its own right

So what does the history tell us?

• The practice of healthcare and medicine has been around for a long, long time in various forms

• The practice of healthcare and medicine has been consistently valued and has evolved in accordance with demographic requirements

• The various professions have evolved in accordance with demographic requirements

So what does the history tell us?

History of the NHS

• The NHS was born on July 5 1948 officially started by Aneurin Bevan

• ‘Good healthcare should be available to all, regardless of wealth’

• For the first time doctors, nurses, pharmacists, etc. are brought together under one umbrella organisation

The Timeline

• 1948 the NHS commenced• 1953 the structure of DNA was discovered• 1960 the first kidney transplant• 1967 the Salmon Report• 1978 the first test tube baby• 1980 keyhole surgery• 1988 breast screening introduced• 1990 internal market introduced• 2007 robotic intervention

Nursing uniforms c1890

Student nurse uniforms c1960 from Youngstown Hospital Assocation and St. Elizabeth Hospital

Youngstown State University student nurse uniform, 1967

Throughout the 1960s and 70s, many hospitals discontinued their nursing programs or partnered with local universities to provide some of the academic training. These new programs with colleges and universities opened up the profession to a more diverse population including married women, minorities, and men.

Healthcare professions of today

• Doctors and dentists

• Nursing and midwifery

• Allied health professions

• Healthcare scientist professions and the smaller professions

• Healthcare support workers

• Management, ancillary and other staff

Fields of practice

• More than 15 specialties of medical practice with additional sub-specialties

• 4 main branches of nursing with enhanced specialisation in practice – multiple sub-specialties

• Around 12 allied health professions with multiple sub-specialisms

• Over 30 healthcare scientist professions with a host of sub-specialisms

• Primary, secondary and tertiary care settings• Integrated services e.g. with social care

Changes in practice• At one time, nurses and

other professionals couldn’t take blood pressures – this was a medical procedure

• We now have highly skilled practitioners who undertake a range of procedures and are also responsible for diagnosis e.g. advanced practitioners in cervical cytology

What does this say about current healthcare practice?

• Its complex! • Its reliant on a range of

practitioners in different settings and sectors with the appropriate skills

• Technology advances and will continue to advance

Healthcare workforce – a recent history

• The 1990s saw serious workforce shortages

• Health Select Committee enquiry into workforce planning in 1999

• NHS Plan produced in 2000 – a 10 year strategy

NHS Plan Headlines

• More staff, better paid

• Modernisation of workforce and services

• Improved outcomes

• Critical targets

The Key Workforce Messages

MORE STAFF

WORKING DIFFERENTLY

Workforce Objectives

• 150,000 more staff• Doubling in applicants and 60+% more

trainees• Explosion of new roles

– Delegated tasks e.g. prescribing– Extended roles e.g. nurse endoscopist– New roles e.g. advanced practitioner

• Positive staff survey results• Lower vacancy and sickness absence rates• Over 90% of staff on new pay systems

Where are we now?

• New workforce planning crisis– Graduates in some professions unable to

find a job in their vocation

• New Healthcare Select Committee Enquiry in 2006

• New attempts to ring-fence education and training and strengthen workforce planning

Swinging pendulum

Policies since the NHS Plan

• Payment by Results– Tariff-based commissioning system

• Choice and Competition– Stronger patient opinion and voice

• Practice Based Commissioning– Stronger role in primary care

• Commissioning a Patient Led NHS– Major reorganisation

• All have had an impact on workforce…..

• A world class NHSFair – equitable to allPersonalised – tailored to the needs of the

individualEffective – outcome-focusedSafe – public confidence

Eight defined areas of care

• Maternity and newborn• Children’s health• Planned care• Mental health• Staying healthy• Long term conditions• Acute care• End of life

to

The focus on workforce

• The NHS employs over 1.3 million people• 70% of costs are staffing• The NHS spends over £4 billion annually on

education and training• Need to overhaul the system and strengthen

workforce planning and commissioning education and training

• Need effective clinical leadership• Need to avoid repeats of the boom and bust

What are we aiming to achieve

• We need a workforce with the right skills in the right quantity in the right place at the right time

• A workforce that is appropriately educated and trained to deliver the service

• A workforce that can deliver quality care to patients

How is the workforce planned?

• Not dissimilar to history – its based on demographic requirements, however the healthcare arena is significantly more complex today

• Workforce planning is designed around the patient

• Based on the skills and competencies to deliver the required services

• Planned in harmony with finance and services

3 current key priorities in NW

• 18 week wait – where are the workforce gaps?

• Public health and health promotion – what are the workforce needs in terms of education and service delivery

• Health inequalities – some significantly deprived areas - need to ensure appropriate workforce with correct skills is available

Blurring of professional boundaries

• The average patient sees over 40 different people associated with delivering their care during a single episode of care

• A patient is often assessed more than once• Many of the professions have overlapping

skills and roles in patient care• Many of the professions dispute who should

be carrying out particular roles

Workforce modernisation• Modernised roles focused on delivering the care

pathways and targets• A workforce that demonstrates the appropriate

attitudes and aptitudes• Breaking down of professional barriers where

appropriate• A flexible workforce• A workforce that embraces continued professional

development, advancing technology and evidence-based practice……….

…….A workforce capable of delivering world class

healthcare in the 21st century

You know you work for the NHS when…………

• Discussing dismemberment over dinner seems perfectly normal

• You firmly believe unspeakable evils will happen when someone says ‘Wow its quiet in here’

• You have ever had a patient who looks you straight in the eye and says ‘I have no idea how that got stuck in there’