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Is the extended nursing role causing the demise of nursing in general?

I was listening to Radio 4 yesterday (a source of much inspiration I have to say - some of my best poems have come from responding to items on Woman's Hour or You & Yours). There was a very interesting item on nursing.

It threw up many many issues. The catalyst for the item was an article in the Journal of the Royal Society of Medicine about nursing skill mix.(1) The title of the article - The demise of nursing in the United Kingdom - a lesson for medicine - is quite emotive and cleary meant to provoke discussion. Unfortunately I couldn't download the article but I am going to make sure I get my hands on it and digest its contents.

Anyway the discussion on the radio included representatives from the Patients Association, the NMC Chief Executive and Registrar, Sarah Thewlis, and the new General Secretary of the RCN, Peter Carter.

As I said it threw up many issues. This included discussion about preparation for practice, and whether nursing should be an all graduate profession as it is now in Wales and Scotland. If preparation for practice is at degree level, what skills and knowledge should be included and what model of preparation should be used? It also discussed whether taking on 'basic' medical tasks like cannulation and other extended roles means nursing is losing its caring side. Also whether nurses have abandoned core nursing skills (such as washing etc) to healthcare assistants (HCAs) in order to take on these basic medical roles to the detriment of the profession and to patient care. It also highlighted the rise in complaints to the NMC and the Patients Association about nurses and basic nursing care.

My initial response to the item was that it covered so many issues that it obscured them all. I am not sure that the increasing role of HCAs in healthcare is directly related to the extended role of the nurse. Also not all extended/expanded roles in nursing are about taking over 'basic' medical tasks - some of them are highly complex and about new roles not old ones!

My other response to the item was that yet again nurses were perceived solely as ward workers (bedpans were mentioned quite a bit) and there was absolutely no mention of primary and community care. Where are we in all these debates?

Let's get our voice heard. Let us know what your experiences of skill mix are in primary and community care. What roles are HCAs undertaking and how are you extending/expanding your role? Are you in favour of the changing role or are you concerned that we are losing sight of what nursing should be about? Let us know what you think.

And while I remember, have you had your say about the new NMC Code of Conduct? Visit the NMC website, download it, read it and then respond on the online survey - you have until September 2007.

Shields L, Watson R. The demise of nursing in the United Kingdom - a lesson for medicine. J Roy Soc Med 2007;100:70-4.

Your comments: (Terms and conditions apply)

"I truly belive that the extended nursing role is having a very detrimental effect on the nursing profession and that we are most certainly losing sight of what nursing should be all about.  The roles of the medical profession and the nursing profession are becoming increasingly blurred these days and I'm not sure why nurses think that that's a good idea. We are doing ourselves no favours whatsoever by taking on more and more extended roles for virtually none, if any, extra pay or professional respect from both the medical profession and general public alike. I could go on and on about this subject but luckily for you I won't, but it's something that I feel very strongly about and something that saddens me enormously" - Sue Parker, Practice Nurse, West Midlands