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Primary care nurses: you really matter

In an interview with Nursing in Practice, RCN President, Andrea Spyropoulos, shares some of her thoughts on the issues currently facing primary care nurses in the UK

What do you think about the current shortage of nurses in the UK? What should we be doing about it?
Where there is poor practice there are poor staffing levels - this was seen quite recently with the scandal at Mid Staffordshire NHS Trust. We should be investing in the simple things, such as preventing pressure ulcers, and the people we need to make that happen.

Staffing shortages are happening across the board and the RCN is keen to work closely with the regulator to bring back standardisation in terms of key skills. We also need good supervision in practice, and I think that is lacking in some areas; midwives have a very good system of supervision and I think this could also be adopted in general practice.

Do you think nurses should have a prominent role on GP consortia?
Common sense tells me nurses should have a role on consortia - they are the biggest provider of services and generate the most income. If you really want to change things, you start with the people who deliver the services. If you don't, you fail.

I think commissioning needs to be looked at in terms of a team approach. Many GPs are saying they don't have the skills to commission, but lots of nurses have worked in PCTs and have learned these skills. The big issue is having nurses at the top table, and I think that's an omission from the bill.

The RCN is always willing to help, and we hope, when the changes are rolled out, that there will be opportunities for nurses to be part of the commissioning process. We need to ensure that those taking responsibility for commissioning have the appropriate skills and that it is not used as a tool to dismantle the NHS.

I think GPs do a great job, and there will be some who are able to take on the task - but many are saying they don't want it, and it's outside their skill set. The current system is open to scrutiny, between the purchaser and the provider, and I don't know how this is going to happen. GPs are skilled but are they the right people to handle this sort of money? I haven't seen a model like this anywhere else outside the UK. Will it work? I don't know.
Accountability is a big issue for the NHS at the moment. What would you say to nurses who are
worried about being sued for making mistakes?
I taught law to nurses and accountability is a structure for good practice. We all make mistakes and some are minor and you learn from them, but others can be more serious. When I meet nurses, I don't hear them complain about salary. They say they are worried about standards of practice and they feel they don't have the facilities to look after the number of patients they see.

The easiest test of whether you are doing something right or wrong is to imagine you have someone sitting on your shoulder. If you don't want them to see what you are doing, perhaps you shouldn't be doing it.

Accountability can be scary if you don't understand the issues surrounding the law and that it is about legal principles rather than what's happening in practice. We need to give people the tools to continue to work but to feel able to challenge low staffing levels.

Do you think there has been a rise in the number of complaints made against nurses?
The media has a lot to answer for, with big headlines about scandals. I want to see the good in all of us come to the fore and not allow poor practice. You should feel competent and confident to challenge someone if you feel they aren't performing.
I would like to remind nurses of all the good they do and that what they do really matters. Every day matters to patients and it's a great feeling to be part of that.

Your comments (terms and conditions apply):

"The shortage of nurses is the fault of nurses - I mean those that have management posts. Nursing is a profession and individuals are trained before you can be called a nurse or a professional. A nurse after training and qualified should be able to work independently without any form of supervision and should be able to work with his/her initiative. My comment about this shortages is that the interview panels are not based
their shortlisting of staffs on the bases of experience, knowledge, education and skills again. They always look for staff that will teach and supervise because they want to show superiority to a colleague. This is a very common idea among some of the UK nurses. This is not a good method of solving the problem of staff shortages. Interviews should be conducted based on the knowledge, skills, education and experience of the candidate and individual should be able to give opportunity to demonstrate their skills and knowledge and accountable for
their action, doctors and teachers after graduation, they work on their competency and you will never see another Senior Doctor or colleague claiming superiority on each other. I think Nurses should also try to use this system as professionals either at Secondary or Primary Level. Administrative staff  should be responsible for all issues relating to appraisal, annual leave, sickness and absence in either PCT or in hospitals.
Nurses should erase the idea of thinking one is superior than others and let us treat ourselves like professionals as all Nurses are trained are qualified either as an Health visitors or practice nurses, or public health practitioners, The name for all qualified nursing personnel is NURSE. Unnecessary complain about nurses to cause problem should stop. If complain come fro an outsider about a nurse of making a very serious
mistake, proper investigation should be carried out before making a decision of dismissing a staff. Decision should be based on truth and honesty as issue of unwarranted dismissal of nurses has also contributed to shortage of staff.
Colleagues or managers should stop putting their colleagues into problem because of hatred or jealously. This has never happen in other profession like medicine, pharmacy or even teaching, I think this is due to the fact that females are more in nursing profession and most of the nurses are not degree holder. Nurse can be in any position and work in any department so far the eligible and correct candidate is given the chance to work in the area. We have many nurses that are well skilled,educated and can work competently in any commissioning role. Nurses at all level should try to respect each other and our profession this is the only way that can help nursing profession to move to the next level with other professions" - Maryam Omitogun, Surrey

"Our PCT are using the same practice nurse on the black country consortium, not allowing other nurse applicants for positions to use their skills and develop their role, when these nurses have more clinical knowledge and experience to offer" - Jacqui Harper, Sandwell

"Sadly we now live in a society that encourages complaints. That's not to say that poor practice should not be addressed. Rather that we have to constantly be vigilant, to the point that trying to protect yourself and the patient may stop you doing something that should be done. I worry that with the cuts in primary care budgets that training will suffer. I also worry about the amount of 'specialist nurses' who do not communicate effectively with practice nurses and other disciplines. I co-manage a large integrated nursing team which includes practice nurses, district nurses and health visitors. We are employed by the organisation directly and we are all feeling the cuts. I am very concerned that staff will not
access appropriate training. Accountability is crucial and I agree scary at times. Standards are falling in some areas as is the want to care" - Mara Golden, London