As part of my studies, I recently read an article that discussed the public image of nursing and the perceptions people have about what a nurse's job involves (ten Hoeve et al, 2014). This public perception often does not reflect the professionalism, skill and autonomy of the profession. Nurses' skills and attributes are set to increase with the latest standards for nurses published by the Nursing and Midwifery Council (NMC) (2018).
Annexe B of the standards sets out the procedures in which nurses must be competent. Examples include chest auscultation, cannulation and electrocardiogram tracing (NMC, 2018). A few years ago, many of these procedures would have been undertaken only by advanced nurse practitioners, specialist nurses and critical care nurses and, before then, they would have been the sole province of doctors.
The NMC standards are for all nurses and are starting to be incorporated into pre-registration nursing programmes, which is great news for the profession and, hopefully, its public image, putting to rest the idea that nurses are doctors' handmaidens (ten Hoeve et al, 2014).
High-level nursing roles
Nurses carrying out procedures that require high levels of experience, competence and skill is not a new concept to the profession, however. In 2003, NHS Greater Glasgow and Clyde reported that nurses would soon be carrying out minor surgery in plastic surgery and dermatology (NHS Greater Glasgow and Clyde, 2005). In recent years, we have seen more nurses undertaking additional, specialist training to carry out advanced roles. Earlier this year, The Telegraph reported that, as part of the NHS People Plan, nurses would be able to undertake a 2-year course to enhance their skills, allowing them to carry out minor surgery and to assist in major surgery such as joint replacements and heart bypass operations, in the role of surgical care practitioners (SCPs). This role, according to NHS Health Careers (2020), would also involve running clinics, carrying out ward rounds and even providing training to trainee surgeons.
Another role that nurses can consider is that of the advanced critical care practitioner (ACCP). This role also requires high levels of skills, experience and competence. ACCPs make high-level clinical decisions regarding patients, to ensure effective, personal and timely care, according to the Faculty of Intensive Care Medicine (FICM) (2020). The FICM has highlighted some of the procedures carried out by ACCPs, including invasive procedures, comprehensive clinical assessments and working autonomously when patients are critically ill.
SCPs and ACCPs are two hospital-based roles that nurses might consider. However, another advanced role that has emerged is in pre-hospital medicine. A recent article described the role of the first pre-hospital emergency medicine consultant nurse in the country (Pearce, 2020). He was recognised professionally by the Faculty of Pre-Hospital Care, part of the Royal College of Surgeons of Edinburgh, who accredited him as a level 8 consultant in pre-hospital emergency medicine. He was the first nurse and the first non-medically qualified person to be given this accreditation (Pearce, 2020).
Pre-hospital emergency medicine nursing allows nurses to take care of patients before they are transported to a hospital, performing high-level emergency care to stabilise patients to ensure they can be transported to a hospital safely. Along with high-level skills and experience, this role requires autonomy and initiative, because these professionals often work alone without the support of the other professionals you would have in a hospital emergency department. There is also the environment to consider—the patient might be critically ill and trapped in a car after an accident, for example.
Planning my career
I considered nursing as a career from a young age. As a teenager, I was a voluntary first aider for the British Red Cross. I also undertook work experience in a veterinary surgery while at school. I think these two roles and my wish to care for others combined to make me think about nursing. I loved the excitement and satisfaction of administering first aid and the unpredictability of the cases presenting to the vets.
I have had a range of placements to date on my nursing programme, but I am definitely drawn to the acute and surgical roles, with my two favourite placements being interventional radiology and upper gastrointestinal surgical care, which was ward-based.
Nurses can follow an advanced career that will fall into one of four categories: leadership/management, education/academia, research, and clinical practice (Royal College of Nursing, 2018). I am planning a career path in clinical practice. I think my ideal role would be one of the three discussed earlier—an SCP, ACCP or pre-hospital consultant nurse. All three of these roles require high levels of skills, experience, competence, autonomy and respect. I would argue that all four pillars of practice are needed by all nurses, whatever their role.
Nursing in Scotland
Nursing in Scotland can be challenging. Scotland has significant geographical issues when it comes to healthcare and nursing. NHS Highland, for example, covers an area of 32 500 square kilometres and has a population of around 320 000 people (NHS Highland, 2020). Rural nursing has many challenges and pressures. For example, access to specialist services and even access to hospitals can be difficult in some areas. Resources can be stretched and rural healthcare and nursing can be isolating for staff and cause issues such as responsibility burden and reduced or limited access to continuous professional development (Deaville, 2003; Deaville and Jones, 2003). However, NHS Highland staff can offer a depth and breadth of clinical experience developed because of the geography of the area. Many have outstanding generalist skills because of the challenges they face.
Scotland, unfortunately, does not win any brownie points for staffing either. Nursing and midwifery vacancies rose to 4.5% in 2017–2018 (NHS National Services Scotland, 2018). Although nowhere near the number of vacancies in England, Scotland still has significant numbers of vacancies in nursing and midwifery. However, the Health and Care (Staffing) (Scotland) Bill, which became an Act in July 2019, aims to make sure there are correct levels of staffing for NHS Scotland and other care providers (Scottish Parliament, 2019).
Scotland has an ageing population and significant health inequalities. For example, Scotland's drug-induced death rate is well above the level of most (if not all) of the EU countries, and is increasing year on year (National Records of Scotland, 2019). It is imperative that we get the education and support of our nurses correct, offering them good working conditions, access to education and opportunities, as well as the respect and appreciation they deserve, so that they can provide the healthcare Scotland needs.