work related blog - no quake this time...
This may not be of much interest to many of the (thousands of) regular readers I get, but this is my blog so tough pants. Some of you may know that when not being a quake modder and parent I'm a qualified nurse working with people with learning disabilities. If you didn't, you will after reading the following. Questions and disucssions welcome from similar professionals or whoever.
Learning Disabilities Nursing
What’s it all about then?
For those working in this field, and yes I’m unilaterally taking it upon myself to speak for absolutely every LD nurse, it was always felt that our sphere of nursing was somewhat 3rd best in the pecking order. A kind of, until recently at least, Liberal Democrats to General and Mental Health’s Labour and Conservatives.
But then it got worse.
Increasingly that feeling has developed and been exacerbated, to the point where if not, our whole existence being threatened, at least questioned and forced into re-evaluation.
It seems that regularly we need to create a new identity for ourselves, almost Madonna like – our function, raison d’etre and image needs updating. From the pulling away, rightly, from medical models of care to the decidedly hands off function that appears to be heading our way.
Locally, and no I’ll not say where “locally” is, there are 2 residential LD services within the town’s PCT. (Admittedly there are 3 other residential services but they are run by a neighbouring county’s LDS) These services are both Short Term Breaks (nee respite) one for children, and the other, unsurprisingly, for adults. Except the future’s not looking great for either; “not great” as in their continued presence within the local PCT’s learning disabilities service. The children’s service has two options; either moving to Children’s Services and being managed by Health Visitor’s / School Nurse management tree, or being becoming a joint team with Social Services. The adult service is undoubtedly moving to a joint team scenario.
Now, I have absolutely no problem with joint teams. I don’t for one moment think that LD nurses are the only professionals able to work with people with learning disabilities, and I admire and respect the work that Social Care does. What I do worry about are the consequences for my profession; we are an expensive commodity, with, in many people’s eyes, an unnecessary, or at best, confused function. How many of us have heard people say, “so what do you do that a social worker can’t?” or “why do you need to be ‘qualified’ to do that?” In our shy and immodest way, and coupled with a desire not to denigrate another professional, we fail dramatically in “bigging” (as I believe the phrase goes) “ourselves up”
And sometimes we’re our own worse enemies, I spend a good amount of my time training support staff to give rescue medication for epilepsy, supporting them through their NVQ 3, helping them through a Safe Handling of Medications course.
But to what end?
Now I have no problems with support (“unqualified”) staff developing a greater range of skills, having more responsibilities, taking on additional tasks and from there moving onto better pay and a more interesting job, the worries, again, are about the consequences to my profession.
If unqualified staff on a Band 3, with an NVQ 3 and all the correct training and certificates can give out daily medication, rescue medication and lead a shift, what right-minded, budget-conscious senior manager or service planner is going to employ a band 5 or 6 (yes locally qualified, residential LD nurses have been given 6’s) nurse? Or at best, in sufficient numbers?
The direction, the road and the destination is clear; LD nursing as a profession is being funnelled into a two tight, narrow roles; Managers and Community Nurses. Now (notice the trend here?) I have no problem with either, indeed I was a Manager, and am a Deputy Manager, and hope, after a few life changes, to be a Community Nurse, they are fine admirable and rewarding jobs, who serve a valued (well in the case of Community Nurse anyway) function. But (and yes the other trend) the problems lie with the consequences for my profession. Less and less jobs will subsequently exist, the “team leader”, “Band 5”, “qualified nurse” hands-on residential role will face extinction, or at least become an endangered species; a rarity only spotted by the fortunate few or kept only in captivity (okay maybe I’m taking this analogy a little too far.)
Which has an additional problem. Without experiences gained, skills learnt, techniques mastered, understandings made and personal development …...”developed”, where are the Managers and Community Nurses going to come from. The days are gone, or so I understand it, that a bright, young, promising newly-qualified nurse can make the transition from student to CN, Where are they going to grow and develop as a skilled practitioner, ready to be sent out into the community to advise, guide and support families and individuals?
Without years spent leading shifts, managing mini-crisis’s, making increasingly important and difficult decisions and learning how to not be contactable in two places at once, how are the qualified nurses of tomorrow going to develop into the managers of the day after tomorrow?
And, (yes I like sentences beginning with “and”, and yes, it is grammatically allowable) not everyone wants to be a Manager or a Community Nurse. Many nurses just like being a qualified nurse, with the responsibility that currently goes with it, working hands-on with people and being part of a team.
But the options for that are running out, and none of the current service trends are doing anything but increase their demise. The consequences for the qualified LD nurse are there to be seen; as an expensive, non-pigeon-holed, jack of all trades worker with under-appreciated skills it is hard to see a scenario where we’re first choice for under-pressure service planners and budget holders looking to staff a service in the most cost-effective way.
But it gets worse.
There’s what could be seen as a more serious consequence to all this. The effect on client care and the quality and flexibility of services. Now without wanting to denigrate other professions, or to be seen as being immodest, it’s time to “big us up” a little, we’re pretty much the only professionals who are trained to work with the whole range of needs people with learning disabilities have.
Efforts to reduce qualified nurse 24hr cover have led to reductions in services for those clients with either behavioural needs that challenge, or complex health needs.
Now some will say, parents and carers are meeting those needs every day in their own home, with a great deal of success, and they would be right. So why can’t anyone be trained to meet those needs? But there is a significant difference between learning what you need to do to meet your son or daughter’s needs, and learning and being able to work effectively and professionally with not just one particular child’s needs, but with a whole range of similar, not so similar and completely different set of needs.
So what’s the solution? What needs to be done to not only maintain good quality, nurse led and nurse staffed services but also safeguard and protect LD nurses as respected practitioners working in varied of roles, in plentiful and appropriate numbers?
Firstly, and in my honest and (well not very actually) humble opinion, we need to define our role, not just in what we do, but for whom we do it. We need to define the needs for which we are the best professionals to work with. There’s been much talk, not formally and informally, about what constitutes “health needs.” Using one tool, clients with the extremes of challenging behaviour fall into our remit, but no one else. Using another, clients with complex health needs would be the lucky service users. Using yet another it would be no one, and we would “merely” (I use quotation marks, as I don’t wish to downgrade the role) be advisors.
But I humbly believe we know best our client group, and it is not as rigid as the aforementioned categories, nor as closed as the third. Our client group, if it can be limited by such a term, is broad, yet specialised, and representative of the range of additional needs people with learning disabilities have. To see it, I look no further than the local Children’s Short Term Break Service, what could be considered to demonstrate the future range of needs adult services must be designed to meet. In a brief and simplified nutshell:
· Multiply-profoundly disabled people with complex health needs
· People with severe autism
· People with complex epilepsy
· People with challenging behaviour associated or coupled with physical/health needs e.g. epilepsy, sensory needs etc.
And combinations of any, or all, of the above. (There’s that “and” again)
Those people form our client group, and we are the best professionals to work with them. Which brings me nicely to my next point.
Secondly, we need to explain, in assertive, plain and meaningful (to other professionals and service planners) ways, why we are the most suitable, able and skilled professionals to work with them. Which I will now attempt to do.
Nurses bring with them a 3-year LD specific training course, which instructs us specifically in meeting those needs, not just as individual workers but as leaders of teams.
Nurses have both the psychological skills and experience but also the Nursing skills needed to work with the whole range of needs found in the increasingly complex conditions people with learning disabilities have.
Nurses are the only comparable group of professionals to have the background knowledge and skills to not only quickly develop the expertise needed to work with an individual complex clients, but also the background knowledge to apply to developmental work and progressive and positive approaches.
But we know all that, don’t we? However, and to quote a word I dislike (but hey, I’m in management so I should use it more anyway) we need to be proactive in forging the way forward and defining not only our role but more importantly our future as a profession.
Us just knowing all this is useless, if those in control of budgets, those making the decisions about service planning and provision and those other professionals, members of the public and even the media, who wonder what we do, why we’re here and what we’re good for, don’t know and don’t realise the benefit we can bring to a service and the users of it, then it’s all pretty useless ain’t it?
I’m at crossroads career-wise. Management isn’t really that inspiring, Community Nursing may beckon, but it’s not the Golden Fleece for me it once was. What I really would like to do, especially when (if) my degree is completed, is to get a position where I can either be making service policy and planning decisions, or at the very least influencing them. If so, and with a little luck, I’ll be job creating for LD nurses. Because I think we’re great, and I think we’re “cost-effective”.
And, more importantly, so should everyone else.