Modernising nursing careers in diabetes – when and how?

In last month’s editorial I discussed the need for DSNs to step up to the mark and prove their worth. By talking to colleagues around the UK, it has become apparent that DSN posts have been affected in the current climate of cuts within the NHS, and the number of DSN posts in Leicestershire, Birmingham and Northumbria have recently been reduced. This situation is likely to occur throughout the UK, despite the continuing rise in the incidence of diabetes.

Back in 2008, the Department of Health (DH) published A High Quality Workforce: NHS Next Stage Review. This document outlined how the DH was investing in education for all healthcare professionals to the tune of £100 million per year to tackle skills gaps. This funding was supposed to be managed by the Strategic Health Authorities in collaboration with the Learning and Skills Council.

The document stated that “Nurses play a vital role in the NHS: they will always be at the heart of shaping patient experience and delivering care. Our ambition is to ensure that the NHS delivers high-quality care in all aspects – an ambition that is impossible to achieve without high-quality nursing. Our aspiration, therefore, is for the quality of nursing care in England to be recognised as excellent, to continue to attract highly motivated and talented individuals and to support nurses in leadership roles at all levels in the NHS” (DH, 2008). Unfortunately, the sentiment was there but the commitment now seems lacking as the cuts are currently hitting hard within diabetes nursing.

Whenever I attend a study day or conference it is increasingly common to find that nurses are there in their own time, unable to get study leave from their employer regardless of whether it is a GP practice, a primary care trust or a hospital trust.

The NHS Knowledge and Skills Framework was introduced in 2004 to support the effective learning and development of individuals and teams – with all members of staff being supported to learn throughout their careers to develop in a variety of ways, and being given the resources to do so (DH, 2004).

But how can we expect to maintain our skills and knowledge, and provide high-quality care in our working environment, if we are not given the opportunity to expand our clinical skills and knowledge? What has happened to the portion of the £100 million that was allocated for education in nursing in A High Quality Workforce: NHS Next Stage Review (DH, 2008)? There are many such documents floating around the NHS that set out to improve patient care but sadly fall short because they are shrouded in so much bureaucracy.

Modernising Nursing Careers: Setting the Direction (DH, 2006) aimed to align nursing careers with the national NHS Career Framework and develop new career paths for nurses. The NHS Career Framework is depicted as a “wheel”, with concentric circles aligned around a focal point (NHS, 2010). The wheel is divided into five segments – mental health and psychosocial care; family and public health; supporting long-term conditions; acute and critical care; and first contact, access and urgent care. Each segment has four subsections of research, education, management and clinical. The wheel maps out different career pathways within a given area of nursing that can be used to plot career progression from registered nurse in the outer circle to professor or university dean, for example, in the inner circle. The framework focuses on education and achievement, from diploma/degree level through to doctorates, moving from Level 5 (practitioner) all the way up to Level 9 (senior leader).

The next project to be undertaken by TREND-UK (Training, Research and Education for Nurses in Diabetes – UK) is to work in collaboration with educationalists to plot the courses, both academic and practical, which will underpin the different levels within An Integrated Career and Competency Framework (TREND-UK, 2010). This will, we hope, make a more cohesive and easy-to-follow pathway for any nurse working in diabetes care to progress their career. Watch this space!