RCN Foundation: Investigating Learning Disability Nurses’ Perceptions of Registration with the Nursing Midwifery Council -

and wider Impact on RNLD Nursing Students
and People living with an Intellectual Disability

From twitter: Dr Lorraine Henshaw RN PD. https://x.com/lor_henshaw

'Are you a Learning Disability Nurse who is no longer registered with the NMC? Would you be happy to discuss your experiences with us for our important research into the RNLD role. See contact details below for further info. Please also share with your networks !' 

'This study ‘Investigating Learning Disability Nurses’ Perceptions of Registration with the Nursing Midwifery Council and wider Impact on RNLD Nursing Students and People living with an Intellectual Disability’ Study Aim and Objectives 1.To investigate RNLD perceptions of registration with the NMC and their thoughts about the impact on RN:D nurses on people living with an intellectual disability and thoughts regarding the future of RNLD nurses a)Obj 1- to ascertain where LD nurses are working and in what capacity/role. b)Obj 2- To explore the impact of this work on their identity as a RNLD 2.To investigate student RNLD nurses’ experiences of practice placements and perception of the role of RNLD nurses a)Obj- to understand the impact of the reduction of RNLD registered nurses (with the NMC) on the future workforce 3.To examine the impact that RNLDs have on people living with an intellectual disability and their families/carers. a)Obj- To explore the perceptions of service users and carers of the value of the RNLD.'

Site: https://salford-repository.worktribe.com/project/3385884/rcn-foundation-investigating-learning-disability-nurses-perceptions-of-registration-with-the-nursing-midwifery-council-and-wider-impact-on-rnld-nursing-students-and-people-living-with-an-intellectual-disability

RCN Congress 2025 Liverpool i

... the twists and folds of debates

Repeating myself (again) but worthwhile I think(?), the past week brought my second RCN Congress. If you are new student nurse, international (Std) nurse, or nursing support worker and not engaged with a professional body, or union; do try to get involved. Don't leave it as long as I have (I joined a union as a nursing assistant). By way of a small excuse, listening this week it seems I am not the only one to leave it 'late'. Based in Liverpool (again after 2019) means there's a torrent of potential content. So where am I/We? By their nature all the debates are worthy. I have picked a few:

Discussion - Celebrating a nursing career

You can read above the main focus for the discussion. For me it prompted the following (no doubt - familiar)  reflections ...

The number of potential careers in health and social care is amazing:

350 careers. One NHS.

Your future.

Not only what the NHS (for training, education) can 'offer', but within that the number of nursing roles and specialities. The discussion inevitably drew the 'longevity' card. Students do pick on the temperature of their chosen community of practice. They recognise when they are surrounded (not literally!) by colleagues who have careers numbered in the several decades. But like a card the side that presents the occupational safe harbour from the threat posed by artificial intelligence, is countered by the seemingly relentless pressures imposed on nursing staff. The debates also revealed the pressure and negative impact of 'lived' work experiences for students and newly qualified nurses. I remember in the late 1970s early 1980s student nurses being counted as 'staff'. Have we really not progressed? I wrote 'offer' above because many students cannot get jobs once they have qualified. Not the best start to a shiny career. Having to fold, as they qualify.

Speaking of "career", can we please twist that? There is a great deal of talk - soul searching - about how on earth the (so-called) health service truly transforms itself to be health promoting and preventive. In the NHS's history perhaps there was a window of opportunity to begin in the late 1960s. Not so much a 'moonshot' as a healthshot. Now with the demographics that potential is being lost, unless this is positive way that AI can make up the shortfall? Alternately, nursing can utilise the health career, as in Hodges' model which are invariably impacted by an individual's life chances. As such there may be signs and signatures in the person's familial background? We can imagine a timeline composed of Hodges' model as 2x2 frames through a person's life, even prior to their conception and their legacy. 

More to follow . . .

Previously: 'RCN' : 'nursing' : 'power'

Please pardon the 'gambling' analogies, but we are literally asking students to gamble with their careers, financial status and well-being (life chances - no less). Should they be lost to the service, you can't blame young people. They know the logic of care, also known as demographics. They can do the maths? So who is it who can't do basic arithmetic?

'International Nurse's Day' 2025 #2 - c/o ICN & WHO

State of the World’s Nursing Report 2025

State of the World’s Nursing

Report 2025

'As the world’s nurses celebrate International Nurses Day (IND), ICN issues a rallying cry to governments around the globe for urgent nursing support, following the launch of the second World Health Organization (WHO) State of the World’s Nursing (SOWN) report.

The SOWN report is a vital assessment of the global nursing workforce in the aftermath of the COVID-19 pandemic and underscores the urgent need for bold investments in nursing to address shortages, strengthen health systems, and promote global resilience and economic stability.

The SOWN report reflects ICN’s IND 2025 report, Caring for nurses strengthens economies, and related Survey of National Nurses' Association (NNA) Presidents, reinforcing the central role of nurses in achieving global health, including Universal Health Coverage (UHC), and calling for immediate action to address long-standing challenges. The SOWN data presents a mixed picture. It highlights progress in areas such as advanced practice and nursing leadership, but indicates gravely concerning continued workforce shortages, inadequate compensation and working conditions, poor mental health support, inequities in the distribution and employment of nurses, and failures to fully enable nurses as practitioners and health care leaders.'

Continued ...

Caring for nurses strengthens economies

Caring for nurses
strengthens economies

'As we face growing health care challenges, from ageing populations and rising chronic diseases to climate-related emergencies and deepening global inequalities, the need for a strong, sustainable nursing workforce has never been greater. We cannot meet these challenges without sufficient nurses who are themselves well-cared for and supported. ICN’s International Nurses Day report reveals the severity of our current nursing shortage and well-being crisis – and the path forward. ICN’s “Caring for Nurses Agenda” provides a comprehensive roadmap for creating environments where nurses, patients, and entire health care systems can flourish.'

Source: ICN

'International Nurse's Day' 2025 - c/o The RCN

'Today is International Nurses’ Day – a day to highlight and celebrate the incredible skill, dedication and impact of nursing.

Nursing staff like you bring so much to those you care for each day. You are there for people during their best and worst moments. You change lives every day, despite our profession facing considerable challenges.

Nursing is highly skilled and rooted in excellence. That’s why patients place their trust in you when they’re at their most vulnerable.

We see the resilience and strength it takes to do this complex, safety-critical work. So today – and every day – we say thank you.'

Text c/o The RCN and video:

Also with RCN Congress starting today ...

Call for Participation in NHS Survey

ARE YOU WORKING IN THE NHS? IF SO, HELP NEEDED URGENTLY! Please read this email. 

Glasgow Caledonian University is inviting NHS Staff across the UK to participate in this doctoral research survey to analyse the impact of responsible leadership on improving well-being and organisational trust among NHS Staff members. 

 

To be eligible, you must be an NHS staff member from any area of the UK in any job role. The survey collects no recognisable information and is wholly anonymised to protect participant privacy and confidentiality. It has received full ethical approval, will take around 10 minutes and will help provide an improved understanding of the area of well-being in the profession.

 

Please forward this survey link to everyone in your contacts working for NHS. This will help gain more responses, increasing the study's reach and validity. Your help is highly appreciated, and we thank you in advance.

 

Here's the link for the participant information sheet and survey: 

https://app.onlinesurveys.jisc.ac.uk/s/caledonian/impact-of-responsible-leadership-on-employee-well-being-and-org

Warm wishes
Umm E Habiba Tariq (Chief Investigator)

 

Umm E Habiba Tariq (she/her) | PhD Candidate, MSc, BBA (Hons)

Occasional Lecturer | Department of HRM | Glasgow School for Business and Society (GSBS)

Glasgow Caledonian University is a registered Scottish charity, number SC021474

My source: Nurse-Philosophy List.

Call for participation in a Doctoral Research Study

ARE YOU WORKING IN THE NHS? IF SO, HELP NEEDED URGENTLY! 

Please read this email. 

Glasgow Caledonian University is inviting NHS Staff across the UK to participate in this doctoral research survey to analyse the impact of responsible leadership on improving well-being and organisational trust among NHS Staff members. 

 

To be eligible, you must be an NHS staff member from any area of the UK in any job role. The survey collects no recognisable information and is wholly anonymised to protect participant privacy and confidentiality. It has received full ethical approval, will take around 10 minutes and will help provide an improved understanding of the area of well-being in the profession.

 

Please forward this survey link to everyone in your contacts working for NHS. This will help gain more responses, increasing the study's reach and validity. Your help is highly appreciated, and we thank you in advance.

 

Here's the link for the participant information sheet and survey: 

https://app.onlinesurveys.jisc.ac.uk/s/caledonian/impact-of-responsible-leadership-on-employee-well-being-and-org

Warm wishes

Ummey Tariq (Chief Investigator)

 

Umm E Habiba Tariq (she/her) | PhD Candidate, MSc, BBA (Hons)

Occasional Lecturer | Department of HRM | Glasgow School for Business and Society (GSBS)

Glasgow Caledonian University is a registered Scottish charity, number SC021474

---

My source: NURSE-PHILOSOPHY list
https://www.jiscmail.ac.uk/cgi-bin/webadmin?A0=NURSE-PHILOSOPHY

"Enough (long since ...) already!" - #FairPayForNursing

 

 INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

	'enough' "as much as is necessary; in the amount or to the degree needed: as much as or more than is wanted:"
	enough is ENOUGH

enough is enough

"something you say when you want something to stop:

Enough is enough - I don't want to argue with you any more."

 

https://dictionary.cambridge.org/dictionary/english/enough

 

Image: c/o RCN - https://twitter.com/theRCN/status/1321438463162540033

 

The paradox of Service Vs Person-Centred Care

Looking at Hodges' model and its basic structure of axes and care (knowledge) domains, I wrote a note to the effect that:

- the INTERPERSONAL (INTRA-) and SCIENCES domains are fundamental to individual care. 

This follows, of course, from the vertical axis.

Then I added, that the SOCIOLOGICAL and POLITICAL domains are fundamental to person-centred care.

 

Person-centredness is vested, is realised in and by the care domains that involve concepts mediated and related by the group, the collective.

 

There seems a (strong?) recognition of social justice and justice at work.

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

individualised	individualised
person-centred	person-centred

Perhaps this is the implicit origin of the call to new learners and professionals alike to 'Make a Difference', 'Be the Difference'?

Then I thought of the perennial duality of service-centred and person-centred care.

 

Accepting the idealised nature of these thoughts, when 'presented' with a case, health services - through their practitioners, focus on the individual. The individual may express personal choices, hopes, but the extent to which these garner a response, are acted upon, also depends on the SOCIOLOGICAL and POLITICAL domains. 

In terms of the ideals (that apply, and what I will call upon) there are two extremes - I have mentioned previously, consider:

In the triage situation, apart from establishing consciousness - communication and interpersonal are collapsed into seconds, and response to stimuli / pain, communication is not key. Task orientation, practice, procedure, events, rehearsal, stock and equipment checks are to the fore.

 

Alternately, there is the level of interpersonal skills that are exercised to communication with the patient, to learn of, recognise, and respond to their personal choices.

 

All of a sudden things seem to be reversed.

 

Short of being plain wrong (?) -

THIS seems powerful, essential and required medicine for the 21st century.

service	SERVICE
person	PERSON

It is even more nuanced, however, and I'm not trying to clever (mathematics and logic are definitely not my subject), but making the above easier to describe:

s	S
p	P

Above, I'm trying to suggest and represent:

1. A lack of regard and relative neglect of the humanistic domains [ s AND p ];
2. This is then reflected in the ongoing issues of parity of esteem for mental health, illness and psychological interventions [ s OR S ].

In #1, we can add the UK decade long, debacle of funding for social care and the status and recognition of the workforce; the legacy (lessons) of medical sociology and the potential of attention to the social determinants of health and the sustainable development goals (paper to follow mapping the SDGs to h2cm).

The [ S AND P] in the SCIENCES and POLITICAL domains - might (also) be indicative of the continuously espoused benefits of technology as part of health care delivery. While accessibility and improvements in this are emphasized, often Politically people are isolated due to lack of technology, or funds. There remains a SOCIO-technical divide.

The years to follow, will no doubt see the microscope from the SCIENCES placed in the humanistic domains and technology's impact - benefits examined there. Who knows: maybe a new instrument, simultaneously (transdisciplinary) qualified will be found?

Conclusion that might be drawn:

The bio-psycho-social model is insufficient for person-centred care (having an opportunity, then yes - I would say this).

The overall aim and objective of Hodges' model when applied, is not to tick boxes but to diffuse the disciplinary boundaries, to assure, and integrate.

More to follow... (a paradox?)

'Pad culture' ...

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

DEMENTIA SELF ORIENTATION - INSIGHT Listened to .. 'Hear me'? dignity and respect Mental capacity (awareness?) emotional distress Appears confused - Physical cause: dehydration, delirium..? [A shared convenience?: How many persons are assumed to be diagnosed with a dementia?]	in-CONTINENCE Place: [Home, Community Hospital, Residential care, Nursing Home] IT/Record systems 'Parity of Esteem' i Mental Health and Physical health 'Parity of Esteem' ii [Mental Health and Physical Health] AND Social Care Time: ASSESSMENT, Care Plan, Evaluation ...
'Pad Culture'	'My Pad' Culture - buy/sell £££ $$$ Standards of Care Nursing - Social Care policy - funding

File on 4 BBC Radio 4 21 June 2022 - 20:00hrs

Dementia: The Final Indignity

"Around 800,000 people have dementia in the UK. For those suffering from the illness, incontinence can often be seen an inevitable consequence - but that’s not always the case. Deemed as too embarrassing or taboo, it’s a topic that rarely hits the spotlight. Experts say preserving someone’s ability to go to the toilet is crucial to maintaining their dignity and quality of life and should be a priority in care settings. But is that always happening? A new report shown exclusively to File on 4 has looked at how continence care is being managed in hospitals – and how, in some cases, those who are continent are actively encouraged to soil themselves. Datshiane Navanayagam speaks to families who say their loved ones were ignored when it came to their continence needs in hospital and that the consequences have left them with health issues and requiring additional support. Nurses and medical staff say that continence training is often seen as a ‘Cinderella subject’. We also hear from dementia patients themselves about why maintaining your own dignity and independence is so crucial with this disease. With the government set to reveal a new dementia strategy this year, will continence care be placed higher up the agenda?"

Featherstone K, Northcott A, Boddington P, Edwards D, Vougioukalou S, Bale S, et al.
Understanding approaches to continence care for people living with dementia in acute hospital settings: an ethnographic study. Health Soc Care Deliv Res 2022;10(14). https://doi.org/10.3310/
QUVV2680

 
Source: Today BBC Radio 4, 21st June, 2022.

Oncology nursing in the Global South during COVID-19

A new special issue published in ecancer includes narratives from oncology nurses across the world describing the psychosocial effects of the COVID-19 pandemic on their family and work lives.

Oncology nurses and their patients face a double burden in Lower and Middle Income Countries (LMICs), where resources are limited under normal circumstances and now must accommodate pandemic-related challenges.  The special issue includes personal reports and narratives describing the the early psychosocial effects of the pandemic, for example lockdowns and increased staff shortages due to diversion to COVID-19 wards or vulnerable nurses with chronic conditions or pregnancy staying at home while some became infected with COVID-19 and died.

The significance of the oncology nurse’s contribution to the care of people with cancer is more relevant than ever before due to their role as the cornerstone of health services, either on the frontline offering compassionate care or in leadership, research and education.

The special issue is open access and can be read here:

https://ecancer.org/en/journal/special-issue/30-oncology-nursing-in-the-global-south-during-covid-19

Katie Foxall
Head of Publishing

+44(0) 117 942 085213 King Square Avenue, Bristol, BS2 8HU

HIFA profile: Katie Foxall is Head of Publishing at eCancer, Bristol, UK. katie AT ecancer.org

My source: HIFA

Gatekeeping: Across the care domains

individual
|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

Cognitive gate (access): Mental state: Risk to Self/Others? Literacy: My articulation of my needs Understanding of Consultation/plan Service name: acronyms My understanding hence awareness of services, referral Opt-in Self-neglect	Physical gate (access): Physical state 'emergency'? Telephone call, reception Obtain appointment Phone/Video, Face-to-Face Surgery, Clinic, Hospital, Home Letter: 'x' days? [ Triage Assessment, Planning Intervention Evaluation ] Individual: Collective: WAIT data?
Social-Cultural gate: Cultural diversity/Accessibility Service - Semiotics/Semantics/Signage Family/Social commitments (access) Sociology of Illness/Sick role Carer role Community/Local Understanding & Involvement? Reporting, Info sharing	Political gate: Service Provision/Use [by postcode?] Referrer's knowledge ... "Policy says..." ... URGENT, routine, 1,5 days... Service Pathways/Signage/Appearances Work commitments (access) Previously known? [ MAIN GATE: Therapeutic Modality? ]

 

Open to suggestions... 

What's in a Name?

  Or, The First Rule of First Aid* ... #SafeStaffing

Health care is often described as complex ...

there are tools to help simplify, conjoin 

and help care navigation and learning ...

Despite this and even if people are listening

politics, politicians and policy makers seem determined to turn health care into a maze ...

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

HUMANISTIC -------------------------------------------------- MECHANISTIC

SOCIOLOGY : POLITICAL

|

GROUP

*Protect yourself first.	"WAITING ROOM" "WAIT HERE"

RCN Safe Staffing Campaign:
https://www.rcn.org.uk/employment-and-pay/safe-staffing

patient safety learning hub:
https://www.pslhub.org/

'Named Nurse' 25 years ago.
Mitchell G, Strain J. The role of the named nurse in long-term settings. Nurs Older People. 2015 Apr;27(3):26-9. doi: 10.7748/nop.27.3.26.e679. Review. PubMed PMID: 25809049.

My source (and image):
https://twitter.com/helenh49/status/1210956380636663813

Q. "How can Technology Save the NHS?"

A. It can't - on its own.

Image: Sept 18 2018 The Times Tech Summit Supplement
https://the-dots.com/projects/google-cloud-tech-summit-cover-249662

"On 20th October 2008 50 members of the UK Faculty of Health Informatics attended a master class entitled: "10% Technology 90% Business change - Maximising the added value of new technology for the NHS."




"At the event itself, and afterwards using a post-event wiki, members tried to address the question of: What should be done to make, what is often called a "sociotechnical" or "user-centred" approach to the delivery of technology projects the norm in Health and Social Care?"



Ref.UK Faculty of Health Informatics.(2008) 10% technology, 90% business change; maximising the added value of new technologies for the NHS. Discussion Paper, NHS, London.

A. Anyway, if by 'save' you really mean 'save' then pay and support the necessary staff first then consider the 'technology': socio-technically.

'Muchness' - Enabling nurses to be more person-centred within their workplace culture: participatory research

Are you a nurse interested in staff well-being? Would you like to be involved in a participatory research study, exploring the idea of 'muchness' (subjective experience of well-being) & how it can be nurtured in the workplace. If so, please visit: https://t.co/XXQjnT8HlI pic.twitter.com/rF7Y9NgcTS

— Kate Sanders (@Kateatfons) April 18, 2019

Nursing's Golden Ratio: Safe-Staffing:Law

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - POPULATION

Care Philosophy: Task orientation Vs Person-centred (Reality: Hybrid that assures person-centredness?) Individual Patient's, Friend's and Family impression Individual Patient's, Friend's and Family experience (AND memory) Confidence in Care (Confidence as a Learning Environment)  Individual Nurse's Values Individual Patient Outcomes PURPOSES	Numbers - count "40,000 missing Nursing" [RCN] Ratios: x :: y Staffing Research (Falls, Quality...) Operational Research; Measures Dependency; Chronicity; Nursing hours / day; Skill-mix; Care undone Productive Nursing Care Demographics: Local, National, Int. TIME: tasks, events, priorities, shifts The E's: Efficiency, Effectiveness, Equity, Equality  PROCESS
Qualitative Duty of Care Public awareness / sensibilities History of Research into Staffing (Time and Motion studies) Direct Nursing Care High Quality Nursing Care = The Golden Ratio PRACTICE	Quantitative Recruitment, Retention, Attrition Workforce Planning Professional Accountability Commensurate: Policy - Law NMC Code of Conduct Contract of Employment Employment T&C Emigration Policy, Overseas Workers Professional Bodies inc RCN, Unions ... Nurse Administration Support Information System - Synergy?  POLICY

My prompt with thanks: https://twitter.com/DannGooding/status/1110929934262898689


Additional sources [ c/o @DannGooding ]

A critical moment: NHS staffing trends, retention and attrition
Health Foundation, ISBN: 978-1-911615-25-5

RCN

American Nurses Association, Nurse Staffing Literature Review

Enough Nurses - Special Collection c/o Journal of Research in Nursing

"JRN is pleased to introduce this online special collection of papers. Edited by Jane Ball, this collection comprises previously published papers and reviews that give a taste of the constellation of issues that contribute to having 'enough nurses'. They illustrate the complexity and interdependency of the many elements that must be addressed to achieve the elusive goal of having the right staff, in the right place, at the right time."

My source: https://twitter.com/JRN_latest/status/985889478882578432

Frontline First campaign: cost-saving innovations whilst improving patient care

Dear Peter,

Innovations are the key to saving the NHS money. Every day, nursing staff on the frontline are finding new and better ways to deliver patient care.

As one nurse recently wrote to us:

"Without a working knowledge of clinical care provision how can ideas be practical and ensure quality of care is maintained? Nurses are in a prime position to look at care provision to identify better ways of working and therefore identify cost savings without sacrificing patient care and experience."

As part of our Frontline First campaign, the RCN is collecting examples of cost-saving innovations at NHS services across the UK. What nursing solutions have you seen in your workplace that could achieve savings without sacrificing patient care?

http://generalelection.rcn.org.uk/innovation

There are two ways the NHS can find billions of pounds in efficiencies:

discover innovative ways to save money
or
make cuts to staff and services

Every day, UK nurses are helping to devise and implement cost-effective solutions saving their employers money and helping to protect jobs. We've already heard from dozens of nursing staff who told us about innovations in their workplace, from changes to day-to-day practices to
whole new ways of working.

Please take a moment to report any cost-saving innovations you've seen at the workplace:

http://generalelection.rcn.org.uk/innovation

Thanks for speaking up and helping to protect patient care.

Yours sincerely,

Janet Davies
Director of Nursing and Service Delivery

My source:
Subject: Improving patient care
From: "Janet Davies, Royal College of Nursing"
Date: 04 August 2010 16:53:30

Editorial JRN. Coalition in leadership: Politics - the big picture and the big game

In the Journal of Research in Nursing, Veronica Bishop's editorial -

Coalition in leadership.
Politics - the big picture and the big game

- explores the state of the body politic in nursing. Bishop's focus is research, but the implications extend beyond the UK, to nursing globally. The body is indeed immersed in politics, but it seems the feet are dry and there is no one at home.


Considering that The Politics of Nursing by Jane Salvage was published c. 1991 political maturity is long overdue?

While the sexual politics of nursing have been campaigned for in the nursing media and vigilance is needed, it seems that a political birth for nursing needs to be induced. There is a political mentality there, there has to be. The future is too challenging, too fraught, too close to be mollified by appeals of "Anything for an easy life (and death)!."

Bishop begins with a quote:

The very essence of leadership is that you have to have a vision. It’s got to be a vision you articulate clearly and forcefully on every occasion. You can’t blow an uncertain trumpet.
Theodore Hesburgh (1917–(2015))

If you are familiar with Hodges' model then you know what is coming. ... In quantitative (and qualitative) terms 25% of our deliberations using Hodges' model can be POLITICAL. This is not just the political dimensions of the patient, carer and the health and social care enterprise. The model includes the practitioner, but back to Bishop:

Having ‘power’ is a concept that sits uncomfortably with many nurses – it does not fit with the ideal of caring and many clinical nurses are quite open in their lack of regard for those in management, seeing them as power-seekers rather than power-movers. Clearly nurse leaders have in many cases failed to take their clinical colleagues with them in the drive to put nursing where it belongs, at the decision-making point that drives the agenda for health services, a point borne out by Stanley (2009).

How ironic that 'comfort' itself has been the subject of concept analysis and theorising in the nursing literature. If student nurses are exposed to the POLITICAL from the outset of their careers, then surely at the very least they will be more comfortable dealing with the guises and disguises of power?

Bishop refers to leadership and ownership and the two are frequently conjoined. The question of politics in nursing - in thought, practice, management and policy (research!) - makes me wonder ownership of what?

If the political domain is so frequently a vacant lot as far as nurses are concerned, then perhaps when we do put in an appearance we are not taken seriously. It really is a case of: what are you doing here?! As Bishop points out through -

Nurses are scientific. When they want to get to the core of a problem they always try to drill down. Yet politics are about the big picture. Nurses are agriculturalists in that they grow and nurture things but politicians are hunters – they’re always after the big game. It’s these kinds of differences nurses need to start to understand. (Cumberlege, 2007).

Nurses are there in the POLITICAL domain: they are constantly trying to complete the big picture.

... we were considering the best way for her [Baroness Cumberlege] to approach an interview the following day, and eventually, after we had viewed the uppermost issue of the day from every angle she said ‘Oh, nursing is so big!’. How right she was – there is hardly any aspect of life that it does not overlap or impinge on, so considering the big picture is a mammoth task! And again, she was right, we need leaders who have clarity and energy, and can cut through the detail and focus on the professional entity.

Yes, the big 'P'-icture is a mammoth task, hence the need to uncover, compose and frame it early. POLITICS is not just a matter of whistle blowing, industrial relations, policy, the system, us-and-them, banner headlines. ...

Politics is much more and crucial to research as Bishop attests. So, if our students do not reflect upon and articulate the politics of health: ill-health, well-being, equality and inequality, wealth and poverty ... then that professional entity will be a political ghost. A ghost playing a little game in an alien and alienating domain.

Veronica Bishop (2010) Coalition in leadership. Politics - the big picture and the big game, Journal of Research in Nursing; 15; 291.
DOI: 10.1177/1744987110374692

RCN UK 2010 General Election 6 priorities - framed in Hodges' model

Previously [Please sign up: NURSING COUNTS ]

The RCN's 6 priorities hit the POLITICAL sweet-spot. In the table below I have related each of the priorities to a care domain of Hodges' model with a rationale that follows:

Give nurses time to train	Protect the Nation's health
Improve care for those with long term conditions	Standing up for staff who speak out Safer staffing levels Sustain health care investment

Timeout from the clinical arena for training is always a political issue. It is also at the behest of the individual. This includes individual practitioners and their managers.

The public's health (and mental health) is of course grounded in the group, but is initially framed by evidence, knowledge and preventive medicine.

Long term conditions may impact the quality of life of the individual concerned, but the effect on carers and the social ripples are also profound.

The Demand - Supply equation in health care may be reduced to raw, mechanical numbers, but they quickly become the political football of investment statistics.

So many false economies in stretching the more expensive resources when it comes to staff AND patient (carer) safety. Skill mix and staffing levels are vital for job satisfaction, service development, quality and safe outcomes.

Motivation and intent may be concepts exercised by individuals, but the political environment must support nurses who speak out for high standards of care, safety, the public good.

Elderly Care: "Follow me please" along the gangway

It goes with the job, seeing people in residential care and nursing homes. The past few weeks walking through several care facilities - corridor-lounge-corridor - you pass a series of open doors, an invite to gaze that way. (People do ask to have their doors left open and visitors should not be able to walk past open doors if privacy and dignity are at risk?) Walking along - a smile, nod of the head, wave of the hand it's like a gangway.

Recently, though it was a case of 1, 2, 3 and counting: residents sat in their rooms; chair, wheel chair, special chair bound.

A gallery of still-life studies. So many heads bowed, cast as life and world-weary statues. So many aged variations of The Thinker.

The homes and their staff do the best they can, some employ people dedicated to 'activities'. Despite this, it's not easy for many new carers to appreciate the value in engaging people who are disoriented for TI:ME, PLACE and PERSON in chit-chat or a group activity when five minutes later they have forgotten all about it. People are referred to mental health services because they have a mental health 'problem' and yet in many cases their bags are packed and they are ready to take you on a journey: if you care to listen.

We seem to focus on the cognitive value of the things we do, but is this a variation of task orientation that delivers a concrete output (PROCESS vs PURPOSE again)? What about the emotional value of the things we do and the possible benefits, whether visible or intangible? ALL work and the effort it requires carries a price and despite the forgetting, the emotional engagement and safe social contact can still make a real positive difference to people. The price paid by residents in being engaged in conversation, can reduce any sense of alienation, loneliness and the aggression and agitation that can follow.

What do I mean 'safe' social contact? Many people in care are disinhibited; they say things to their fellows and staff that are very personal and upsetting. Cognitive decline is a fact of life, but even for people diagnosed with dementia, the damage done varies from person to person. For many they are profoundly impaired and yet their personality flickers through and with it sensitivity to things said by their peers. Remember those anxious moments in the play ground? Social mores are deeply ingrained in us. Maybe this is why for youngsters the current spate of e-bullying is having such a impact. Bodies may be battered and worn, but INTRA - interPERSONAL and SOCIAL exercise mediated by carers (and relatives!) can pay longer term dividends.

In between care needs that also demand quiet, rest and sleep and our need to be realistic and objective; personal and group engagement can I'm sure make a real difference. It depends on the resources + the right attitudes to make it happen. To see the person not the statue.

Even if only for a few moments
bringing statues back to life is real magic.
Walking the gangway is one thing,
but residential care should not be the gangplank
as it is so often portrayed for residents or staff.
Converse-2-conserve.

Rodin image original source: http://users.ox.ac.uk/~ball0888/oxfordopen/Rodin.htm