Abstract
As a newly registered nurse who took up my first staff nurse role in an infectious diseases department during the first wave of the COVID-19 pandemic, the importance of quickly adapting to and following the most current evidence base has never been so apparent or crucial. From guidance regarding dexamethasone’s therapeutic role, to the use of intravenous Remdesivir and tocilizumab, to aiming for oxygen saturations of 90–94% SpO2, well below what we would typically aim for, or advising patients regarding the benefits of proning. Based on the direction given to us by our medical colleagues, the evidence-informed guidance we have followed has changed not only week-to-week but day-to-day and sometimes hour-to-hour.
As nursing students in the UK, the Nursing and Midwifery Council’s (NMC) Standards of Proficiency for Registered Nurses informs our undergraduate education (NMC, 2018). These standards teach us that the registered nurse’s role is to provide, lead and co-ordinate evidence-based care; that to do so, we must acquire and develop the confidence and skills to become critical thinkers with the abilities to provide this expert, evidence-based care. During this pandemic, while we have been following such rapidly evolving evidence, it has at times been challenging to have and maintain this confidence. For example, while undoubtedly effective in managing COVID-19, the use of dexamethasone has caused those with diabetes, or in some cases undiagnosed, underlying diabetes, to experience hyperglycaemia, which has required careful monitoring and medical and pharmaceutical intervention. Becoming a new registrant during this time has reinforced how important it is that we are educated to develop, but more importantly, are given the time for continuing professional development (CPD) opportunities, enabling us to maintain the necessary confidence to deliver the most up-to-date, effective, evidence-based care. Maintaining this confidence is especially prudent when new evidence can contradict our experiences of the previous best evidence for providing person-centred care.
However, I have discovered that there is only so much our undergraduate education can prepare us for. I am not dismissing what I learnt at university, but I have learnt much more about interpreting and following the evidence base over the last year because I have been doing so daily in practice. Therefore, I found this study regarding implementing a novel programme for nurses and allied health professionals to develop capacity for evidence-informed clinical practice insightful and a potentially exciting initiative. Primarily as undertaking such an initiative would provide registered nurses in the UK with some of the 35 CPD hours they are required to complete every three years as part of the NMC revalidation process, 20 of which must be participatory, to remain on the registrar as practising nurses (NMC, 2019).
While I do not identify with the study’s acknowledged barriers of lack of access to research evidence or critical appraisal skills, I am cognisant this may be due to the nature of my undergraduate education or the timing of when I became a new registrant during a global pandemic, which required an expedient synthesis of the most up-to-date evidence and acting on these findings. However, I recognise the identified barriers regarding the lack of time registered nurses have to participate in education and CPD opportunities, despite this being a requirement of maintaining our professional registration, as detailed above.
I bore witness to this as a nursing student in clinical placement. Also, in my previous role as Chair of the Royal College of Nursing’s (RCN) Students’ committee, and now as a steering committee member of the RCN Nurses in Management and Leadership Forum and RCN Newly Registered Nurses Network curator, I have anecdotally heard of registered nurses facing these barriers. I believe this is primarily due to the short staffing levels we experience, a phenomenon not exclusive to the UK. Registered nurses are an invaluable resource who cannot be freely released from their clinical environments to access additional training without a detriment to patient care. Reinforcing this issue is at present – most NHS Trusts and national Boards do not allocate or secure any protected time for registered nurses’ CPD activity – a stark contrast to that which we afford our medical colleagues. Is the development of registered nurses not seen as being as valuable? I am confident our patients would disagree and want registered nurses who are as evidence-informed as possible. Therefore, I would argue CPD time for all registered nurses should, nay must be protected. As with so many other nursing issues, I would hazard this harks back to the age-old argument of nursing’s general perception of being a vocation rather than a degree-educated, evidence-based profession.
While I agree with the study’s findings, we need to foster a generation of research literate nurses engaged with accessing evidence. I feel we need to address the root cause of why they are unable to. I would love to undergo the additional proposed training highlighted in the paper, as I know many of my colleagues would. However, I have seen colleagues denied access to further learning opportunities because there simply ‘was not the time’ or they ‘could not be released’. I do not believe there is an unwillingness on behalf of individual registered nurses, the vast majority of whom would relish the opportunity to engage with the initiative described here. Instead, there are much broader and global systemic issues preventing individuals from actively engaging with or being allowed to undertake such additional training, as detailed above. Presently, given the choice, which do we favour: having registered nurses remain in their clinical settings, delivering safe and effective patient care because we cannot afford to release them, or freeing them to engage in such initiatives, which would ultimately improve patient care, since they would become more confident in their research and evidence-informed clinical practice, but it would leave their clinical settings understaffed?
I fully support the study’s findings that having mentorship, masterclasses and clinical leadership and support would help develop practitioners who understand how to interpret and synthesise research and, more importantly, have the confidence to implement these findings into their daily practice. It is both a noble and ideological principle. Although, until we address the more comprehensive, systemic issues preventing these from being universally accessible for all registered nurses across the NHS, I sadly do not see how this is possible. We have pockets of excellence across the UK and in certain specialities. But do all our patients not deserve the same? I believe we need to address understaffing and pay, terms and conditions, which includes ensuring we allow registered nurses protected CPD time as we afford our medical colleagues. Not only because this is a requirement of the NMC revalidation process for registered nurses, but because it will allow for the advancement of our profession. Suppose we address the issues I have highlighted. In that case, it would provide us with the necessary staff numbers to facilitate an NHS that can remain focused on delivering optimal patient care. It would also enable staff access to the much-needed additional educational opportunities, as described in this study, allowing us to fulfil our NMC revalidation requirements and develop as a profession. Presently though, due to circumstance, I do not believe we can have both, however ideal; a detriment to the nursing profession and our patients.