On 12-14th June 2017 the International Learning Collaborative (ILC) on Fundamentals of Nursing Care http://intlearningcollab.org/ met for its 9th annual meeting. ILC is a member-based organisation, set up in 2008 to bring together like-minded healthcare and nursing professionals, academics and leaders to transform the way we deliver care in high tech environments and to elevate the standard of fundamentals of care around the world.

At the meeting this year in Uppsala Sweden the ILC members from 11 countries were represented and the focus of the one day conference followed by a two-day meeting was ‘Involving the patient’. The first day is held in conference format with a wider audience and then a members meeting was held over the next 2 days. This gives ILC an opportunity to explore issues in depth and ensure we are realising and setting actions each year towards our goals.
At the conference we heard a number of presentations and I was privileged to be part of the expert panel bringing the education perspective to the debate. One presentation by Professor Jack Needleman, economist from the University of California Los Angeles really struck home to me and I wanted to share Jack’s presentation and editorial he has written (Presentation) (Editorial) with Jacks permission of course and to share with you the essence of Jacks thesis and the thoughts it left me with. Jack has been researching in this area for 3 decades and is well placed to propose his thesis.
Can we afford the fundamentals of care – Professor Jack Needleman
In summary from Jacks excellent presentation I took away the following; in short yes, we can afford the fundamentals of care. In more detail, Jack argues that nursing is treated as a cost centre rather than a core service. Efforts to contain costs result in cutting the number of registered nurses or replacing them with lower skilled workforce.
He argues that there is now a strong evidence base established across the USA, Europe and other countries that lowering the % of registered nurses leads to poor patient outcomes including higher mortality, infection, falls and longer lengths of stay. He goes onto to say that the consequences of relying more on less educated staff rather than registered nurses is not so well established in the evidence.
Jack as an economist has undertaken work that has enabled him to estimate that the costs to services is higher when the % of registered nurses are reduced and substituted for less educated staff.
Jack further argues that another reason for persistent interest in substituting lower skilled personnel is that work of nurses is not well understood. The most visible work of nurses is task orientated as a result misguided administrators think that nursing can be easily substituted. In contrast Jack argues that the work of nurses is complex both cognitively and managerially. Alongside the visible tasks nurses are assessing, monitoring, risk assessing, intervening, educating patients and families, providing psychological support and have a critical role in team-based care co-ordinating across different professional groups.
My reflections
Whilst I sat listening to Jack presenting the strong evidence base to support the value of registered nurses and the dangers for patients even if not fully quantified of deskilling the workforce I started to think about the recent developments in the healthcare workforce in the UK. I sat there wondering is the motivation to move towards the nursing associate a result of the idea that nursing is a cost
centre and costs needs to be controlled or will healthcare services take the opportunity to increase the number of workforce hours in the system to provide better and safe care. I will leave you to ponder on that one but my plea would be to service providers to avoid the tempting scenario of thinking that the number of hours within the workforce is a valid measure. I would ask service providers and nursing leaders to challenge this and argue for ensuring the ratio of registered nurses is kept at the levels evidenced as having positive patient outcomes.
What does this mean for me and can I translate these reflections into tangible actions? One area I am looking at is how we can support our service partners to best meet their workforce needs under very difficult circumstances. For example, I am aiming that we will work collaboratively with our partners to develop new degree level pathways into nursing alongside the more traditional 3 year undergraduate full time degrees and we shall be supportive of developing new and innovative routes such as degree level apprenticeships.
If we are challenged that the fundamentals of care cannot be afforded then we can give a robust response when asked ‘Can we afford it?’ our response must be – ‘YES WE CAN’ and it is for us all to advocate the value of well-educated nurses in the workforce.