What is the role of the Registered Nurse?

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In recent times, the work and intentions of the National Health Workforce Taskforce (NHWT) have been occupying me considerably. As a nurse academic with responsibility for running a nursing programme, one would be foolish not to give this serious thought as it has the capacity to significantly change the nature of nursing as we know it.

Recent pronouncements in various fora have made it clear that the NHWT sees Registered Nurses (RNs) as crucial players in the delivery of future health services. This is heartening. However, it is also clear, to me at least, that the role envisaged for the RN, by at least some in the Taskforce or by others commenting on its work, may not be that which many RN's currently ascribe to—to paraphrase Virginia Henderson ‘to do for patients that which they would do for themselves if they could, in such a way that maintains their dignity’ (1966, p. 15) and which one would hazard to guess, reflects the focus of most contemporary pre-registration nursing programmes. Instead, this new perspective on the RN role is more akin to that currently referred to as ‘the physicians assistant’.

When I have raised this issue with colleagues, some have shown alarm, seeing it as a nail in the coffin of the independent roles of nurses. Others have shrugged and said things akin to ‘that's okay, nursing has always moved with the times’. Others have acknowledged the issue, but seem confident that ‘everything will turn out okay’. I have to say, ‘I don’t’ share this optimism.

Recently on the radio, I heard a senior representative from a major provider of health care services say something to the effect that ‘RN's could be doing a lot more useful things for patients than they do now’. At one and the same time he was saying that there is currently a need for ‘someone’ to fill the ever-widening space left by busy and increasingly specialized medical staff, in relation to ‘providing and monitoring medical treatments’, with RN's being that ‘someone’; and, that this was reasonable because this would be more ‘useful for them to do’ than the work they presently do.

One cannot argue that this need is not there. One could also support the idea that some RN's may wish to take on this role, but, they need to do so following adequate preparation. In other words, it should be another nursing specialty, with entry to that specialty occurring after graduation as a comprehensively prepared RN. What I am opposed to, is the suggestion that this should be the future role of the RN, at least in acute services. I am not only opposed to the idea that this role would be a ‘more useful use of RN's’ but I am outraged that someone involved in health care could say the holistic, caring role of the nurse, which has been at the heart of our profession for centuries, is actually something that could reasonably be given to someone else; the implication being that this could be to someone less qualified. Just when will the message get through, that ‘care’ is what most people need from health services and that ‘quality care’ is something that cannot be guaranteed merely because a care-giver is ‘kind’?!

It is apparent then, that it needs to be made clear to the NHWT that Nursing sees that there is a gap to be filled (indeed, many are already doing so via role-extension, though one would ask ‘with what degree of [at least formal] preparation?’) and that the profession is prepared to assist in doing so. However, it also needs to be made clear that the provision of high quality, holistic, professional nursing care, is not something that can be reliably devolved to lesser qualified people. Thus, while there may be a role for RN's to fill the gap that physician's assistants have filled elsewhere; it must not be at the expense of the traditional RN role. It is important that we respond in this fashion, as I fear that to not do so will place nursing into the position of ‘part of the problem’ (and there are many) rather than part of the solution.

In addition, the nursing profession needs to be able to more clearly express its role to others and the patient benefit which accrue from that care, via the articulation of nurse-sensitive patient outcomes. Data from such tools could then be added to the plethora of existing material which highlight the efficacy of a RN workforce, over one made up of lesser-qualified practitioners.

Perhaps most of all, the profession needs to martial its resources so as to ensure that consistent messages about itself and its significant contributions to health care, find their way through to the policy makers.

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Reference 

1. Henderson V. The nature of nursing. New York: Macmillan Publishing; 1966;p. 15
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