Tag: universities

Learning how to see: industrial action in universities and the nursing workforce

5ef34afb-e2b4-47ec-ad34-be229c7b135c
Photo by @sarawhittam

I take the view that ‘everything is connected to everything else’, to use a phrase I recently learn is attributed to Leonardo da Vinci. More on him later.

Over the past week I’ve been involved in industrial action as part of #UCUStrikesBack. What I’m not going to do in this post is to explain why university staff are currently on strike, largely because this has already been adequately covered elsewhere (for example, see here and here). Instead, I want to share some picket-line reflections linking what happens in universities with what happens in the health service. These are connections which are not being made frequently enough, including by some who should know better.

As a mental health nurse academic I am acutely aware of the perilous position occupied by my profession in the NHS, with reports from earlier in 2019 pointing to a loss of 6,000 mental health nurses in NHS England since 2009. Below is a graph, created using NHS Digital data, which starkly reveals the current situation:

MHN numbers 2019As an aside, data of this type are not published here in Wales. They should be. In any event, quite correctly much concern has been expressed about this startling decline in the workforce, with mental health nursing now singled out as a group needing particular help to improve both recruitment and retention.

Reflecting my position as a health professional academic I hold joint membership of the University and College Union (UCU) and the Royal College of Nursing (RCN). The RCN, along with other health service unions like Unite and Unison, is trying to reverse the crisis facing the nursing workforce. It is campaigning on safe staffing, has published a manifesto to assist nurses wanting to interrogate prospective parliamentary candidates ahead of the December 2019 general election, and through its Fund our Future campaign is lobbying government to reverse the removal of tuition fee and living cost support for students of nursing in England.

These campaigns are important. So far, however, in its public pronouncements the RCN has failed to make the necessary connections between working conditions in universities and the present and future education of student nurses. Put simply, an adequate supply of educated, evidence-minded, person-centred nurses demands an adequate supply of secure, well-supported, fairly paid nurse educators and researchers. Nurse academics typically have career trajectories which are significantly different from those in other fields, with implications for their recruitment, retention and development. The modern norm for historians, physicists and sociologists seems to involve years of precarious, post-doctoral, employment characterised by repeated short-term contracts before landing (if ever) much sought-after full-time academic posts. In contrast, with some exceptions nurses are generally recruited into higher education by dint of their practitioner expertise, their posts linked to the servicing of courses of professional study. This was certainly how it was for me: my academic career commenced with an initial series of short-term employment contracts associated with the leading of a post-qualification course for community mental health nurses. In all universities, nurse academics can soon find themselves carrying major teaching and course management responsibilities, often for programmes and modules of study which run more than once across a single year. Demanding education and education-related workloads can squeeze out time for research, scholarship and wider engagement, in workplaces which traditionally value productivity in these areas for the purposes of career progression.

Expanding the number of nurses to fill the gaps which now exist, for which the RCN and others are rightly campaigning, requires thought and careful planning. In the run-up to the general election both are in short supply as nursing numbers become reduced to political soundbites. More student nurses must mean more nurse academics, but in any future rounds of staff recruitment potential entrants will have their eyes wide open. The erosion of university pensions relative to pensions in the NHS does nothing to encourage those contemplating the leap from health care into higher education (or, at least, into that part of the sector in which the Universities Superannuation Scheme predominates). Very reasonably, those considering future careers as nurse academics will also want to weigh up the appeal of doing work which is undoubtedly creative and rewarding with what they will hear about workloads, developmental opportunities and work/life balance.

I also learn, this week, that Leonardo da Vinci saw the making of connections as necessary in order that we might see the world as it truly is. In my working world, education, research and practice are intimately intertwined. It is disappointing that these connections are being missed by organisations which campaign on the state of nursing and the NHS, but which do not (as a minimum) also openly acknowledge the concerns that nursing and other academics have regarding the state of universities. Right now, some words of solidarity and support would not go amiss.

Higher education Green Paper

The much-trailed higher education Green Paper appeared last week. For the full document, the place to go is here and for a Times Higher summary the link is here. Immediately worth bearing in mind is that higher education in the UK is a matter for devolved government, meaning that most of what the Green Paper says relates to English universities. I say ‘most’ because, as is noted towards the beginning of the document, the Research Councils (like the MRC and the ESRC) have UK-wide remits, whilst the REF and the various editions of the RAE preceding it were carried out on a four-country basis. It would also be naive in the extreme to suggest that universities and policymakers here in Wales can ignore the England-only bits of what the Green Paper has to say; for a nice piece on the Green Paper and devolution, follow this link. And, for an insight into work ongoing in Wales on matters higher education-related, here’s a link to a current review of funding arrangements.

Fulfilling our potential: teaching excellence, social mobility and student choice, to give the Green Paper its full title, proposes plenty of change. It also leaves much of the detail unfilled, and (in at least one analysis) contributes to an emerging higher education policy framework which is both vague and contradictory. One idea is for the Higher Education Funding Council for England and the Office for Fair Access to combine functions within a new Office for Students. Plans for a Teaching Excellence Framework are outlined, along with variable rates of tuition fees. Ahead of the publication of the document there was some talk that REF2014 might have been the last of its kind. What the Green Paper actually says (briefly) is that dual support for research should remain, and that some version of the research excellence framework should continue and be used as the basis for the allocation of government block funding. The next REF, it is suggested, will take place by 2021. But there is obviously more to follow in this context, with sections in the document referring to the administrative burden and cost of the REF and the possible use of metrics to ‘refresh’ quality assessments in between full cycles of peer review. There is also the small matter of having to determine, if the Higher Education Funding Council for England disappears, which body should in the future assume the task of allocating quality-related funding to English universities.

Meanwhile, the sole nurse to get a mention in the Green Paper and its surrounding commentary is Sir Paul Nurse, Nobel Laureate, President of the Royal Society and chair of the review into the UK’s research councils. Nurses, of the type of which I am one, have to look elsewhere for the specifics on possible future arrangements for the organisation and funding of health care professional education and for debates in this area.

Reflections on a pre-conference week

Funding for Welsh students and Welsh universities is in tonight’s news, I see, and I’m beginning to wonder how long the Welsh Government’s current policy in this area will survive. More immediately, it’s been a varied enough week for me personally: and that’s without my two days at the NPNR conference in Warwick which begin with a frighteningly early start tomorrow morning. But at least I’ll have Gerwyn Jones and Mohammad Marie in the car for company, so all will be well.

Highlights so far include a meeting of (most of) the excellent RiSC team (which includes the newly-professored Steven Pryjmachuk), to make further progress on our evidence review of ‘risk’ for young people moving into, through and out of inpatient mental health services. This is a two-phase project, and we’re now in the second segment. This is involving searches for research and other materials across a number of databases, and putting out calls for evidence to local services and other organisations.

Data has continued to be generated in COCAPP, and this week a date has been set for a first planning meeting for an exciting new project I am involved in led by Michael Coffey. More to follow on this in the fullness of time, I expect. And yesterday took me to a second meeting of the Mental Health Research Network Cymru Service User and Carer Partnership Research Development Group, an event convened at Hafal‘s premises located in the grounds of the magnificent St Fagans: National History Museum. A good place, St Fagans: well worth a visit.

Elsewhere there have been comments to make on students’ draft assignments, research ethics committee work, undergraduate teaching to prepare (on roles in health and social care teams) and writing plans to be laid. I’ve also been reading a PhD ahead of a viva scheduled in the next few weeks. So this short post will do for tonight: time to knock off, iron some shirts, pack a bag and have an early night.

Research and mental health nursing

Over on the Mental Health Nurse Academics UK blog, the group’s chair Dr Michael Coffey writes:

The Research Excellence Framework (REF) looms large for many of us. This is part of the regular round of judging of peer-reviewed research publications on which the UK government bases its decisions on distribution of institutional research funding. Decisions within Higher Education Institutions are being made around now on who is considered returnable and then whether it is strategically advantageous to submit these researchers in the exercise. For individual research careers these decisions weigh heavy. For the profession of mental health nursing there may be wider implications. Previous research assessment exercises have seen more and more evidence of mental health nurses being returned. This has undoubtedly led to an improved profile within individual universities and recognition of the contribution of research to improving the experience of people using mental health services.  There remain significant opportunities for mental health nurse researchers to contribute and bring to bear a professional view on what needs researching and how this should be conducted. We will have to wait until 2014 for an idea of what the landscape will look like in relation to mental health nursing. One thing for sure is that we need a highly engaged mental health nurse academic workforce to continue to provide high quality education and research. By doing this we can make a meaningful contribution to the development of mental health care both here in the UK and beyond.

Nursing certainly did do well in the UK’s last Research Assessment Exercise, the precursor to the REF to which Michael refers in his post. Results for all higher education institutions submitting to Unit of Assessment (UoA) 11 (Nursing and Midwifery) in RAE 2008 can be found here. In his subject overview report for UoA11, Professor Hugh McKenna of Ulster University ended with this:

In conclusion, the sub-panel members were very impressed with most of the submissions they reviewed and with the pervasive pattern of world-leading and internationally excellent research. There are many models of good practice from which developing research groupings can learn in terms of research activities, outputs, environment and esteem. It is clear that investment by Governments, funding bodies and universities has increased research capacity and developed research leaders capable of undertaking nursing and midwifery research that is internationally excellent and world leading. These funding streams need to be sustained and enhanced if the upward trajectory and momentum are to continue and if the quality differentials between the strongest and weakest departments are to be addressed.

And, when the results from the last RAE were published in December 2008, The Guardian ran an article titled Nursing research takes its place on world stage. Here it said:

Nursing, for many years medicine’s poor relation, has come of age in the 2008 research assessment exercise (RAE). Academics in the field can justifiably claim to be world-leading in terms of research. Nursing and midwifery was among the subjects with the most highly rated research in the results published today.

Heady stuff indeed, and testimony to years of hard work, strategy, and capacity-building investment. All this does, though, seem an awful long time ago. As Michael reminds us in his MHNAUK post, attention has long since turned to preparations and prospects for REF 2014.

I have written about nursing and the Research Excellence Framework 2014 on this site before, drawing attention to the workload facing members of UoA A3 (Allied Health Professions, Dentistry, Nursing and Pharmacy) and to the challenges of demonstrating and assessing ‘impact’. So, as we hurtle towards the deadline for REF submission, in what shape does UK mental health nursing research find itself?

Readers of this blog will know that this is a question that MHNAUK is also asking, and is seeking an answer to in organised fashion. Professor Len Bowers led a discussion on this at the MHNAUK meeting held in Cardiff last March. When the group reconvened in Liverpool in June, Dr Fiona Nolan asked members for items to include in her planned survey of research activity and capacity.

Whilst we await findings from Fiona’s project in the first instance, my personal view is that there is much to celebrate in mental health nursing research but also room for development. A small number of universities are home to strong and established research groups. Leaders of these have built national and international collaborations across disciplinary and institutional boundaries. They have laboured to secure funding in open competition and to complete and publish studies with real implications for policy, services, education and practice. This is excellent progress, and I think we now need more of this type of activity across more universities. This means people (and I include myself here) extending their ambition, and perhaps being a little bolder. As an example, early next year the European Union’s Horizon 2020 research and innovation programme invites a first round of applications for funding. How excellent it would be for mental health nurses in the UK to be leading, and collaborating on, high-quality bids submitted there.

My more general reading of the field is that, in many universities, mental health nurse researchers are thinly spread. I’ll bet that in most of the sixty-plus universities represented at MHNAUK the number of people predominantly involved in teaching far outstrips the number predominantly engaged in research. Teaching is important – really important – but the lone researcher in a team of teachers is in a tough place indeed. As I cast an eye around the departments I am most familiar with I also wonder where the younger mental health nurse researchers are. How many mental health nurses in their 20s are studying for PhDs? If the answer is ‘not many’, then what should we collectively be doing to make research a viable, and attractive, career proposition for nurses at the start of their careers? How might we nurture a future generation of mental health nursing clinical academics?

Anyway: all is speculation until we have some evidence. The MHNAUK survey, I anticipate, will paint a more rounded and complete picture of the true state of research activity and capacity than will the Research Excellence Framework. The REF, being what it is, is subject to all sorts of inter- and intra-institutional politicking and will produce only a partial view of what’s really going on.

Selecting students of nursing

During my recent visit to the Netherlands I learned that universities there are obliged to offer places to applicants provided that the formal entry requirements are met. So, for applicants to nursing courses, there are no selection events: no interviews, no assessments of aptitude or attitude, no tests in numeracy or literacy. Here in the UK, the NMC (our regulatory body) requires that offers of places on nursing degrees are only extended after face-to-face selections have taken place. The NMC asks that interviews include assessments of motivation, and of reasons for choice of intended field of practice (adult, mental health, children or learning disability). Would-be students are also invited to demonstrate their understanding of the work of nurses. An interesting difference in approaches, I thought.

University of South Wales

A quick post before I head off for the train. Interesting to see that the merger of universities in this part of the world has taken a step forward. Yesterday it was reported that the name of the institution which will bring together the University of Glamorgan and the University of Wales Newport next year is to be the University of South Wales. Some of this has been quite fraught, what with Cardiff Met strongly resisting pressure from Welsh Government to join the party.

I’ve worked through an institutional merger of this type, having first been employed in the University of Wales College of Medicine before moving across to Cardiff University in 2004 when the two joined. In a day-to-day sense I’m not sure I ‘felt’ the significance of this move initially. Sometimes the impact of a change of this type takes time to work its way through the system, but I’m sure the limbering up for merger which has been taking place across other local universities has been anxiety-provoking for some. In the fullness of time it will be interesting to catch up with colleagues in Glamorgan’s Department of Care Sciences to hear how things are progressing. I wish them all well.

The train calls.