Journal of Clinical Nursing 1992; 1: 231-232

I l ( C l l t O n 3 . 1 li ' •' ii.Mi .nl i... The United Kingdom Central Council for Nursing, Midwifery and Health•' ' '' ' ' " I Visiting (1992), has just produced a position statement entitled The Scope of

'''-' '• ' ' Professional Practice. The introduction to the statement is as follows:

: ^ i r t i , -I - -I i ] 'The practice of nursing, midwifery and health visiting requires the applicationof knowledge and simultaneous exercise of judgement and skill. Practice takesplace in a context of continuing change and development. Such change and

. , development may result from advances in research leading to improvements intreatment and care, from alterations to the provision of health and social care

, . :. . services, as a result of changes in local policies and as a result of new approachesto professional practice. Practice must, therefore, be sensitive, relevant andresponsive to the needs of individual patients and clients and have the capacity toadjust, where and when appropriate, to changing circumstances' (p.l).

' ' '•' The flexible and dynamic role ofthe nurse combined with the need to consider'- ' ' the social context in which nursing takes place is clearly emphasized.

' In Great Britain, demographic trends are resulting in an increased proportion of' ' I Mi elderly people within the population, and in particular, a large rise in those aged

- ' i ' over 80 years. It has been estimated that approximately 40% of the health andpersonal social services budgets are spent on meeting the needs of elderly people

; •; , (DHSS, 1981). For both economic and humanistic reasons, it is current socialpolicy to enable not only frail elderl)' people to remain in their owti homes ratherthan be admitted to residential care, but also people with learning disabilities andmental illness. This policy requires co-operation between the health and personalsocial services sector which to date has often been found lacking (Audit Commis-sion, 1986; DHSS, 1988). The Govet-nment has responded to this issue in aDepartment of Health (1989) paper which states that community care must be

j , organized more efficiently and eflectively. The main recommendation is that Local,, / • ' Authorities should, through their Social Services Departments, purchase packages,., , of care for people tesiding in their own homes who are unable to cope with the... . activities of living, unaided. It is likely that more nurses will be employed in the

..\'. . , Social Services sector or that the Social Services sector will purchase nursing carefrom the Health Service as a result of this policy.

In any purchaser/provider scenario, whether between two parties within theHealth Service or a Social Services/Health Service relationship, conflict could ariseif the purchaser did not wish to buy the amount, level and quality of service that theprofessional provider believed appropriate. Any professional who is employed

] rather than in private practice, has to consider the relationship between professionalaccountability and responsibility to their employer. Throughout the world, nursesare faced with making judgements involving individual patient's needs, whetheremployed by a national department of health, a private hospital or voluntaryorganization. It is individual judgement based on the efficacy and cost of nursinginterventions which result in a nurse deciding which child to treat first in a warzone, the length and frequency of therapeutic sessions for a person with agora-phobia and the acceptable extent of interventions to an elderly person who wishesto be left to die in dignity in their own home. Part of being professional involvesmaking judgements while taking into account all the factors involved in any givensituation.

It is presumably in the light of the current social changes identified and the

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232 Editorial

complex nature of making professional nursing judgements, that the UKCCdecided to produce this new paper. It states that nurses have not only to applyknowledge, judgement and skill, but also to see nursing practice as something thatwill change and develop in a flexible and dynamic manner in order to meet theneeds of society. Registered nurses are reminded that they must accept indirectaccountability and responsibility for those tasks which they delegate to otherworkers. At the same time, the UKCC suggests that wherever possible, careshould not be fragmented, implying the need for nurses to take on a co-ordinatingrole when mobilizing other resources to ensure individual patient's needs are met.

The fact that nurses will work increasingly in Social Care and domestic settingsis acknowledged in this paper, but perhaps strangely, a statement is made thatwhere nurses are employed in the Social Services or Residential Care sector, theyremain accountable to the UKCC, and subject to the Council's Code ofProfessional Conduct, even if their posts do not require nursing qualifications.This is a difficult concept to grasp and highly questionable.

The new UKCC (1992) paper is, in my opinion, too detailed in its attempt tooffer nurses guidance on the scope of professional practice. Ultimately, anysociety will be best served by a nursing workforce which encourages an individualnurse to use their own judgement in any given situation, provided that theirjudgement is guided by the principle of 'always acting in such a manner as topromote and safeguard the interests and well-being of patients and clients'(UKCC, 1992 p.4).

Fditor, MARY WATKINSBeeches, Crapstone, i'-" '" rMk»\ July 1992Yelverton, ^Devon FL20 7PW, UK '

References

Audit Commission (1986). Making a Reality of Community Care. HMSO, London.DHSS (1988). Community Care: Agenda for Action. A Report to the Secretary of State jor

Social Services (Chairperson Sir Roy Griffiths). HMSO, London.DHSS (1981). The State ofthe Publie Health. HMSO, London.Department of Health (1989). Caring for People. HMSO, London.United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1992). The

Scope of Professional Practice. UKCC, London.

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