International EMS systems: United Kingdom

This article will describe the access to, and delivery of, emergency medical care in the United Kingdom. We describe how UK Ambulance Services respond to emergency calls and how UK Emergency Departments are configured to provide emergency clinical care. Ambulance technician and paramedic training and clinical skill mix is outlined and UK emergency medicine training and the involvement of doctors in prehospital care is highlighted. We describe the strengths and weaknesses of current Emergency Medical Systems (EMS) in the UK and comment on future areas for improving and developing emergency patient care.     

Newborn screening policy in the United Kingdom & the United States: two different communities of practice

Newborn screening is a rapidly developing area driven by both technological advances and public pressure. If they are not yet, all nurses working with mothers and children will soon be involved with implementing newborn-screening programs, and it is therefore important that they appreciate both the benefits and potential harms of such programs. In the United Kingdom, policy regarding the implementation of newborn-screening programs is developed at national level, and consideration of the introduction of new tests is subject to a formalized evaluation framework. In the United States, by contrast, each state develops its own screening program. Knowledge of developments in newborn screening in different countries that have diverse types of healthcare systems helps to inform nurses about the totality of healthcare for newborns, and assists them in becoming more knowledgeable about how international standards differ from those in the United States.     

The United Kingdom national breast screening programme: implications for pathology departments

Following an assessment of available data it was recommended that a national breast screening programme should be established in the United Kingdom. This advice was accepted by the Government and specific funding provided to implement the service by 1990. It was envisaged that basic screening units would be established to serve a population of 41,500 women aged 50-64 years and that specialist assessment centres would each cover the work from up to three basic screening units. This will require careful organisation and cooperation between different specialties; pathologists must ensure that they are fully consulted. The increased workload will have a significant impact on laboratories and appropriate funding and manpower will be needed. Pathologists will have to provide expertise in the interpretation of diagnostic samples from such techniques as fine needle aspiration cytology and needle localisation biopsies. To ensure the success of the programme a national Quality Assurance scheme is being implemented, and this will include validation of pathology data.     

The experiences and perspectives of overseas trained speech and language therapists working in the United Kingdom

There is a growing body of research which has investigated the experience of the migrant health worker. However, only one of these studies has included speech and language therapists thus far, and then only with extremely small numbers. The aim of this study was to explore the experiences and perspectives of migrant speech and language therapists living in the UK. Twenty-three overseas qualified speech and language therapists living in the UK completed an online survey consisting of 36 questions (31 closed question, 5 open-ended questions). The majority of participants came from Australia or the USA and moved to the UK early in their careers. Participants reported a range of benefits from working in another country and more specifically working in the UK. The findings were consistent with other research on migrant health workers regarding known pull factors of travel, finance, and career. This study suggests additional advantages to working in the UK were realized once participants had started working in the UK, such as the UK job lifestyle. Finally, the migrant speech and language therapists were similar in profile to other migrant health workers in terms of age and country of origin previously reported in the literature.     

Nursing power and practice in the United Kingdom National Health Service

Over the last decade the National Health Service (NHS) in the United Kingdom has experienced major organizational change. Successive government initiatives designed to improve local management of hospitals have tended to marginalize nurses. Resource Management, a major initiative, which is the model adopted in the NHS Review for hospital management for the 1990s, appeared initially to offer nurses an opportunity to influence decision-making directly. In practice, nurses' experiences of Resource Management were mixed. This study of the six hospitals which piloted the introduction of Resource Management showed that nurses did not always grasp the opportunity to enhance their power and practice. There was evidence from the study that the introduction of information technology curbed innovations in practice, and removed nurses from patient care delivery.     

Integration of overseas Registered Nurses: evaluation of an adaptation programme

BACKGROUND: The growth in overseas nurse recruitment to address staff shortages in the United Kingdom (UK) has led to the proliferation of adaptation programmes for overseas nurses to gain appropriate experience and enable them register with the Nursing and Midwifery Council. This paper reports on selected findings from an independent evaluation of an adaptation programme for overseas Registered Nurses offered by a large acute National Health Service trust. AIM: This paper reports on a study to evaluate the programme with reference to its objectives, outcomes and overall success from the perspective of various stakeholders. METHODS: A pluralistic evaluation research model was adopted to identify the criteria that stakeholders used to judge the success of an adaptation programme, and then to use these criteria to judge the programme in question. Data were collected by means of focus group and individual in-depth interviews with overseas nurses, ward managers, mentors, senior nurse managers and educators over a 12 month period and analysed by drawing on the principles of dimensional analysis. The criteria for success identified by the various stakeholders provided a framework through which the overall success of the initiative could be judged. FINDINGS: Five meanings of success were identified: gaining professional registration; fitness for practice; reducing the nurse vacancy factor; equality of opportunity and promoting an organizational culture that values diversity. Key findings relating to each of these are presented. The ease with which nurses gained UK registration and integrated into the nursing workforce was influenced by the characteristics of the work environment, level of support, and organizational context. CONCLUSION: Industrialized nations recruiting from the global nursing market need to invest in providing appropriate support to enable overseas nurses to adapt to working in a different health care system and social and cultural context.     

Entrepreneurial nurses and midwives in the United Kingdom: an integrative review

AIM: This paper is a report of an integrative literature review to investigate: (a) the extent of entrepreneurial activity by nurses, midwives and health visitors in the United Kingdom and (b) the factors that influenced these activities. BACKGROUND: Internationally, social and commercial entrepreneurial activity is regarded as important for economic growth and social cohesion. METHODS: Seventeen bibliographic databases were searched using single and combined search terms: 'entrepreneur$', 'business', 'private practice', 'self-employ$', 'intrapreneur$'social enterprise$'mutuals', 'collectives', 'co-op' and 'social capital' which were related to a second layer of terms 'Nurs$', 'Midwi$', 'Visit$'. 'Entrepreneur$' Private Midwi$, Independent Midwi$, and 'nursing workforce'. In addition, hand searches of non-indexed journals and grey literature searches were completed. The following inclusion criteria were: (a) describing nurses, midwife and/or health visitor entrepreneurship (b) undertaken in the UK, and (c) reported between January 1996 and December 2005. RESULTS: Of 154 items included only three were empirical studies; the remainder were narrative accounts. While quality of these accounts cannot be verified, they provide as complete an account as possible in this under-researched area. The numbers of nurses, midwives and health visitors acting entrepreneurially were very small and mirror international evidence. A categorization of entrepreneurial activity was inductively constructed by employment status and product offered. 'Push' and 'pull' influencing factors varied between types of entrepreneurial activity. CONCLUSION: Empirical investigation into the extent to which nurses and midwives respond to calls for greater entrepreneurialism should take account of the complex interplay of contextual factors (e.g. healthcare legislation), professional and managerial experience and demographic factors.     

The 'greying' of the United Kingdom nursing workforce: implications for employment policy and practice

One in five nurses on the United Kingdom (UK) professional register is aged 50 years or older. Over the next few years, the profession will lose, through retirement, many of its most experienced practitioners. The significance for policy makers and for employers of this age-shift is two-fold. Firstly it is clear that greater numbers of nurses and midwives are reaching, or soon will reach, potential retirement age. Secondly many more nurses are now reaching their middle years and they are likely to have different requirements and attitudes to nursing work. This paper examines the employment policy and practice of the ageing of the UK nursing population. The paper examines data from official sources, and information from attitudinal surveys and case studies with employing organizations to assess the major effects of the ageing of the nursing workforce. Key findings are that the age profile of those nurses working in the National Health Service appears to be 'younger' than that of the total population, with the age profile of nurses working in nursing homes and as practice nurses being older than that of the NHS nursing workforce. However, the overall age profile of NHS nurses masks considerable variation between specialties and trusts, and the 'pool' of potential nurse returners from which the NHS and other employers attempts to recruit, is declining in numbers, as it too ages. Other major issues requiring policy attention are the provision of appropriate flexible hours to older nurses who have caring responsibilities, improving access to continuing professional development, and reducing pension provision inflexibility.     

Implementation of community care policy in the United Kingdom: will it be achieved?

In the United Kingdom, the provision of health and social care within the community is the subject of major reform This reform is aimed at reducing the dominance of the state as provider of welfare services whilst encouraging the independent sector to provide the bulk of services through competition and market forces The purpose of this paper is to discuss the implementation of government policy with respect to health and social care in the community The policy recommended in the 1989 White Paper Caring for People , which is sanctioned in the National Health Service (NHS) and Community Care Act (1990), is the focus for discussion Implementation theory is used as a framework to explore the modification and reshaping which inevitably accompanies the translation of government policy into reality The nature of any actual or potential deficit between stated policy and community care reform in practice is examined against this theoretical background An historical stance is taken in order to place current policy into the wider context and consider what determinants may have led to the radical proposals for community care, and indeed other sectors of public service A consideration of predominating philosophies is prudent to an analysis of government policy-making and therefore the values and beliefs of 'new public management' are employed as a conceptual framework underpinning current reform The feasibility of a quasi-market in the delivery of health and social care is considered and some of the main issues which may result in implementation deficit with respect to the implementation of Caring for People are examined     

Minor surgery: an extended role for ophthalmic nurses in the United Kingdom

This article discusses the reasons for extending the scope of ophthalmic nursing practice in the Princess Alexandra Eye Pavilion, Edinburgh, Scotland, particularly with regard to the ophthalmic nurses' role and management of meibomian cysts (chalazions) through minor surgery to the eyelid. The article describes how the in-service teaching program was established in the hospital for those ophthalmic nurses who were interested in developing their knowledge and practical surgical nursing skills to undertake the management of meibomian cysts. The appropriate legal and ethical aspects of patient care involved in extending the scope of practice in the United Kingdom are discussed, including accountability and duty of care.