Nurses with high skill sets are leaving the speciality. How is the Royal College of Nursing addressing the issues that contribute to this?
Words by Helen Donovan, Professional Lead for Public Health Nursing
Sexual Health Services have seen significant upheaval and transformation since the inception of the Health and Social Care Act in 2012. The principle of integrated delivery of contraception and infection care under one roof promoted within the Act is broadly welcomed. There have been several unintended outcomes particularly with the shift from NHS Commissioning to Local Authority Commissioning. Another was a workforce with incomplete skill sets for the new model of delivery.
The new model required nurses to be skilled in both contraception services and the management of sexually transmitted infections and or HIV in order to be able to manage the holistic needs of all patients. Nurses coming into integrated teams tended not to have the complete skill set. In addition to the needs of nurses within integrated services, there was also fragmentation of services. This saw HIV care fractured from the familiar model of integration with Genito-urinary Medicine Services to a stand-alone service within secondary care. The demand for Sexual Health Services, however, has never been higher. Syphilis has seen an all-time high since the end of the Second World War, and there has been an increase in Gonorrhoea (PHE 2019).
As a result of this, there were anecdotal reports from staff working in sexual health of poor training opportunities, a lack of understanding of training needs, poor morale and lack of funding. This was leading to nurses with high skill sets leaving the speciality. The RCN conducted a member survey to understand the issues more fully. The analysis of this was published in an RCN report – Sexual and Reproductive Health. Four key themes from the RCN report on the impact of funding and service changes in England (RCN 2018) emerged:
- Access to and availability of education and training at appropriate levels for nurses
- Complexity of commissioning arrangements
- Workforce planning and skill mix between support staff and registered nurses
- Impact of current commissioning on services and users of services.
Nurses reported that there was a lack of understanding by service providers as to what level of education was or was not appropriate with no clear recognition of parity between courses. The lack of training for some nurses was being compounded by others being expected to duplicate training, all contributing to inefficient service delivery.
The RCN has developed a suite of resources to support those working in Sexual Health (RCN 2019) which sit within the public health clinical topic resource for Sexual Health.
- Sexual health education and training, including a video on sexual health services.
- The Education Directory
The tool includes seven areas to help address the issue of what levels of education staff need at advanced level in integrated sexual health, through to support workers and those working in other services which may have a sexual health component in their role, such as midwives working in termination services or practice nurses delivering contraception.
The tool will support individual nurses, managers and commissioners to make sure that there is a safe, trained effective and efficient workforce in order to deliver a holistic model of care that contributes to good patient and public health outcomes.
- There is a publication which sits alongside the Education Directory to show career progression
- Career stories and case studies and video to show the routes into sexual health
Many Local Authority Commissioned Contracts have expectations that different levels of sexual health care are delivered by different cohorts and workforces such as School Nurses, or Health Visitors for example. The expectation is that non-specialist providers will be part of the solution in improving health outcomes and normalising sexual health discussion within the population.
There are many opportunities for discussion relating to sexual health, but they are often lost to lack of skills, confidence and embarrassment. These resources from the RCN will support staff, provide clarity and ensure that nurses are able to practice safely, deliver robust evidence based holistic clinical care whilst meeting the expectations of their medical colleagues, managers and/or commissioners.
PHE (2019) Sexually transmitted infections (STIs): annual data tables https://www.gov.uk/government/statistics/sexually-transmitted-infections-stis-annual-data-tables