Caring for children – fact or fiction?

As shelves groan under the growing pile of recommendations for children to be cared for by appropriately qualified staff, yet again in the UK we face the possibility of the flow of newly qualified staff being severely reduced if `specialization' in children's nursing is made the preserve of post registration courses. Is this a good or bad thing? The debate continues, but arguments both for and against initial generic registration followed by `specialization' through additional education rest almost entirely on personal opinion rather than methodical analysis of the many issues involved. Having practised, pre-project 2000, in Scotland (direct entry to RSCN) and England (post-registration RSCN), I believe that both systems have advantages, but neither is necessarily better than the other. One fact is irrefutable. At a time of serious concern over nurse recruitment and retention, recruitment to child branch diploma programmes (direct entry) is the least problematic in a very troubled arena. Would we lose these recruits if it took 4.5 years, rather than 3, to reach their goal?

Those of us who trained in the pre-Project 2000 system in England have disparate views. ‘We’ weren't put off by the requirement to complete first generic then children's nurse education/training (rather a biased sample by anyone's standards), but who knows how many were? What career opportunities beckon now that would either have not existed or seemed inaccessible all those years ago? How powerful is the current perception of nursing in society and of nursing as a career in attracting/alienating potential recruits, be they young or mature (as increasingly is the case)?

What about the strength of the professional voice? We have children's nurses in a number of senior national positions, where their priority is, rightly, the whole patient/client base, not just children. So they can support our cause, but only in the wider context, and not with any perceived bias in our favour.

There continues to be a worrying trend to remove (through service reconfiguration and merger) those in senior positions representing children's nursing within child health services. This has removed management role models, and reduced the most senior children's nurse in many services to F or G grade staff (clinical managers) with no senior support or leadership, especially in the community where the focus of care is increasingly being directed (RCN, 2001). Community services are growing, yet here also there is a tendency to provide watered down services with nominal, if any, nursing input for sick children by those specially trained in their care.

Most commentators (public and private) have no problem identifying the two other smaller branches of preregistration nurse education in the UK – learning disabilities and mental health – as having a distinct identity and justifying separate education from those undertaking adult branch training. Many, however, have difficulty appreciating that children need specially trained nurses, never mind justifying a special branch of education at preregistration level. When local health service managers express this opinion in public, debate about the structure of education pathways for such nurses pales into insignificance.

Thus, community staff are faced with caring for patients for whom they feel ill-prepared to provide appropriate and competent nursing care, and know there is nothing to be gained locally by expressing concern (Brocklehurst, 1996). Is a health visitor really an appropriate supervisor for community children's nurses (providing nursing care), unless multiply qualified? Why are so many health visitors with children's nursing qualifications and experience forced into health visiting if they wish to practise with autonomy with children and their families in the community (Eaton, 2000)? Is this an appropriate use of hard earned and expensively provided skills and education?

As care in any setting becomes more rather than less complex, we have a duty of care that places the emotional needs of families at equity with their physical needs. For nurses to provide such care they need to feel valued, supported and suitably equipped for the demands of the role. If we cannot recognize the special needs of children (except with lip service to meet political agendas), then how are we to achieve a work force of competent, caring professionals able to meet those needs?

We need to look to our motives, establish the facts, and truly assess the needs (of nurse and patient), if we are to prevent yet more scandalous practice to occur, with damage to children and their families (and often to the staff involved) which certainly lasts a lifetime. So many questions, so much potential to make decisions that may be regretted in the future!