Nurses were not socialised nor developed educationally to adopt leadership roles, particularly at a national level.  Historically an assumption was made that nurses would accept whatever changes were imposed on health care and this currently still appears to be the case.   Although nurse leaders do exist at many organisational levels throughout the NHS, they still tend to be absent from the national stage, although the RCN does have a nationally and locally recognised presence. The importance of developing leadership in nursing has been increasingly recognised and there are a number of leadership programmes – with the RCN, the Kings Fund and the NHS Leadership Framework, available.

The professional organisations which exercise leadership on your behalf include: the Royal College of Nursing, which has professional and trade union roles and UNISON which is a large trade union with many nurse members.    

It will depend on the setting and on which of the four UK countries you are studying in.  However discussion about such change may include the experiences of working in health and social care settings, which are often very busy.   For those of you working in acute hospital wards where bed occupancy is almost 100%, due to the decreased number of acute beds, then there may be discussion about patient throughput and how these beds are used.  This may include so called patient flow through the hospital, and how this is tracked and monitored.  Discussion about social care may include how care in communities and other settings outside acute care is delivered, how patient’s access this and the role of nurses and their knowledge and understanding, about these processes.  This may seem very distant to you at present, however as a registered nurse it will affect you when you are responsible for delegation and management of patient care.

The strategies you and your mentors may find useful in this context, are discussing how care is organised in each of your clinical practice placements.  Sound leadership is essential to facilitate change and to enable nurses to cope with it positively.  It is also vital to have an understanding of how to work effectively in a nursing team and how communication facilitates this.  It is important to understand the roles of the multidisciplinary team members, and to be aware of the processes involved in arranging care at home.  Reflection in and on practice with team members such as mentors, is also essential.  

Telemedicine uses telecommunications technology as part of the diagnosis and care of patients.   Although it remains poorly defined, it is constantly evolving as technology advances and responds and adapts to societies changing health needs.   Its purpose is to provide clinical support to those who are not in the same physical location using a variety of types of ICT, to improve health outcomes.  The internet has accelerated this and uses web based applications such as teleconsultations and the use of digital resources. It is suggested that telemedicine will transform the delivery of care away from hospitals and clinics into people’s homes, by for instance using remote methods to undertake breast screening, tele- ECGs and undertake tele-radiology.     

In terms of how telehealth could be beneficial when discharging patients, it can enable remote tele- monitoring of a variety of physiological measurements, including, blood pressure and blood glucose.  It can also encourage self-care to improve the management of the patient’s condition, particularly when these are of a long term or chronic nature.  

In terms of how telecare could be beneficial when discharging patients, it could help to maintain patient safety with the use of a variety of equipment, including sensors and alarms to detect movement, falls and changes in temperature. 

A 2011/12 review of learning disability nursing across the four UK countries, took place due to the many changes in learning disabilities nursing over the last 30 years.  This involved a shift from institutionalised care to a social model of care provision and this has reduced demand for learning disability (LD) nursing as a specialism.  It is evident that LD nurses should work in a person-centred way and support people’s rights to achieve the things they can achieve.  A Person-Centred Framework (PCN) such as that of McCormack and McCance (2010) could be used.  It is based on four constructs:

1. Prerequisites: Attributes of the nurse, including being professionally competent; having developed interpersonal skills; being committed to the job; being able to demonstrate clarity of beliefs and values and knowing one’s self
2. Care Environment: Context in which care is delivered including: appropriate skill mix; systems that facilitated shared decision making; sound staff relationships; supportive organisational systems; sharing of power and potential for innovation
3. Person-Centred Processes: Care that works with patient’s beliefs and values; engagement; a sympathetic presence; sharing decision making and providing for physical needs
4. Outcomes: The central component of the Framework and is the results of effective PCN including: satisfaction with care; involvement in care; feeling of well-being and creating a therapeutic environment