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Improving care by releasing the creativity of nurses

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Lord Nigel Crisp Lord Nigel Crisp, former chief executive of NHS England

I have spent time with nurses in many countries around the world during the last few years. While there are many obvious differences in their daily lives and working environments, there are also many common themes.

One such theme is that, too often, nurses feel undervalued and unable to work to their full potential. They are rarely involved in decision making, despite their understanding of services and patients’ needs. When they are properly valued, however, they can put this knowledge to good use as a few examples show.

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When the South African health minister authorised nurses to prescribe anti-retroviral treatments in 2009, it was a turning point in the HIV/AIDS epidemic. His decision was vital, but it was the way nurses developed services that meant many more people were treated. I met nurses in Pietermaritzburg who explained that fear of stigma led many people to refuse HIV/AIDS testing. The nurses’ knowledge of local culture, however, enabled them to design services where people could be tested and treated without anyone else knowing – for example, as part of routine health checks for themselves or their children.

Elsewhere, nurses in Sao Paolo in Brazil use bars in the favelas to initiate consultations to provide health advice and encourage men to use health facilities, while nurses in Tonga run programmes with local communities to tackle non-communicable diseases. Nurses in Narayana Health in India play a vital role in preparing patients and their relatives for surgery and, equally important, their recovery afterwards.

Here in the UK, Heather Henry, an independent nurse, recognised that the unemployed fathers in a part of Greater Manchester could be valuable assets for their community and worked with them to create community activities, improving their health and that of the community at the same time. Meanwhile Hazel Stuteley, a nurse and health visitor worked with a police sergeant in Cornwall to develop a dance club for young people. Fifteen years later it is run by young people and has improved the mental and physical health of several generations of young people in the local area.

All these examples show how nurses, with their good understanding of local culture and patients’ needs can innovate, design and lead services if they are enabled to use their own creativity. Nurses are increasingly playing a leading role in managing long term conditions and in primary and community care. Raising the profile and status of nursing and releasing the talent and creativity of the largest part of the professional health workforce will bring enormous benefits to patients and health systems globally.

Lord Nigel Crisp is a former Chief Executive of NHS England. His new book
Turning the World Upside Down Again – Global Health in a Time of Pandemics, Climate Change and Political Turmoil (CRC Press) is out now.

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