November 23, 2017

The changing landscape of nursing in care homes | Louise Morris - Care Home Assistant Practitioner (CHAP) Project Lead


Louise Morris is the National Care Home Assistant Practitioner (CHAP) Project Lead for Four Seasons Health Care. In her blog, Louise reflects on her nursing journey and the changing landscape of nursing in care homes:

Florence Nightingale | "The Lady with the Lamp"

“I was invited to attend a service to commemorate the life of Florence Nightingale at Westminster Abbey on 17th May 2017. I felt extremely honoured and proud to be a part of such a special service and to represent Four Seasons Health Care Nurses.

Part of the service involved a procession called the Lamp Party. A lamp that is kept in the Florence Nightingale Chapel at Westminster Abbey was carried by a scholar and followed by a procession of student Nurses and Midwives from Edinburgh Napier University. When the procession reached the High Altar, the lamp was passed to another two scholars, representing the transmission of knowledge from one Nurse to another, and highlighting the diversity of care given by Nurses for the benefit of humanity.

For me, the Lamp Party was a particular special moment during the service and I felt that this represented nursing as a whole and also my personal journey. I took the opportunity to reflect on my career and analyse my thoughts further.

Florence Nightingale became known as “The Lady with Lamp” during her work in the Crimean war. Nightingale herself spent every waking minute caring for the soldiers. In the evenings she moved through the dark hallways carrying a lamp while making her rounds, ministering to patient after patient. The soldiers, who were both moved and comforted by her endless supply of compassion, took to calling her "the Lady with the Lamp." Others simply called her "the Angel of the Crimea." Her work reduced the hospital’s death rate by two-thirds. The Lamp has since become a symbol of nursing internationally.

The challenges of modern nursing 

I believe all Nurses can identify with The Lamp. Not just the working of nightshifts and supporting the wounded or sick, but as a beacon of hope in the dark places that Nurses can find themselves within their careers. Nursing is not an easy profession – in Florence Nightingale’s time there were different challenges to present day nursing. However, I would argue that the issues of today can be just as challenging in different ways. Often we have to struggle with the ideals of compassion and quality of care, yet manage with limited funds, a shortage of Nurses and other challenges of modern nursing.

After 11 years of nursing and while working as a Sister within a large GP practice, I became frustrated and felt I needed a career change. I had completed a degree in Practice Development and I wanted to use my skills but didn’t want to be in the environment where policy didn’t meet reality. For example, when your knowledge and experience tell you that you need a particular piece of equipment or treatment to support a patient, but your budget can’t support it. I was disillusioned and felt I couldn’t make the difference that I hoped I could when I started my career.

Although we had regular meetings and the issues were aired, things didn’t always change. I felt I had no voice. I left nursing at this point in 2013 and went into teaching Health and Social Care. Looking back this seems an unusual choice given that I felt so uninspired, yet I was in a formative position in students’ lives where I had the opportunity to inspire, coach and mould them into our Nurses, midwives, carers and social workers of the future.

In hindsight, it was just what I needed to re-ignite that Lamp of Light in me and I was able to find my voice and passion for nursing again. By teaching others the foundation values of care, I was able to find my own. I developed a skill for teaching academic subjects in a vocational way to an audience that did not always consider themselves to be academic.

During this time, I was asked to be involved in a project that brought me into teaching within Social Care. My teaching work took me into care homes and I learned so much from the carers and Nurses that I met. They had so much compassion for their residents and were making a difference to their lives on a daily basis. The residents depended on them to brighten their day as well as meeting their care needs with skill. The passing of knowledge from one to another was very apparent in this environment, they learned from me and equally, I learned from them. My perception of social care changed during this time.

The changing landscape of nursing in care homes 

When an opportunity came up to work at Four Seasons Health Care, I took it. I was soon working within a role that allowed me to coach, nurture and mould our future Care Home Assistant Practitioners (CHAPs). I am now able to influence policy changes and lead on wider projects and really make a difference.

I believe that the CHAP Project is part of the solution to the national shortage of Nurses that we have. CHAPs are making a difference to our services by supporting and assisting our residents, using their skills, compassion and experience to benefit both the Nurses and the residents. CHAPs are not a replacement to Nurses but an enhancement to what we already have.

Nursing as an all graduate profession is a concept of modern nursing – and one I fully agree with, however I don’t believe that those without degrees cannot nurse. Within the short history of the profession, we have had Registered Nurses that have not been degree qualified (Enrolled Nurses or Diploma trained Nurses), who have equally cared for patients and residents to an excellent standard. The change to an all graduate profession has meant that we have missed an opportunity to train those with good values but without the academic entry level qualification to nurse.

When we are faced with a national shortage of registered nurses, this has presented an opportunity to bring in another tier to the nursing structure and this is where, in Four Seasons Health Care, the CHAP role sits.

Registered Nurses are leaders of the profession, their specialist skills cannot and should not be replaced, however the more minor and less complex duties that a Nurse working in the care home sector traditionally carried out can safely be delegated to competent CHAPs.

Nursing is evolving – by training CHAPs well to assist Nurses, we are adapting to pressures, challenges and shortages in a proactive and innovative way that enhances residents experiences. The passing of knowledge from one Nurse to another, as symbolised by the Lamp Party, is not just representative of clinical skills, but how to cope with the complexities of modern nursing and how to adapt to meet the needs of residents and patients in safe and dynamic ways.”

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Louise Morris

As Care Home Assistant Practitioner (CHAP) Lead I work to support the rollout of the CHAP Qualification across the UK. The CHAP role aims to provide Care Assistants with the knowledge, skills and confidence to take on more responsibility within our homes. We couldn’t provide outstanding care without the work of every member of the care team and we want to support all our colleagues in their professional development. I am lucky enough to see our Care Assistants take this next exciting step in their professional care career.

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