The RNID – An Evolving Profession
The NMBI Summer Series event co-hosted with St Angela’s College was focused on Intellectual Disability Nursing, with the theme ‘An Evolving Practice’.
CEO of the Nursing and Midwifery Board of Ireland (NMBI), Sheila McClelland, began proceedings by welcoming all attendees to the third NMBI Summer Series event which was also livestreamed to an online audience. An Irish Sign Language (ISL) interpreter was also provided.
Amanda McCloat, President of the College, also addressed and welcomed attendees. She highlighted how the college has transformed over the last few years and the College’s transition from accreditation by NUI Galway to affiliation to the Atlantic Technological University. She said the College has a student-centred approach and was recently ranked the best in Ireland in a social mobility ranking study for student progression. The School of Nursing and Health Studies has seen a huge increase in student numbers, with the current student numbers standing at 1,600.
NMBI President, Essene Cassidy also welcomed all attendees to the Sligo event, saying the discussions had been organic and allowed to develop.
She also acknowledged and thanked everyone involved in the organisation of the event, in particular Dr Evelyn McManus, Acting Head of School of Nursing, Health Sciences and Disability. A special welcome was afforded to Minister Frank Feighan and Professor Ruth Northway from the Faculty of Life Sciences and Education, University of Wales.
NMBI Director of Education, Policy and Standards, Carolyn Donohoe, presented NMBI demographics to attendees. Data was presented for the overall registration numbers across divisions with a focus on the current registration for the intellectual disability (ID) division. As of 1 June 2022, there were 5,161 ID nurses in the division. It was noted that around 10 per cent of ID nurses are male. Ms Donohoe also noted that Sligo has the highest number of ID nurses in the country outside Dublin and Cork.
St Angela’s College, Acting Head, School of Nursing, Health Sciences and Disability Dr Evelyn McManus, highlighted the programmes for undergraduate and postgraduate studies at the school, as well as for standalone courses and courses for international nurses. It is an evolving school and continues to evolve, said Dr McManus.
Seamus Dolan, Lecturer, Department of Nursing, Health Studies and Disability Studies, chaired the panel discussion. Each panellist had the experience of intellectual disability nursing from a different perspective.
The panel consisted of Carmel Jennings, Lecturer, Department of Nursing, Health Studies and Disability Studies, Susan Carton, Lecturer, Department of Nursing, Health Studies and Disability Studies, Judy Ryan, Director, NMPDU, HSE Kilkenny, Sarah Barrett, final year student BNSc ID.
Carol Doherty, Clinical Nurse Manager 3 with HSE Disability Services Sligo/Leitrim Tomás Murphy, Self-Advocate and Margaret Turley, Self-Advocate.
Seamus Dolan began the conversation by asking about key changes in practice. Susan Carton indicated one of the key changes came from the Convention on the Rights of Persons with Disabilities adopted in 2006 by the United Nations. It is also the reason why we have the Assisted Decision Act. Ms Carton said the convention involved disabled people and is based on the social model of disability. The social and medical model of disability has changed how we think and the landscape of how the world works. Previously disabled people were segregated and left out of society; therefore, they were not part of the development of disability practice. The social model allows nurses to look at things differently and start identifying what are the barriers and how it affects nurses. It is changing how everyone thinks and works, she said.
Carol Doherty also spoke on the shift in the profession from medical to a social model, and how healthcare personnel look at adapting needs to suit disabled persons. Nurses are now active listeners to provide support. She said adults with a disability should live a life of their choosing and assisted decision-making is key to developing this. RNIDs should ensure people with a disability are empowered and seek to manage risks instead of avoiding them.
Tomás Murphy indicated people with disability need to be the driving force. Routines of medication etc are things from years ago. Times have changed and people with disability need to be supported, not controlled, and they need to have a say in their care, he said.
Margaret Turley said she believed there can still be too much emphasis on rules and safety for people with disability and being told what is best for them. They need to make their own choices that anyone else would be able to make and be supported to do things that they choose.
Carmel Jennings highlighted the use of language preferred by ID service users. About language, for example, the preferred term is disabled people. She said that focus now is on how people want to live their lives and how nurses can support them in living their lives and work in partnership with the person. She added: “Our way of thinking, looking at our curriculum philosophy and changing the way we do our teaching and changing our attitudes is part of the process. We have a way to go, but we are getting there.”
Carol Doherty suggested we need to manage and adapt to the changing demographics and transition to the community settings. In line with aspects like sexuality awareness and HR training, practice development and improvement in service. She said it had to involve active collaboration with the disabled person, and not just some sort of tokenism.
Judy Ryan said a review of clinical placements is needed with the majority of placements in traditional settings. ID nurses are available for roles in many different settings including in homeless populations and prisons. She said this needed to start with the undergraduate programmes. People with ID access a range of services, including maternity, mental health, and acute services, she added.
Carmel Jennings also spoke on the strength of the courses delivered at St Angela’s where graduates make a real difference to clients. She also said nurses supporting disabled people need to be informed by disabled people. “Our experts are disabled people themselves and they need to be represented in curriculum and policy groups and inform how we develop our practice to support people in the right way,” she said. Developing ANP and Clinical Nurse Practitioner roles and the education for this is an acute-based need for social model thinking, rights and the convention.
Margaret Turley and Tomás Murphy said that it should not be presumed that disabled people need follow-on support, as it may be that they ask for once-off support. They said that sometimes disabled people are afraid to ask for support or say they are unhappy with something because of the consequences. Nurses need to listen to you and support you when you need it, they said.
Tomás Murphy believed that it is important that people with disability are involved in the policy processes and decision-making spaces, so they have a chance to speak on how to progress with care and service.
Sarah Barrett - a 4th-year student – was asked how she would like to see her role evolve. She spoke about studying the new curriculum, the modules on person-centeredness and rights and equality. She hopes to be able to reflect and apply to practice what she has learned from disabled people and support them. She wanted more opportunities for RNID, for example, to be able to work across different services and the liaison roles in acute services and mental health, older persons and other services.
Sarah said she wanted to see additional post-registration courses and opportunities to access other postgraduate programmes to develop knowledge and enhance skills. Additionally, there needs to be greater opportunities for RNIDs in leadership roles in how services develop, evolve and ensure that services are created together with disabled people, rather than for them. They should be leading the service.
NMBI and St Angela’s College were delighted that Ruth Northway, a professor of Learning Disability Nursing at the Faculty of Life Sciences and Education University of South Wales, was able to travel to Sligo for the discussion.
The special guest told the audience that before working in nurse education, she worked alongside people with learning disabilities in the community and in residential settings. She reflected on how far care had evolved in the last 40 years. The profession has been forced to critically review what we were doing and why we do it, as ID nursing practice was put into question, she said. This has also assisted in evolving the profession and enhancing the lives of people with disability. She indicated that knowledge and skills are facility-independent – not specific to hospital settings. ID nurses are important in various settings, such as communities, schools, residences, public health and prison settings. She advocates for the diversification of roles led by looking at the needs of people. Leadership is an important part of the transformation, nurturing nurses to develop leaders and confidence in whatever role they are working in, she said.
We should not be waiting for opportunities; we need to be proactive and create developing skills and work in partnership and form alliances with various individuals, said Prof Northway.
Minister Frank Feighan said he found the event an interesting and informative discussion, and he indicated that he is aware of the work being done particularly in the North West.
The Minister said the RNID has a unique role and is ideally placed to support complicated care in the community during stages of life, to ensure the full potential of the individual is realised. RNID is equipped to act as a lead professional and educator, mentor and friend to the individual and ID, providing the appropriate mix of professional care, education, guidance and support. RNID enable the voice of people in ID to be heard when accessing care.
Minister Feighan said that his colleague the Minister for Health, in conjunction with the Chief Nursing Officer, is working to increase the percentage of Advanced Nurse and Midwifery Practitioners in the workforce from 2% to 3%, with an allocation of €11.6 million in 2022. This will provide an additional 160 Advanced Nurse and Midwifery Practitioners, and the ID services have two candidates. He indicated it was great to meet everyone and impressive to hear the presentations of RNIDs and the self-advocates and thanked everyone for their great work.
Those present answered questions from the audience as well as from those watching online before NMBI CEO, Sheila McClelland brought the event to a close.
Ms McClelland thanked all those who took part in the discussion, acknowledging that service users need to be a continuous part of how RNIDs evaluate services. She also referred to comments by Tomás Murphy, who said services and society are continuously changing and everyone involved in nursing needed to be cognisant of that.