Clinical Governance Improving the Continuing Education of Nurses – Myth or Reality? Nurse Management MSc Practice Development Nursing Practice Route Faculty of Community Studies, Law and Education The Manchester Metropolitan University Jean Rogers Tutor: Mary Shaw Submission Date: 8th August 2005 Word Count: Nursing has changed radically over the last two decades and is continuing to do so. Some would say for the better others for the worse (Rushford and Ireland 1997).
The purpose of this assignment is to offer a critical analysis of clinical governance as it applies to nursing and the effect it has had on nurses’ on going continuing educational needs. By the term critical analysis I do not mean that I shall attempt to discredit clinical governance, or claim that it is harmful to patients or staff. Instead, I will attempt to discern its nature in a rigorous way and examine how it has led to a change in the way professionals and patients in health care are conceptualised and how this has had an effect on the on going continuing education of nurses.
The introduction of clinical governance has resulted in change not only in nursing practice but also in the subjectivity of nurses and their educational needs. Staff do appear to be embracing the notion of clinical governance, however there appears to be very few changes apparent at the level of patient care (Brown and Crawford 2001). The major changes appear to involve their attitudes, and how they conceptualise themselves and their work. In addition, the introduction of clinical governance appears to involve encouraging a new kind of consciousness on the part of patients, amongst whom a greater degree of responsibility is demanded.
In reviewing the literature on clinical governance in nursing it appears that there have not been many critics. Indeed, searching the main electronic databases which cover topics which relate to nursing the Cumulative Index to Nursing and Allied Health (CINAHL), Psycinfo and Medline and numerous books has not revealed material which adopts a critical stance towards clinical governance and evidence based practice which are currently ‘buzz words’ in the nursing profession and the broader network of health care provision in the United Kingdom (UK) as a whole.
There has been some criticism in relation to nursing research This omission is surprising as Brown and Crawford (2001) maintain the efforts of commercial organisations to change their culture and urge this change on their workforce is similar to those changes being encouraged in the health care system and have been subject to considerable debate and critical analysis (Du Gay, 1997, Casey, 1999).
Yet overwhelmingly the nursing literature has concentrated on how the process of clinical governance can be facilitated rather than anything else (Lilley, 1999; McSherry and Haddock, 1999). In order to critically analyse these concepts it is judicious to define clinical governance. Clinical governance has been promoted as a way of managing the organisation, resourcing and delivery of health care in the UK for several years now and it is a process which has grown in strength and popularity during that time.
The standard definition of clinical governance which is promoted in the literature is from the paper a first class service (Department of Health (DH), 1998) is that it is a Framework through which National Health Service (NHS) organisations are accountable for continuously improving the quality of their services, and safeguarding high standards of care, by creating an environment in which excellence in clinical care will flourish. (Page )
In addition to this, the precise pathways under which this was to be achieved were elaborated in an earlier document The New NHS: Modern and Dependable (DH, 1997) which outlined three major strands in the strategy. First, there was to be a set of clear national standards, delivered through national service frameworks (DH, 1999) and the National Institute for Clinical Excellence (NICE). Second, the local delivery of quality services was to be undertaken via the mechanism of clinical governance and a statutory duty of quality and this was to be supported by lifelong learning programmes and professional self-regulation.
Thirdly, the services themselves were to be monitored via the Commission for Health Improvement (CHI) and the NHS Performance Framework (Lilley, 1999). However, very often these bodies and mechanisms of control are rather remote from everyday life in the ward and, staff and patients are made increasingly reliant on their own powers of self control in order to live up to these political and managerial imperatives (Holmes, 2001).
It is the second strand that this assignment will be concentrating on. Conclusion Whatever nursing’s response to clinical governance, it is vital that nurses are aware of the kinds of changes which it will involve for their consciousness and subjectivity as practitioners in order to ensure they retain their professional independence in the light of these new policies.