The Big Interview: Dame Professor Donna Kinnair
IN-DEPTH - 1ST OCTOBER 2016
One of Britain's most senior nurses talks to Prognosis about her roots in community nursing, sitting on government commissions and why she believes the title 'nurse' is in dire need of protection.
“To be honest, I wasn’t exactly sure what a damehood was when I got the letter,” says Dame Professor Donna Kinnair as we sit at a round table within the Marylebone headquarters of the Royal College of Nursing. “One of my sons had to research exactly what it meant. It was a huge surprise once I realised the honour that was being bestowed. The letter had been sitting there for three weeks as I had been away in America, so I had to get a move on with the reply in case they thought I was turning it down.”
“My brother died when I was about 14 years old and I didn’t think I wanted to be around illness and death,” she says. It was not until she was working in Marks & Spencer, having decided to drop out of a maths degree, that she again crossed paths with the nursing profession.
It was validation of a career with deeply personal roots. Dame Donna’s father was chronically asthmatic and she saw first-hand the impact that good quality nursing could have on a patient. This left a deep impression on her—but it wasn’t a straight line from childhood dream to nurse’s uniform.
Having married her childhood sweetheart, Donna was pregnant with her first child when a visit to the company’s occupational health nurse changed the direction of her life. “I was telling her how much I had wanted to be a nurse as a young child, when she looked at me and said: ‘You still could be.’ I realised then that the desire had never really gone away. As soon as my son was born, I entered nurse training.”
She knew instantly that she had made the right decision. She loved the patient contact from the beginning, and nursing satisfied that academic part of her nature that had been left unfulfilled by university. “I am one of those people who likes studying and this career has given me the opportunity to study as much as I want to, over a wide variety of areas,” Dame Donna continues. “I remember spending a lot of time improving my understanding of the brain during training, simply because it happened to interest me.”
She recalls using that knowledge to draw a diagram of the brain for a patient who had suffered a minor stroke. The patient was trying to understand why the problem had not been flagged up during initial tests. “It helped the patient understand what had happened to her, which eased some of her anxiety.”
For Dame Donna, this is a wonderful example of the two sides of nursing coming together: technical knowledge and emotional intelligence. “There is a real sense of satisfaction when you make this kind of connection,” she says. “You can see the good you are doing for another human being.” She believes that these moments of communication lie at the very core of nursing.
Dame Donna’s career has given her a clear-headed view of what is needed to do the job well. There is no place for misty-eyed romanticism about “gentle angels mopping fevered brows”; dealing with illness can be dirty, physically demanding and emotionally draining. And while there are patients who develop good relationships with nurses, there are others whose reactions range from stubborn non-cooperation to outright hostility, and a nurse needs the ability to deal with it all.
Nursing calls for a special kind of person: someone who can combine critical thinking with compassion, and whose central concern is always the welfare of the patient. Such people are not as easy to train as some would have you believe, says Dame Donna, and those we have are often not valued enough. While some—notably, she says, some of those in Westminster—would disagree with these statements, everyone can agree on one thing: the NHS does not have nearly enough of them—a situation which has led to an over-reliance on agency staff.
The RCN headquarters on Cavendish Square
One of the aspects of this situation Dame Donna finds most frustrating is that the present state of affairs is neither new, nor unforeseen. In 2010, she was invited to sit on the prime minister’s commission on the future of nursing and midwifery. Its purpose was to look at the state of nursing from recruitment and training, through to the challenges nurses face on the ward and out in the community.
“One of the really interesting strands of the discussion was, for the first time, the government really thinking about the role of the community nurse and how care could be integrated into the community,” she says. “A community nurse sees a patient with Alzheimer’s, say, only occasionally, but the patients’ families live with them full time. Part of the role of the commission was to discuss how we could work with carers in an effective way, to support the nurse in providing high quality care for the patient while not leaving the family isolated and exhausted.”
It required taking an honest look at the number of qualified nurses available, asking if their training was up to the task and if it wasn’t, what action needed to be taken. “One of the phrases I clearly remember from that commission was ‘carequake’. Both on the ward and in the community, we did not have enough nurses, which meant they were under increasing pressure to deliver a wide variety of types of care. Unfortunately, this is now something nurses are experiencing on a daily basis.”
In the end, the timing of commission meant it fell foul of the political cycle. An election led to a change of government—one with different priorities. The commission’s final report was, however, published, with recommendations that were grouped into seven areas, all of which need urgent attention. One in particular resonates deeply with Dame Donna, because she believes it lies at the heart of many of the issues currently faced by the nursing profession—the suggestion that the title ‘nurse’ should be given statutory protection.
“In some ways it’s difficult to define a nurse, because they can work in so many fields—neonatal units, care homes, intensive care, accident and emergency, cancer units—each of which require different and often specialist skill sets,” she explains. “But there are fundamental attributes which underlie nursing everywhere: can you observe when a patient is deteriorating and needs some assistance or an intervention to get them back on track? Can you understand their recovery path from whatever illness or procedure they have had? Can you spot if they are struggling emotionally as well as physically? Do you have the empathy skills to help them through a difficult patch? Finally, if their prognosis is terminal, do you have the ability to work with them psychologically so that, wherever they are going to, they arrive in peace.”
The British public holds nurses in high regard, which according to Dame Donna, can sometimes be a double-edged sword. “The NHS is a very easy target for politicians, and with nurses making up the highest percentage of NHS workers, making pronouncements about nurses can be a shortcut for talking about the NHS as a whole,” Dame Donna explains. “Politically, you can play games with the term ‘nurse’, as it is not currently protected.”
"What we can expect from the NHS in the future? What can it fund, and how are we going to change the structure to do what we think is necessary? As the people most often in contact with patients, it is vital that nurses’ voices play a role in the debate"
At present, the training programme produces four types of nurse: adult, children’s, mental health, and learning disabilities nurses . However, people who have not passed a nursing degree course can still use the term ‘nurse’ in their title—something Dame Donna feels is unhelpful. She explains that what the Royal College of Nursing wants to guard against is the public being confused about whether the person attending to them is a nurse who has undergone three years of training, or a healthcare worker who has not.
Dame Professor Donna Kinnair
“The government wants to introduce what is called a ‘nursing associate’,” Dame Donna explains. “At the RCN we are not keen on this title, because while the final level of training they will need is yet to be finalised, it looks like it will be below that of an enrolled or state registered nurse.” While it is still early in the process, the current proposal is to make these nursing associates band four healthcare professionals, meaning they have some kind of healthcare qualification, but crucially have not undergone nursing training, so can only work under the supervision of a qualified nurse. “If this does end up being the final position, they could have had no formal nursing training, yet still have the word nurse in their title,” she says with a hint or frustration.
The healthcare landscape is already crowded with ‘nurses’. Many healthcare workers do vital work supporting physiotherapists or rheumatologists, for example, but while there is no real nursing involved in their duties they are routinely referred to as nurses.
Dame Donna sees political benefits in a growing profusion of ‘nursing’ titles. “At the moment a politician can claim to be increasing the number of people in nursing by including these roles. While technically true, it is misleading and can lead to confusion about the real level of action needed to redress the current shortage of trained nursing staff.”
Of course this discussion is not taking place in a vacuum: the world in which nurses operate is continually changing, and as it does so, new challenges are emerging. One of the biggest we are facing at Royal College of Nursing the moment is an ageing population, with the growth in dementia-type conditions that come with it. The country as a whole will have to find a way to meet this challenge, but it is healthcare professionals, and nurses in particular, who are going to be at the sharp end, managing the conditions and supporting families.
“For me one of the biggest challenges is that of rising expectations. What we can expect from the NHS in the future? What can it fund, and how are we going to change the structure to do what we think is necessary? These are difficult questions and as the people most often in contact with patients, it is vital that nurses’ voices play an important role in the debate,” she says with real feeling. “The public value nurses immensely, but the relationship between nurses and politicians is very different. There needs to be an honest conversation about the role of the nurse within the field of healthcare: what nurses’ responsibilities are and where nurses stand in relation to other healthcare professionals.”
While the issues facing the profession are serious, and Dame Donna is working hard to tackle them, a twinkle is never far from her eye as we talk. While it is no doubt stressful at times, in essence her job is to find creative ways to make things better for those that work in a profession she loves. Any success makes the lives of thousands of her fellow nurses better. “I try to make sure that any conversations I have—whether it is with government ministers, representatives from other countries, or nursing leaders from around the UK—are positive, and that they inspire confidence in nursing,” she tells me. “I want to make sure that people understand that we do have wonderful nurses in this country; nurses who develop practice that is cutting edge, and becomes the benchmark.”
The Royal College of Nursing spends a huge amount of time exploring good practice around the world—what is being done elsewhere that the UK could learn from, how good practices developed in this country can be shared elsewhere, how new challenges such as antibiotic resistance are being met and how safe practices can be developed for working with epidemics such as the zika virus, protecting nurses and patients alike.
While the implications of her work may sound a bit dramatic, Dame Donna is happy with her lot. “Personally, I have had the time of my life as a nurse,” she says with a smile. “I have totally loved my career. It has been very diverse and has given me the opportunity to manage things, to use my love of academic study, shake things up, work in child protection. There is huge possibility for diversification into different fields. If you have fundamental knowledge of how to nurse and think about why you’re doing things, I think it is a fantastic career.”