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Spotlight Interview with: Anne Marie Rafferty

Spotlight Interview

With Anne Marie Rafferty
Dean, Florence Nightingale School of Nursing & Midwifery
Conducted June 2010

Anne Marie Rafferty’s research interests cover health policy, health services research and the history of nursing. She has been closely involved in developing research on the links between nurse staffing and outcomes. Professor Rafferty is Dean of the Florence Nightingale School of Nursing and Midwifery, Kings College London. She is also a Fellow of the Royal College of Nursing, Queen’s Nursing Institute and Honorary Professor at the London School of Hygiene & Tropical Medicine. In 2009 she was made CBE (Commander of the British Empire) in the New Year’s Honours.


You have been a member of the Prime Minister’s Commission on the Future of Nursing and Midwifery in England. What are the main HR and workforce implications of its recommendations?

Anne Marie Rafferty:

The Commission’s 20 recommendations highlight the need to prepare nurses to meet the growing demand for highly skilled care for people with long-term conditions and the complex needs of ageing, and see nurses as central to delivering this care, both in hospitals and in people’s homes. However, they must be properly equipped and supported to do so.

All the Commission’s recommendations have an HR component. At the heart of the changes, and key to delivering on the range of recommendations, is the continued focus on the educational agenda and the move toward degree-level qualifications for nurses in England. As well, the Commission’s recommendations call for an investment in the development of dynamic and challenging careers for nurses, which bring together the clinical and academic fields of nursing, and, through better linkages, strengthening both.

The emphasis is on retooling the profession for the future through redeveloping and redeploying the existing workforce as well as ensuring high quality education for the nurses of the future. It is underpinned by a workforce strategy that pays as much attention to capitalising on and recalibrating the skills of the existing workforce as it does to the need to adequately prepare the workforce of the future.


Contemporary nursing involves a high level of clinical skill and technical expertise, as well as a range of non-clinical skills required to effectively manage and coordinate care and relationships with other professionals. In this environment, how do Nursing Schools ensure that new graduates are ‘work ready’?

Anne Marie Rafferty:

At the Florence Nightingale School of Nursing and Midwifery, the importance of providing students with a relevant and appropriate education, and ensuring graduates are work ready, is incorporated into our educational programmes from day one. The School works closely with service providers, establishing a 50/50 partnership in providing for nurses’ education. As well, the School works with service providers to produce and skill up mentors to provide support for students. It is important to remember that the School itself only provides half the student’s contact, so establishing a shared purpose and common values with services providers is important, whether this be with the NHS or independent and voluntary organisations.

The Healthcare Trusts (governing bodies of service providers) are also included in the selection of students, and each student has a “home Trust”. This provides a sense of belonging and ownership for both the student and the service provider. Throughout the course, there is continuous assessment and monitoring of progress. This means that students don’t progress through the course unless they can demonstrate that specific milestones are reached, based on competencies that are shared and in part defined by the regulator as well as the students’ own priorities and needs.


It was recently announced that nursing in England is moving to an all-graduate profession. What will this mean for nurse recruitment, and what strategies are being employed in the UK to attract people to nursing as a career?

Anne Marie Rafferty:

The School is continually refining its approach, with a focus on moving from a ‘crowded’ to a creative curriculum. That is, we are aiming to provide a curriculum that not only provides nurses who are skilled in delivering care, but also use imagination and ingenuity to manage the challenges of the future. I believe that by exposing students to different forms of creativity and criticality we can help make then “future-proof”.

Managing the great heterogeneity of the profession and turning this diversity into an asset is also important. A significant proportion of students have work experience in other fields when they come to nursing, and this proportion is set to increase. These students come with both a high level of commitment and a range of transferable skills which are a valuable resource and can be further developed. It is important to recognise that there is a treasure trove of talent in what people bring to the profession from their own life experience, and developing a working and leadership culture which is capable of capturing and nurturing these skills and experiences is one of the key elements of transforming nursing services of the future.

The critical thing is to set the benchmark for entry and demonstrate that if you set your benchmark high, your achievements will follow.

The unwritten back-story of the profession is one of social mobility and enablement: nursing has historically provided entry into the professional labour market for groups that may otherwise be excluded or marginalised from the graduate labour market, including women and minority groups. Nurses have often been the first in their families to go to university, and the profession can expect to continue to play this important role in building human and social capital with the move to graduate education. That is a great attraction of nursing, and makes it doubly important that career paths are also developed that provide avenues for transition and social transformation.

In this context, the Nursing and Midwifery Council (NMC) is currently reviewing pre-registration nursing education, proposing new standards for competence and education. What changes would you like to see as a result of this review?

Anne Marie Rafferty:

It is important for the Nursing and Midwifery Council to continue to play a strong role in determining the principles and standards which need to be achieved. It is equally important that education providers are engaged in that process and able to work creatively and flexibly with the outcomes specified. That is, the NMC should determine what is delivered, but the health educators should be empowered to utilise their expertise to determine how that is best delivered and achieved. 


The Boorman Review (2009) highlighted that nurse managers and leaders can both improve and undermine staff health and wellbeing. What is needed to ensure that nurse leaders are equipped with the skills and knowledge to manage effectively?

Anne Marie Rafferty:

It is the responsibility of leadership to establish that positive culture and set the expectations. This includes clearly articulating the expectations as well as being honest, forthright and supportive in one’s own behaviour. Being true to oneself, demonstrating a genuine commitment to getting it right, and persisting through personal and professional barriers and difficulties until you succeed is important. People provide better care when they are cared for themselves. Learning the skills to provide staff with good quality feedback is also an important part of a positive practice environment, in which feedback on performance is consistent, continuous and seen as an integrated part of broader efforts to achieve continuous improvements in service delivery and care.

Effective management is a matter not just of individual behaviour, but also a product of the work environment including both physical environment and the psycho-social climate. People work best when they are valued and can see the impact of their actions. Nurses need to be given the freedom to use their heads, hearts and hands and be empowered as trusted colleagues to respond and take decisions within their scope of practice, while being supported and backed by strong leadership.

The importance of the emotional climate cannot be underestimated. When we work in challenging environments, we tend to develop fantastic vocabularies for negativity. It is important for nurse leaders to acknowledge that most nurses work above and beyond what is required through both a personal and professional commitment to doing a good job and providing excellent care. It is the job of managers to clear the day to day challenges out of the way so that the excitement and stimulation of this shared mission can be enjoyed.

You have a keen interest in the policy and research context on the links between nurse staffing and care outcomes. How do you see this agenda developing over the next few years?

Anne Marie Rafferty:

To date, outcomes frameworks have tended to focus on those aspects of care which can be clearly quantified. These can provide an empirically accurate assessment of certain aspects of care, but can seem quite removed from those things that the public regards as most important.

I would like to see the development of outcomes frameworks that recognise the importance of the care environment and that resonate with patients and their experience of care: a new prospectus for care that guarantees quality. This is what the pledge outlined in the Commission report is aiming for. It calls on nurses as a profession to swear an oath that we cannot live with anything less than the best. We need to join with the other professions and patients themselves to develop a coalition for quality which is committed to 100% achievement of quality benchmarks.

Nurses need to train to achieve these targets every day, just as Olympic athletes train for hours every day to deliver continually improved performance. It includes striving to do what you do to the best of your ability, but also anticipating future needs and challenges. This means thinking through what it really means to be “world class”, and committing to whatever needs to be done to deliver it. In some cases, it might mean looking at what we do – and who does it – differently, such as increasing the focus on supporting people to look after themselves better, while maintaining our capacity to mobilise professional care when needed.


The recent global financial crisis is impacting on public sector budgets worldwide, and significant spending cuts are being foreshadowed in the UK. Is this likely to impact on nurse staffing and education, and if so in what ways?

Anne Marie Rafferty:

Why waste a good crisis? I am hopeful that by being creative we can use this to our advantage, taking the opportunity to focus on the quality of the work environment, improve retention and reduce recruitment costs. If we can find ways to reduce “churn” in the system during this period, the constraints may paradoxically work in our favour.

The introduction of the higher level of education for nurses may also help with retention. The current environment forces us to look at the system in a new way, and provides an unparalleled opportunity for nurses to be the architects, engineers and designers of a new health care system. We have world-class creative industries in the United Kingdom, and we need to work with those who are already conversant in the principles of good design and design our way out of crisis and into the future.


To mark 150 years of operation Florence Nightingale’s School of Nursing and Midwifery is currently celebrating its Year of the Nurse and Midwife. What do you see as Florence Nightingale’s greatest legacy to nursing?

Anne Marie Rafferty:

Florence Nightingale left an unparalleled legacy, and was an individual with rare gifts in a number of different areas. She combined a high level of intellectual rigour with strong emotional intelligence and strength of character. One of her other great assets was that she was a first class communicator, utilising all the techniques of rhetoric, persuasion and data use in order to gain support for significant and lasting change.

Perhaps her most admirable quality was her determination and resilience in the face of obstacles and opposition. Florence Nightingale provided an exemplar of what can be achieved by refusing to give up. If she didn’t succeed at first, she looked for another way. This determination and resilience provides a model for nurses as they meet the challenges of care provision in the 21st century. She was well educated and came from a privileged background which gave her the confidence to stand up to authority. Yet she empathised strongly with those less fortunate than herself and demonstrated an enduring and unshakable sense of social justice.

Is there anything further you would like to add?

Anne Marie Rafferty:

Florence Nighingale’s words speak to us today. Her writings reveal that she was above all an excellent nurse, attentive to the details of care and a systems thinker. Florence Nightingale was a global citizen, multi-lingual with an encyclopaedic command of health and health systems. She was also a creator of this powerful community of which we are all part.

Further information:
Front Line Care: Report by the Prime Minister’s Commission on the Future of Nursing and midwifery in England (2010)

NHS Health and Well-being: Final Report (Dr Steven Boorman, 2009)

Última actualización el Jueves 30 de Agosto de 2012 09:41