Previous Article Next Article Related posts:No related photos. Malone: a woman in a hurryOn 1 Apr 2002 in Personnel Today Beverly Malone, RCN general secretary, is committed to getting nurses’ feetunder the table at every level of the decision-making process. Nurses should no longer just make thedecision handed down to them, they deserve a centre-stage position, by NicPaton It would have taken someone of exceptional prescience to predict that thefailure of Al Gore to win the presidency of the US back in November 2000 wouldhave a profound impact on UK nurses. But his loss to George W Bush has beenBritain’s gain because it brought Dr Beverly Malone, current general secretaryof the Royal College of Nurses, across the Atlantic. At the time of the election, Malone was President Bill Clinton’s deputyassistant health secretary – the highest position a nurse has held in the USgovernment – but the continuation of her role depended on a Gore win. That’swhy, in June last year, she found herself taking over the reins of the RCN fromChristine Hancock, when the latter moved on to become president of the InternationalCouncil of Nurses. Impressive credentials With two terms as president of the American Nurses Association under herbelt, a seat on Clinton’s Advisory Commission on Consumer Protection andQuality in the Health Care Industry and two listings in Ebony Magazine’s listof the 100 most influential African-Americans, in 1996 and 1998, there is noquestion that Malone is a big hitter. Yet she has come from humble beginnings. Raised in Elizabethtown, Kentucky,she grew up in a southern area of the US that was still racially segregated,before, following integration, making it to the University of Cincinnati in1970 where she studied for a Bachelor’s degree in nursing. This was followed by stints as a psychiatric clinical nurse specialist aswell as studying for a doctorate in clinical psychology from the sameuniversity. She took on a number of further roles with the university, such assetting up a department of clinical nurse specialists and nurse clinicians toprovide in-house and external consultancy. She also established a midwiferynurses programme and started her own private practice in personal therapy andprofessional consultation. In 1986 she moved to become dean of the School of Nursing at North CarolinaAgricultural and Technical State University, during which time she served onvarious public bodies. By 1996 she had made it to the ANA, a body thatrepresents180,000 nurses across the US. The call from Clinton came four yearslater. Firm believer in the NHS Now, sitting in the RCN’s Cavendish Square headquarters in London, Malonecomes across as warm but polished, very sharp and absolutely committed tobattling hard to get nurses a voice at the top tables of the NHS – a healthstructure she evidently admires deeply. “Back in the States the history has been that you fight and grab andscratch for every penny that you can on an individual basis. But I consider theNHS to be the system to have. I believe wholeheartedly in the principle thatcare needs to be free at the point of delivery and that it should beuniversally accessible to everyone. “I am delighted to be able to wake up in a country where this issue isnot the one I have to go out and fight a war about every day, as I had to inthe US – about the underlying, philosophical basis of the system ofcaring,” she says. The RCN has long been a trade union associated with radical demands on payand conditions and a tough, battle-hardened approach to dealing withgovernments. While more than prepared to fight these battles, Malone, assomeone with the clear view of an outsider, is adamant about the need to thinkbeyond the next day’s tussle. “I really believe that if we can get nurses into decision-making places– and I’m talking leadership here – at the table where decisions are made. Thenthere would be less need to be out there scrounging around about pay or otherissues. “Nurses would be shaping the system. That is what I am looking for, notfor us to do things in isolated splendour at the top of a hierarchy. I want tobe around the table with colleagues and I want nurses’ input to be there,”she argues. “I am so discouraged when I see us only taking decisions thatare handed down to us and responding to those in a very reactive way, not ableto shape what it could be like for our patients,” she adds. Greater power for nurses Both the Government and doctors seem, finally, to be heeding her call.Health Secretary Alan Milburn has long recognised the need to give nursesgreater power and autonomy. In February, for instance, he unveiled a raft of new prescribing powers fornurses while Prime Minister Tony Blair pledged greater flexibility in workingpractices for frontline staff and a “highly charged debate” about howhealthcare should be funded. Malone says she believes “wholeheartedly” that the Government islistening to nurses and the medical profession, not least because there is nowso much at stake politically. Perhaps more surprisingly, the BMA in adiscussion document the same month said it might be prepared to abandon thehallowed role of GPs as “gatekeepers” to the NHS in favour of a morenurse-focused approach. It proposed nurses could co-ordinate the care around a patient, so that inprimary care, for instance, nurse practitioners would be the first port of callwith doctors only being called upon when their skills are needed. BMA chairmanDr Ian Bogle even conceded that those working in the NHS needed “to take along, hard look at how they work”. Shortage of nurses This, of course, is all well and good in principle, but if the nurses arenot there to do the job – and 25 per cent of nurses are now aged over 50 – itis simply not going to work. The shortage of nurses, and the need to stop theexodus from the profession is already one of the biggest issues policymakersneed to address, Malone asserts. “How do you convince nurses who feel undervalued that they should stayin the profession maybe another five to 10 years?” she asks. “I think you have to find new ways of working. I really believe thatthere should be newly developed opportunities for nurses who are older so theydo not have to do the same type of work that they did when they were 21, 28 or30.” The age of nursing students is getting older, with the average now 25 to 27rather than the 18-to-20-year-olds of a few years back, making issues of payand opportunities for career progression and lifelong continuing education evenmore critical. “The pay is the single most effective determinant of why nurses stay innursing,” she stresses. Despite all the extra money the Government isputting into the NHS, Malone says she is still “appalled” at how lownurses’ pay remains. “There has to be a big boost for nursing pay to get better. It’s notsomething that can be done in little increments – I have a saying ‘it’s a cinchby the inch but it’s hard by the yard’ – but when it comes to pay we need theyard,” she asserts. She is also horrified by how little thought appears to go into workforceplanning for nurses, something that she believes should be top of the agendawhen there is a recruitment and retention crisis . “I am hoping that the RCN will be able to work with the Government inputting something together that could actually start monitoring workforce andworkforce issues. Whether it’s why people are coming back into nursing or whythey don’t come back, those sorts of questions and research opportunities needto be available,” she says. Occupational health nurses Despite asking for Carol Bannister, the RCN’s OH adviser, to sit in on theinterview, it is obvious that, even with all her other areas of responsibility,Malone has made an effort to brief herself closely on some of the key areas ofconcern for occupational health nurses. “I believe occupational health nurses are some of the most requiredsystems thinkers there are,” she argues, arguing that they often need totake a holistic approach to decision-making. “They have to continually assess the environment and the community.They have to be thinking about how they can shape the response of theircorporation so that it is more accessible to the people who work there.” Not enough of this type of thinking takes place in the NHS, she adds, andoccupational health nurses could be used more to pass on best practice thinkingto, say, acute care nurses. “What can we do in the system to make sure our patients’ stay is asinfection-free and healthy as possible, for instance. How do we make sure thatit is not complicated by other things?” Ultimately, nurses need to stop thinking of themselves as people who simplycarry out the orders of the great and good and realise they have something ofvalue to contribute to the decision-making process, she argues. She cites theexample of some private finance initiative-built hospitals that have been constructedwith corridors too narrow to turn trolleys around, or where nurses cannot seepatients from their nursing station. Malone would like to see the new strategic health authorities being set up”clearly reflecting nursing input at every level” and primary caretrusts similarly putting nurses centre stage in the decision-making process. “I’m talking about making sure that nurses are involved indecision-making, shaping how care is delivered, how buildings are built and howsystems are managed. And it is not just for the glory of nursing, it is forpatient care and that’s why I feel we cannot be patient about this and use itas a long-term goal,” she says. “I think that we should do some knocking of heads together, in a verypolite and courteous but nevertheless very clear and dramatic way, to say thatif you are really talking about building a patient-centred environment, whetherit be in a workplace or a PCT or acute care trust, it has to be that thepatient is central. Because nurses are advocates for patients and deliver 80per cent of their care, they need to be involved in that decision-makingprocess. “It’s a wake-up call, but it’s a win for everyone. At times some peoplemay say ‘oh those nurses they just want more’ but it really is about changingthe system and making sure patients get what they need.” When Malone visits nurses around the country – which she does frequently –the most common complaint is the sense of being undervalued andunder-recognised, she says. There’s a disparity between the high perception inwhich nurses are held within the public eye and the attitudes of doctors,ministers and administrators to their nurse colleagues. “There’s a real gap between how the public views nurses and how we aretreated. There is nowhere that I go when I talk to nurses that this issue isnot raised,” she explains. For occupational health nurses this would mean being in a position wheretheir decisions are affecting the way their company operates, either becausethey are on the board or because they have access to it. “I would like to hear about some occupational health nurses who weresitting on the boards of their companies having a direct way of feeding backinformation about health and safety, how they save that organisation money, howthey get people back into employment and how they are planning and working todo that successfully. To me that would be a measure of success,” she says.With the political clock ticking loudly, Blair and Milburn are men in ahurry to see real improvements in the NHS. Equally, for Malone, getting nursesto the table where decisions are made is a vital part of this process. It needsto sit beside the battle for this percentage pay rise or that number of extranurses. “I believe it has to be short-term goal. I want to see, soon, nurses atthe decision-making table, with communities, regardless of who they are, havingan appreciation that nurses are the ones who are managing the system of care. Ithink we need to be very impatient about this,” she stresses. Comments are closed.