Improving Care: One Small Step at a Time

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Kirsten Huby, Lecturer in Children’s Nursing, School of Healthcare, University of Leeds


As healthcare and patient needs change, so too must nursing and nurses to meet new and increasingly complex needs. The move to an all-graduate profession is critical to ensuring the nursing workforce is prepared to meet these new demands and challenges (RCN, 2007). Despite criticisms, for example that graduate nurses lack compassion a claim firmly denied by the Willis Commission (2012), evidence highlights that graduate nurses do make a difference to patient outcomes. Aiken et al (2014) reviewed nurse staffing and education and hospital mortality in 9 European countries and found that for every 10% increase in graduate nurses employed the likelihood of mortality within 30 days of surgery decreased by 7%.

Nurses are required to deliver evidence based care and be able to think critically, weigh up judgements in order to make sound clinical decisions (Willis 2015). The nurses of today and the future will need to be ‘expert clinicians, change agents, entrepreneurs, champions and leaders of multi-disciplinary teams’ (Willis 2015). Nurse education must equip our graduates to undertake these roles. The ability to think critically; weigh up information, identify weaknesses within assertions, challenge prejudice and bias, think logically and consistently (Borglin, 2012) is an essential requirement for nurses but often something that is difficult to define, teach and engender.

At the University of Leeds students in the third year of the BSc (Hons) Nursing (child) programme are required to identify an aspect of practice that could be improved through innovation and change. The students evaluate the evidence underpinning the innovation and, guided by clear objectives, plan how they would implement the innovation through change. As well as critiquing the evidence base the students demonstrate an ability to understand how the evidence applies to specific practice areas and how it will enhance patient care. This work is assessed through individual presentations and an essay thereby enhancing the student’s ability to present their ideas and clearly articulate a rationale for change. By responding to questions the students dan emonstrate the skills required to defend their ideas based on the evidence base and recognise and respond to flaws in their argument; key requirements of critical thinking.

This year 3 students presented their ideas for change at the inaugural Leeds Children’s hospital Conference giving them the opportunity to enhance their ability to share ideas, inspire others and lead change. Their innovations were drawn directly from contemporary practice and, although appear small, the proposed changes could have a substantial impact on both practitioners and the healthcare experiences of children and their families. The students ideas included: supporting staff when introducing a paperless system in a community setting; improving sibling support in the paediatric oncology setting; and improving preparation for cannulation in the Emergency Department.

The students clearly demonstrated ‘graduate’ skills and an ability to think critically. These skills should be recognised and nurtured by employers to facilitate high quality care to children, young people and their families in the future.

Further reading

Aiken, L. et al. 2014. Nurse Staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet. [online] 383(9931). pp:1824-1830 [Accessed 24 September 2014] Available from

Borglin, G., 2012. Promoting critical thinking and academic writing skills in nurse education. Nurse Education Today. 32 pp: 611-613

Royal college of Nursing, 2007. Pre-registration Nurse Education. The NMC review and the issues [online] RCN: London [Accessed 2 November 2015] Available from

Willis, 2012. Quality with compassion: the future of nursing education [online] [Accessed 2 November 2015] Available from

Willis, 2015. Raising the Bar. Shape of Caring: A review of the Future Education and training of registered Nurses and Care Assistants [online] Health Education England [Accessed 2 November 2015] Available from

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