Over 40 000 registered nurses, working for 18 500 organisations, are employed in the social care sector (Skills for Care, 2024a).
In 2024, the Care Quality Commission (CQC) found that, statistically, there were more adult social care providers achieving a rating of ‘good’, and fewer a rating of ‘inadequate’ or ‘requiring improvement’ than NHS acute hospital counterparts (CQC, 2024) (eg 78% of all adult social care setting were rated ‘good’; 72% of nursing homes versus 62% of acute NHS hospitals).
Despite such positive outcomes and achievements, ongoing stigma and under-recognition of the high-quality, dynamic and innovative nursing delivered in this sector is prevalent and work has been under way to address this across policy, practice and education.
In summer 2024, Skills for Care and the University of Salford hosted a joint conference to explore the contemporary challenges facing nurse education and the social care nursing workforce, as well as celebrating the appointment of the first RCN Foundation Chair in Adult Social Care Nursing (Professor Claire Pryor). The focus of the conference was to bring together nurse academics and educators to ensure that social care nursing is part of the narrative of nurse education and valued as a strong and vibrant part of the nursing workforce.
One of the main challenges regarding social care nursing is the under-recognition of the complex role that social care nurses hold. Therefore, one of the activities of the conference centred around ‘talking walls’, which collated sector expert perspectives on a collaborative way forward. Evaluation of feedback from the wall highlighted five key areas to address:
- Map curricula to ensure they represent the full scope of nursing career opportunities and employment profiles
- Increase the number of placements offered by approved education institutions (AEIs) in the social care nursing sector
- Support providers to see themselves as an integral part of high-quality placement provision
- Develop practice assessors and supervisors in social care settings to be ‘student ready’
- Reduce the unwarranted stigma attached to social care nursing among student, registrant and nurse educators.
Learning opportunities
Contrary to the assumptions around nurse education, AEIs and the Nursing and Midwifery Council (NMC) do not educate and register nurses solely for the NHS. The purpose of nurse education is to support development of a total nursing workforce that is fit and ready to meet the needs of the population that it serves. For pre-registration programmes the NMC mandates that AEIs:
‘…ensure that students experience the variety of practice expected of registered nurses to meet the holistic needs of people of all ages.’
NMC, 2023 : Standard 3.2
This resonates with the underpinning paradigm of social care that focuses on ‘what matters’ to individuals. The key components of person-centred approaches are equally reflected in social care through the respect of individual preferences, holistic approaches and the involvement of family and friends. Unfortunately, there is currently no data mapping the level and depth of social care nursing inclusion in undergraduate programmes of study. However, Chief Nurse for Adult Social Care Professor Deborah Sturdy has called for all AEIs to provide at least one adult social care placement to all nursing students during a programme of study.
Opportunities for learning in social care are vast. Although care homes are the most visible care establishment, there are significant opportunities to host placements in complex home care and education settings, hospices, prison settings and inclusion health. Such placements allow a fusion of advanced interprofessional, clinical and leadership skills.
Social care is often seen as an initial placement for first-year nursing students. However, contemporary social care nursing requires autonomy, critical decision-making and advanced clinical reasoning skills, which are all often more suited to third-year leadership and management placements to refine partnership and cross-disciplinary nursing skills.
Creating a conducive learning environment can significantly influence students’ motivation and their intention to pursue a career in social care. A positive learning environment allows students to effectively link theoretical knowledge with practical skills. Equally, both the original 2018 and updated versions of the NMC standards (NMC, 2023) assert that the integration of theory with practical knowledge is key to enabling students to develop their clinical competencies and professionalism.
Opportunities
With 40 000 registered nurses in social care, there is an untapped pool of potential practice supervisors and assessors ready to support and nurture the future workforce. Social care providers can reach out to their local AEI placement team to discuss support, and develop and grow their ability to offer nursing placements.
Some areas of social care may not have a registrant in place to support students to achieve their competencies, but are integrated into wider health and social care provision, or nurse-led services. Although this is a challenge, several innovative models are available to support students, including indirect or long-arm supervision, allowing for flexible supervision and assessment of students in diverse practice areas.
Nursing in social care is rewarding, and there are opportunities to undertake specialist and advanced practice roles. The NMC (2022) has approved new programmes of study for a community nursing specialist practice qualification (SPQ). Currently, most AEIs provide a community or district nursing placement; however, the NMC is clear that ‘community nursing’ is more commonly understood to include social care nursing.
‘Community nursing: care provided by nurses in the community including but not limited to nursing care provided where people live, at home or close to home, in adult social care settings, educational settings, primary care, community clinics, outreach centres, health and justice and other community settings or establishments.’
NMC, 2022 :18
This recognises the advanced level of nursing practice in this area, which may include skills such as history-taking, physical assessment and non-medical prescribing. In addition, the Queen's Nursing Institute (2022), now renamed Queen's Nursing Institute for Community Nursing, has produced field-specific standards and competencies for adult social care, which AEIs may use in partnership with the NMC's SPQ curriculum, and the Centre for Advancing Practice has released an Advanced Clinical Practice in Older People Curriculum Framework (Health Education England, 2022).
This formalisation of the value of nursing careers in social care recognises the complexity of the population for whom nurses care, which includes people with multimorbidity, life-limiting and lifelong conditions, and frailty, in tandem with needs that influence individuals’ ability to engage with the social world.
Here, the skills of social care nurses shine, balancing person-led opportunities for care and promotion of living well in the individual's home environment, coupled with advanced skills to independently manage complex conditions and situations. These advanced nursing skills may include tracheostomy care, suctioning, total parenteral nutrition management, and administration of medication via routes other than oral, all outwith the infrastructure and connectivity of NHS care settings and services.
The new A Workforce Strategy for Adult Social Care in England (Skills for Care, 2024b) provides a platform for the adult social care nursing profession and the wider sector workforce to focus not only on attracting, retaining, training and transforming the future structure of care itself, but also on how we work and educate people. Led by Skills for Care, the strategy has been developed with input from the sector to sit firmly alongside the NHS workforce plan, ensuring we have the knowledge skills and people to realise the vision for the future of social care.
Social care nursing is at the forefront of public health, with prevention and health promotion being part of everyday practice, maximising the opportunities for people to lead healthy lives in a way that they choose, guided by experts. Integration of this strategy into the nurse curricula is paramount to ensure opportunities are created for nursing students to experience placements in the sector to provide parity of opportunity and meet the aim of a national care service.
Next steps and recommendations
There is uncertainty regarding the presence and depth of orientation to nursing in social care settings in both undergraduate pre-registration nursing curricula and post-registration programmes across the nation. To combat this, Professor Pryor is undertaking a national scoping activity to illuminate the extent, and context in which social care nursing is currently valued in nurse education.
While this work is ongoing, the authors recommend that AEIs work with their social-care partners to recognise their value in nurse education locally and regionally by reviewing current placement provision, supporting placement expansion, and developing practice assessor and supervisor roles in partnership with the placement partners.