It will distress them and compromise patient care.
I was unsure whether to laugh or cry at the recent resolution by the Royal College of Nursing (RCN) of the United Kingdom in support of nurses who are diagnosed with dementia keeping their jobs, notwithstanding the fact that provision was made to ensure patient safety with regard to drug calculations or some “critical decisions.” The resolution, which takes into account the aging nursing workforce and the likelihood of more nurses being diagnosed with dementia, seems to be an inclusive act based on the fact that there are, allegedly, still many aspects of nursing that can be carried out by a person with dementia. My question is: “Such as what, precisely?”
We have, admittedly, come a long way in being more inclusive in nursing of people with disabilities and chronic conditions that would once have excluded them from the profession. It was routine, prior to my time as an admissions officer at The University of Edinburgh, to reject applications, for example, from prospective nursing students with Type I diabetes. I was able to stop that based on the fact that I had trained with a person who had Type I diabetes. She managed her course perfectly and came out a very good nurse. Gradually, we realised that other conditions, once considered incompatible with nursing, could come off the “list” (a virtual and very local list, incidentally) and that we could be both more inclusive and diverse, while keeping the university out of the courts on grounds of discrimination.
However, I am worried about the call for people with dementia to carry on in nursing, and my concerns are manifold. First is the fact that most people are diagnosed with dementia well into the condition—in other words, long after problems with memory and cognition have been recognized. In nursing, these may have been noticed because of an inability to do the job properly, which, in itself, may indicate it is time to stop nursing. Dementia is progressive, and the person will quite rapidly become less able to carry out the job. This will distress them and compromise patient care. The inevitable outcome will be that they will have to stop nursing, possibly at a point where they are less able to understand why. At least one patient organization in the UK has expressed concern, and I share those concerns.
Moreover, this resolution may tell us what those who passed it think about nursing. We can put as positive a spin on dementia as we like, but the facts cannot be altered: It erodes memory and cognitive function, and the combined effect is progressively reduced mental function. I hate to use this phrase, but it is often said—sarcastically—that if you have half a mind to be a nurse, that’s all you need. I have no wish to be sarcastic about people with dementia or about people who may lack the intellectual capacity to study and become a nurse, but the message seems to be that there is plenty left for nursing even if your intellectual capabilities are failing you. In my view, if you cannot carry out all the functions of a nurse—practically, intellectually, and ethically—then you are no longer able to work as a nurse. There may be other, even closely related, work, such as supervised care assistance that is possible for however long a person remains capable, but not professional nursing.
I applaud the attempts of the RCN to be inclusive, and my life’s work has been with people who have dementia. However, this recent resolution, which may be an example of militant political correctness, will cause dismay among the public and among many nurses. I would urge the RCN to think again and the Nursing and Midwifery Council of the United Kingdom—which will ultimately have to rule on this—to act cautiously and sensibly.
Roger Watson, PhD, RN, FRCP Edin, FRCN, FAAN, professor of nursing at the University of Hull in the United Kingdom and a frequent visitor to Australia and China, where he has visiting positions, is editor-in-chief of Journal of Advanced Nursing and editor of Nursing Open. Click here to access Blogger-resident entries posted before 2017 in Watson’s former blog “Hanging smart.”