The Commission on Nursing, the commencement of the degree nurse training programmes and the increase in the number of student nurse places may allow the skills of the nurse in intellectual disability to be fully utilised in the delivery and management of services to people with intellectual disability in a wide variety of locations. But some concerns are still apparent. With the rapid and continuous changes in the way that services are provided to people with intellectual disability, the role and responsibilities of nurses in intellectual disability has come under pressure from many areas.
The Commission of Nursing was quite explicit in stating that the central role of the intellectual disability nurse is a single, stand-alone, independent and autonomous discipline within nursing. The commission went further and called for the establishment of a clinical nurse specialist and advanced nurse practitioner in intellectual disability nursing. If that brings to mind the prospect of magnificent things happening in intellectual disability nursing, think again.
In industrial relations, the outcome of a recent pay awards made to intellectual disability staff left the nurse’s salary lower that that of house parents, assistant house parents and care assistant personnel, who received a well deserved pay increase in recognition of their need to care and support many parts of the health and social-care network in Ireland. However, many of them are not specifically educated for the intellectual disability field. The long-term effect of this disparity in pay levels may be that nursing in intellectual disability as a career option within the healthcare field will be eroded, with fewer and fewer people attracted into the nursing discipline. The CAO entry points for intellectual disability nursing study at universities in 2003 has been set quite low in order to attract students to take up this branch of nursing. This seems to acknowledge the modest level of interest there is in intellectual disability nursing even, during the year of the Special Olympics World Summer Games.
The courts have placed the ongoing debate concerning the role of the nurse in Child Development Education Centres (CDECs) with the Department of Education and Science. This has now been implemented as education in its purest form—delivered by the teacher as the lead profession, and not by nurses. The end result of all this is that the realisation of the maximum potential for the severely and profoundly intellectual disability person may not be achieved. Surely the defining roles of nurses, teachers and other practitioners is crucial if work in this specific area of education is to be consistent with court decisions, as well as to remain consistent with the over-riding need to maximise the potential of the person with severe or profound intellectual disability.
Because of the shortage of nurses in intellectual disability services, the government has agreed to an increase in academic training placements to 240 per annum, promising to maintain this level for the next seven years. Two new intellectual disability-training facilities have been established in Letterkenny and Waterford. Nevertheless, in order to maintain services at the level necessary to meet demand, service providers still have to recruit non-intellectual-disability trained nurses to fill nursing vacancies. In some cases they can only provide basic care. This has resulted in a grade mix of nurses, including psychiatric, general, paediatric and overseas nurses. While any profession can provide a positive influence on the care to people with intellectual disability, inevitably a mix grade of nurses has led to a blurring of roles and a lowering of morale among intellectual disability nurses and led to the original question, is nursing in intellectual disability just another pair of hands?
People with intellectual disability, and their families, are vulnerable members of society and the limitations caused by the poverty of service-funding in Ireland is compounded by the lack of emphasis on quality healthcare—including health promotion, primary care and acute care. The many examples of health needs identified during the ‘Healthy Athlete’ programme of the Special Olympics Games clearly highlighted the need for effective intellectual disability practitioners to play a key role in ensuring that people with intellectual disability have access to all elements of healthcare, as part of social inclusion.
A recent study by McCray and Carter (2002) found it desirable that future practitioners should maintain the specialist perspectives of the intellectual disability nurse, together with the social worker’s role in facilitating care-management. This is not the first time the idea of a social-nurse practitioner has appeared in the intellectual disability debate. Could this be an answer, so that people with intellectual disability and their families are provided with the most consistent support, and nurses do not just become ‘another pair of hands’?