Professor Donna Mead OBE has worked in hospitals and universities across Wales in roles which include clinician, researcher and educator. She was Dean of a large faculty of Life Sciences and education for 18 years. She has been a member of the Royal College of Nursing since student days and has served on the Research Advisory Group (now research committee) and its associated scientific committee and on the education committee. Most recently she was an elected member of RCN Wales Board. Donna is a very proud Fellow of the RCN.
Do you feel as though the nursing workforce provides a space for women to succeed and advance in their careers?
I am an example of where it does. I am a Professor, I have an OBE. I think for my generation, though, I am an exception rather than the rule and I feel that one of the reasons for that is the lack of guaranteed Professional Development education for the Nursing workforce. If I compare it with the medical workforce, once they qualify there is a set training journey, which they all have to go on. They make various selections, whether they want to be a GP or a surgeon, so on. When they have chosen their path there is set training they must do and must demonstrate competence and theoretical understanding along that journey.
For nursing it is very hit and miss, to this day, as to whether you get the CPD that you need to progress in your career. It might depend on where you are working at the time, or more recently because of budgets. CPD budgets have often been cut. In times of austerity, often the first thing that is cut from budgets - and this is very unwise – is CPD budgets. It means you are not developing your workforce.
I took advantage of every opportunity and made it but I think I did that despite the systems that were in place, not because of them.
Nursing has always been inhibited in its quest for professionalism because of its close proximity to another very dominant profession – medicine. So in that sense – if you go back, where medicine was predominantly male and nursing predominantly female. In that sense there is a gender disparity. Medics have got the power and authority that comes from their profession to determine and demand post registration training.
In nursing, although it has got better with Advanced Nurse Practitioner courses and Clinical Nurse Specialist courses, it remains a lottery. Not everybody gets the access that they want, whereas in medicine, everybody gets the access that they need, to pursue their career choice.
Who are the women in your life who have inspired you?
A ward sister, my first ward sister when I became a staff nurse. She was no academic at all but she was very practical and pragmatic with lots of wisdom and common sense. That helped me to realise that you have to balance common sense with study in order to be a well rounded nurse. That was in St Mark’s Ward in St Tydfil’s hospital - no longer a hospital.
Then there was a professor of nursing. The first professor of nursing in Wales. I never worked for her, but I went to her several times for advice. I was by now a ward sister in Llandough hospital. I wanted to make various innovations, made them, was asked to speak to a group of doctors about them and make a presentation. I went to the professor and said ‘what will I do.’ She was so encouraging of me. When I look back at that presentation and the slides that I used, they were dreadful. But she didn’t point that out she just praised me. She was Director of Nursing at Cardiff University at that time, very early days, 1980/81. She just encouraged me. I have always remembered since, that praise is as effective as criticism in many cases. She was very influential as a role model and mentor
A person who has made me proud of what I have done is Betsi Cadwaladr because she came from a very impoverished background, as did I. I think she achieved great things, but that’s not what is important about it, it’s that Betsi always did what was the right thing to do, without fear or favour. That has inspired me. By the time I had started doing my research into Betsi, I was well into my nursing career and I had always looked up to Florence Nightingale as we all had. But Nightingale subscribed to what was called at the time ‘Noblesse Oblige …….’ Which means nobility requires that people who hold such status have a duty to fulfil social responsibilities to assist and support those less well off. For some in Victorian Britain, this principle pertained so long as the less well off didn’t try to rise above their status. So that when the journalists of the day reported the dreadful conditions for wounded British soldiers in Crimea, Nightingale reportedly said. “ I do not mean to say that I believe the Times accounts (journalists regarded as tradesmen) but I do believe we may be of some assistance to the wounded wretches. At the same time Lord Palmerston, the Prime Minister during the Crimean War, said that the greatest deficiencies during the war had been caused “ where there were persons belonging to other classes of the community, in the medical department, the commissariat department and the transport service which have not been filled by the aristocracy or gentry”. In other words, we help the poor and those who are worse off than us but we don’t expect them to rise above their station. Nightingale lived by that rule and Betsi lived by the maxim of doing the right thing for the people she looked after. They clashed horrendously. Nightingale looked down on Betsi because she was Welsh. Betsi opened my eyes and made me far more critical and not so ready to believe everything that is written about Nightingale regardless of her heroine status.
Nightingale’s key autobiography was commissioned by her family and of course that wasn’t going to point out all her flaws. What I learned about what Nightingale did in the Crimea, without taking away from her achievements, was that we were overplaying her achievements and underplaying the achievements of other contemporary nurses like Betsi. Nightingale famously said that ‘all is needed to be a good nurse is to be a good woman’ and by that she meant that you didn’t need paying. Betsi needed to be paid, she was a woman of no means so needed paying.
We know that after her return from the Crimea, Nightingale destroyed the records of paid nurses so that what they achieved would never get into the history books.
There had been a Royal Commission published into the state of education in Wales in the 1850’s. It became known as the blue books of treason. In it, the Welsh were described as immoral, illiterate, irreligious. A dreadful description of Welsh people. It was reported also that “The Welsh language is a vast drawback to Wales and a manifold barrier to the moral progress and commercial prosperity of the people. Its not easy to overestimate its evil effects”, At the time a wealthy aristocrat, Lady Lanover wanted to put the record straight. Not by contesting the findings but by publishing the achievements of Welsh men and women. One of the women she came across was Betsi.
She asked Jane Williams to write Betsi’s story as a rebuttal to the blue books of treason. So Jane met with Betsi. What jane did was let Betsi talk but she also verified that what betsi was saying was accurate. So that led me to always be sceptical as I was taken in lock stock and barrel by what I was told about Nightingale in school. Don’t take anything at face value – look it up, do your own research.
How do you feel you have helped shape nursing in Wales?
I think hopefully by example, as a clinician and educator and a researcher. In 1999 I led the team that wrote the first ever policy document which came from what was then the National Assembly for Wales. It was called ‘Realising the Potential - a Nursing Strategy for Wales in the 21st Century’. In it there was a very controversial point which said that nursing should be an all graduate profession. In the months running up to its publication, I had said, in a conference of senior nurses, that nursing should be an all graduate profession, I was booed. I did research, it wasn’t said on a whim. When I looked at what was required of nurse training, what was required of the job, required by patients, I genuinely believed that it was a travesty that nurse training didn’t result in a degree. When the strategy was approved by the H&SS committee it was then policy and Wales moved to an all graduate profession. The first country of the UK to do so.
I set up the first part time nursing degree at Swansea University. I set up the first full time nursing degree at what is now Glyndwr University and I set up the first full time nursing degree at what is now the University of South Wales.
I was also involved in writing some of the briefing papers as ‘Realising the Potential was considered the overarching strategy and then we wrote various briefing papers. I was heavily involved in writing the research briefing paper and while I was at USW, I applied on behalf of 6 Universities in Wales for a grant to develop research capacity in nursing. That became known as the Research Capacity Building Collaboration which involved 6 universities and all health organisations in Wales. It began with a small grant from the health foundation and then a small grant from WORD (Wales Office of Research and Development). That was followed by a very significant grant from the Higher Education Funding Council Wales. When Edwina Hart was Health Minister another £1 million followed. It was circa £6milion eventually..
We found a way to provide research opportunities for nurses and allied health professionals throughout Wales. We didn’t just provide PHD or Masters training. We established what we called a Community of Scholars. This was a support network for the students in which the intellectual capital from across the Universities was pooled to support the students. Cutting edge master classes were arranged in which very influential researchers from UK and abroad came to meet with the scholars. They formed a support network. This goes on to this day. It has been declared as one of the most successful research capacity building programmes.
My third big contribution is the development of the Clinical Simulation Suite at the University of South Wales. It is so amazing, a whole building is now devoted to learning in a simulated environment. At the time the NMC said there had to be 2300 of theory and 2300 hours of practice. For theory there was leeway, that could be lectures, tutorials, time spent in the library, studying and so on, but for clinical practice there was no leeway. Clinical Practice, however, is capricious. You don’t know if you will witness a particular scenario many times or never. In a simulated environment you could create those scenarios and ensure that a nurse worked through them as many times as necessary to become competent. But in order to do that you needed an environment that is so real it led to what we call suspension of disbelief. That you forgot you were in a simulated environment. We installed the technology so that student nurses could be filmed, they were then able to evaluate and appraise their own performance.
The NMC remained unconvinced that clinical competencies could be achieved in a simulated environment and held fast to the 2300 hours in clinical practice rule. I led the research involving 16 universities across the UK and demonstrated that clinical competencies could be achieved in a simulated environment, and this resulted int NMC altering the requirement for all 2300 hours to be spent in clinical practice. Time spent in a clinical simulation suite could be counted as practice hours.
The clinical simulation centre at USW is still renowned as being one of the bests in the UK. I didn’t do that on my own, but I led it. Professor Keith Weeks and Norman Woolley and several others really helped me to do that. I was the Dean so I led it and I am very very proud of it.
I chaired the first All Wales Nurse and Pharmacy Independent Prescribing Curriculum. I am very proud of that. It was successfully validated in every University that offered the course in Wales.
These are some of the things that I am proud of.
What do you think are the main issues that affecting women in nursing at the moment?
Wales is in many ways very generous in that if you want to train to be a nurse, you have your fees paid and there is something of a bursary. The majority of people train in that way. I don’t think that is the best deal for all women. I am thinking of my own daughter in law who trained to be a nurse not that long ago. If you used the student loan company you would have more disposable income than the very generous Wales bursary scheme. My daughter in law was a biochemist and after she had children decided she wanted to change her career and work with people. She started her nurse training. She had to work as a HCSW all the way through her nurse training to make ends meet. Nursing is a very hard course, especially in terms of time commitment. Placement is 37.5 hours a week. When you are in university also
If she had been able to go down the student loan route (as they do now in England) she would have had more disposable income. This would have to be paid back of course. However, you are required to repay your student loan only when your income is over a certain threshold. Currently the threshold is £27.660 per annum. The amount which then has to be repaid is 9% of the income over the threshold of £27.660
I don’t understand how we haven’t in Wales thought that through to make it easier for women with families to undertake nurse training.
Women are in the main (not exclusively) but in the main, the childcare providers. And for women who already have a family, the income you get through the bursary system is pitiful. In England nobody gets the bursary but they can go to the student loan company. I do think, perversely, that the system in England has many advantages.
In Wales it is felt that the Welsh Government offer is very generous. and to some extent it is – if you had asked my daughter in law, she would have said that during those 3 years of training if she had had a student loan income, she wouldn’t have had to work a HSCW job on top of her nurse training. A situation which made life difficult for the family.
I’m working in an organisation, Velindre, where we have had Menopause Cafes for about 5/6 years. . Men are invited to them too. They weren’t my idea, one of the HR staff was a pioneer in menopause cafes and has won awards for them. For many women sensitive handling of the menopause makes the difference between continuing to work or giving up. This is a very welcome development for women.
Flexible working is a double edged sword. If I am allowed to start work at 9.30am for childcare reasons, someone else always has to start at 7am. It is not a straightforward issue.
I have always been a fan of widening access. Although I pioneered and was responsible for Wales being the first country in the UK to go all graduate for nursing, I have never closed down the entry gate. Ever.
If someone came to me and said I want to be a nurse, I have no qualifications, I would tell them what they needed to do. I told people that if they want to be a nurse we will find a pathway for them to do so. That has been very successful
I have set up across Wales widening access provisions, not only for women but for women in particular, coming back into the workplace after having children. The exit qualification might be a degree with nurse registration or health care support worker with a diploma in Higher Education (with the ability to progress to registration at a later date if appropriate.
I have several of examples of that. At Swansea university – I established a part time degree in nursing for people who were qualified as nurses but didn’t have a degree. Some went on to get Masters degree after it. Students attended university for 9 weekends a year for 3 years to obtain a degree.
There are many examples of widening access into nursing across Wales now I am pleased to say.
I am always keen to find out why the WG haven’t wanted to support apprenticeships as a model of training in Wales. I’m not sure of the reason for this. It is a more gradual entry and involves work based learning. There are excellent examples of apprenticeship training to gain the necessary entry qualification for nurse training but currently, Wales doesn’t offer an apprenticeship route for nurse training. Such provision could benefit many women.
Is there anything else you are proud of?
I have been a High Sheriff – an appointment made by the Queen.
On the 70th Anniversary of the NHS - the Department of Health and the Nursing Times put together a book outlining the 70 most inspirational nurses since the beginning of the NHS. There were 4 Welsh nurses and I was very proud to be one of them.
In 2014 I was awarded the Chief Nursing Officers of the UK Lifetime achievement award at the Nursing Times awards.
In 2008 I was awarded the OBE.
I have a PhD and an honorary Doctor of Science.
I have been elected as a Fellow of the Learned Society of Wales.
I am a very proud Fellow of the Royal College of Nursing.
But the one award I am most proud of is the Best nurse in training in 1977 which came with a gold medal. I am very proud of that for two reasons
1. My mother was alive and attended the award ceremony when the award was presented to me. She didn’t live to see my other achievements.
2. When I was in grammar school, I obtained 9 good O Levels. When I announced that I wanted to be a nurse, my teacher told me that it would be a waste of a good education. Obtaining the gold medal for the best student nurse in training proved her wrong.
