There is “unwarranted variation” in how nurses are prepared for working with digital technologies, and specialist digital nurse roles are still lacking in some NHS trusts, according to early findings of a review shared exclusively with Nursing Times.
The Phillips Ives Nursing and Midwifery Review into the digital readiness of the nursing and midwifery workforce was launched in 2022 as a year-long research project and is set to be published soon.
Led by Dr Natasha Phillips, chief nursing information officer (CNIO) at NHS England, and American nursing academic, Dr Jeanette Ives Erickson, the review is exploring what skills and training the workforce might require when working with new technologies in the coming years.
“The need for a specialist workforce was really loud in [the review]”
Tracey Eyre
In an interview with Nursing Times, Dr Phillips said the review was commissioned to see whether nursing and midwifery practice was “looking different now” and whether “it will look different in the future”.
She noted the Phillips Ives Review had come against a backdrop where nurses were “increasingly working with digital technologies post-pandemic”, citing the exponential rise in recent years of advancements like remote care, virtual wards, telemedicine and electronic patient records.
The purpose of the Phillips Ives Review is to build on the work of the Topol Review, published in 2019, which looked at the readiness of the NHS workforce to deliver the anticipated digital revolution of the health service.
The new review has revealed that some of the technologies currently being used by the nursing workforce have “landed a bit quicker than Topol might have anticipated”, said Dr Phillips.
She added: “We know in Topol they looked very closely at [artificial intelligence], genomics and robotics as the key technologies that would change practice.
“They also looked at telemedicine at that time, but I don’t think they could have anticipated that that would be the front runner at this point in time because of the pandemic.”
Over the past year the Phillips Ives Review has consulted with nurses and midwives across all settings in the NHS and social care.
Key organisations, such as the Nursing and Midwifery Council, the Royal College of Nursing and the Council of Deans of Health, have also been involved.
In addition, other professions, such as doctors, technicians and IT providers, have contributed to the findings to show “how they envisage they may work with the nursing profession in the future” through the use of new technologies, said Dr Phillips.
Meanwhile, there will also be an international angle underpinning the report, she explained.
One key takeaway from the review has been that nurses and midwives “can learn from each other as a global community”, Dr Phillips said, adding: “Nursing is broadly the same whatever country we reside in, we have much in common. I think there was a realisation [that] when there’s an opportunity we should try and do and develop these things together.”
She said that, going forwards, representatives in England would “continue to work with international colleagues” around supporting and implementing digital.
Dr Phillips revealed another key finding from the review was that documentation burden and sharing information remained one of the biggest digital challenges facing nursing.
“This wasn’t new news to the review,” said Dr Phillips. “Often nurses and midwives are spending a lot of time either documenting care and retrieving information and [they said] that it’s very hard to retrieve information when you go across organisational boundaries.”
Dr Phillips added that the review showed nurses’ ambition for a future workforce where digital technology “does a lot of the heavy lifting”, so that information could be digitalised “and nurses can use the information to support people more”.
Importantly, she noted that embracing technology was “not about having fewer nurses”. “It’s about working differently and hopefully having more time to interact with patients,” she said.
Natasha Phillips
Dr Phillips added: “There is an assumption that underpins the review, that if nurses and midwives are served with good tech, ultimately that reduces time on tasks that can be automated, releases time to spend with patients, increases job satisfaction, so is likely to aid retention.”
However, the review has shown that health and social care settings in England still have “some way to go” in ensuring senior nurses are involved in the procurement and design of new technology, said Dr Phillips.
She warned that until senior nurses became involved in the process, then there would “always be challenges”. “Without being involved at that early stage, often [nurses] see the system, do their utmost to implement it, but ultimately it might be challenging because it’s not particularly designed for them,” she noted.
Dr Phillips explained that getting the workforce digitally ready required “everybody’s leadership”, while also highlighting the importance of the role of CNIOs in trusts. “Those individuals have a responsibility to support and lead the wider workforce,” she said.
Last year the chief nursing officer for England, Ruth May, pledged her support for every health and care organisation to have a CNIO.
Dr Phillips noted that recent NHS England data showed there had been a 20% growth in CNIOs in NHS provider organisations since 2021.
She said: “The acute sector is getting stronger in this space [while] community [and] primary care [are] catching up a little bit slower, but their infrastructure is different.”
Another key takeaway from the Phillips Ives Review is the disparity of access to digital education across pre-registration courses.
Dr Phillips said: “What was clear is, we have variation in terms of how people are prepared at undergraduate level for working with digital technologies as a core part of how they practise their nursing.”
The review has revealed that some universities do well at integrating digital technologies as part of core modules, while others do not have any digital content in their modules at all.
Dr Phillips said: “We need to not have that unwarranted variation and make sure that we’re preparing everybody for when they practise nursing, so they can understand and use data well.”
Echoing the same concerns was Tracey Eyre, a nurse and programme lead for the Phillips Ives Review.
Ms Eyre told Nursing Times there was still work that needed to be done to better support student nurses and midwives in working with digital technologies. She said that in the review there was “a big call” coming from pre-registration students to have standardised training around the use of technology, including AI and genomics.
In addition, she said students had called for ethics training around handling data in a digital format. Ms Eyre said: “People are fearful of what it means to be using something digital when it’s there forever. Actually, the ethics of it tells us [that] it’s no different to a handwritten record. But for some reason there’s a fear about it being digital.”
While the Phillips Ives Review was not designed to address wider workforce issues in nursing, it has looked at the role of the specialist digital nursing workforce.
The review found that, across England, there is still variance in the representation of specialist digital nurses across organisations, said Ms Eyre.
She added: “Some organisations [have] no specialist workforce, some have somebody who has been on a six-month secondment, through to somebody who’s in a permanent role.”
Nurses desired a proper career pathway into digital, and the education to support them if they wanted to specialise, said Ms Eyre.
“The need for a specialist workforce was really loud in [the review],” she said. “[Nurses] want to have [digital] recognised as a specialty in the same way that diabetes or oncology is a recognised specialist pathway.”
Equality, diversity and inclusion were also considered throughout the research process. In particular, professionals raised concerns about “digital poverty”, which is the inability to interact with the online world fully when, where and how an individual needs to.
Ms Eyre explained how digital poverty could impact both nurses and patients. She said trusts needed to ensure there was “access to the tools and knowledge that is needed”, so nobody gets left behind as digital is embedded in organisations.
Nurses also described the importance of person-centred care and the need for choice around digital technologies.
Tracey Eyre
Ms Eyre noted that, while nurses were responsible for ensuring that digital opportunities are available in practice, patients should “still have the right to choose”. “It has to be what works for the individual and their families or their carers,” she added.
In her role as programme lead, Ms Eyre said her main focus was “getting the right people in the right place” working on the review so that it could be “really valuable” in terms of its findings and recommendations.
Considering all the responses, Ms Eyre said the main message underpinning the Phillips Ives Review was that “everybody wanted some form of standardisation” of digital technology.
“I think for me the key overarching theme is that everybody who we heard from, whether that was a student nurse through to somebody working in [a] specialist role, absolutely had an input and identified the need for this piece of work,” she said.
The Phillips Ives Review is in the final stages of approval and is expected to be published in the next few months by NHS England.
Attend our Phillips Ives Review webinar live online on Tuesday 18 July at 2pm.
