Opinion  

However, I am less sure that it is right to use the hands-on role to justify a failure to value anyone who doesn't work directly with patients; and failure to engage with any process not directly concerned with hands-on care.

The former is often seen in attitudes to managers, facilitators and educators. Their work is often seen as less important and less skilled because it is away from the front line. Nurses who underestimate these colleagues' contribution can miss out on the vital preparation and support for their own role that managers and educators provide.

Meanwhile, failing to engage in processes that don't directly contribute to care is a missed opportunity. Front-line knowledge, experience and perspective are vital to other processes: how can patient systems, records or environments be well-planned and effective without those voices from the nurses closest to patient care?

Standing on the moral high ground and saying 'I don't do planning, meetings or paperwork' undermines a very valuable part of a nurse's role: using the knowledge from day-to-day practice to improve things for current and future patients.

A key tool for improvement is evaluation of care or services. It is relatively easy to get reports on what nurses have done, but it is much harder to get them to lay claim to the important outcomes from their work. For this nurses need to plan what measures will demonstrate success with their patients; then gather this information and present the results clearly.

Increasingly these days it is not enough to say 'I work hands on with patients, therefore my role is valuable'. It is more important to be able to show what that hands-on role has achieved that is valuable to patients and the people who organise their care. That is the best high ground to occupy.

Rosemary Cook, director, Queen's Nursing Institute.