Confusing rhetoric with reality: achieving a balanced skill mix of nurses working with children

Background and rationale. The option of separate registration in children's nursing has been a feature of nursing in the United Kingdom since 1919, but this is currently under review. The recently superseded governing body of nursing, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, has suggested that generic nurse registration with later specialization would be a more appropriate structure. Polarized views tend to dominate the debate over whether or not children's nursing should remain a discrete branch of nursing rather than simply another postregistration speciality. A long series of reports is often referred to in the debate, but the recommendations of these are often misconstrued and misrepresented.

Aims. First, to provide a factual historical overview of the significant reports on the provision of child health care over the past 50 years, identifying the key principles of each, and to develop from this analysis reasoned conclusions regarding the priorities in skill mix for nursing children. Second, to propose an alternative framework for nursing skill mix that will ensure that children receive care appropriate to their needs, and that nurses are appropriately prepared for the level of service to be offered.

Conclusion: The problems associated with expectations of universal provision of registered children's nurses for all children requiring nursing intervention have resulted from misunderstandings of the recommendations of key historical reports. In the light of evidence presented for the drive for abolition of specialist registration, and the main arguments of the polar stances of genericism or specialization, it is vital that alternative strategies are developed and debated. The proposed framework, based on pragmatism and key principles established from major reports, is discussed in an attempt to address the real issues; namely that all children are cared for by nurses who have adequate preparation commensurate with their needs, and that there is a strong career trajectory for all nurses working in the field of child heath.