Nurses who move away from the bedside to pursue leadership and management roles are experiencing “skill decay”, a conference has heard.
During a debate at the 2025 Royal College of Nursing (RCN) Congress, concerns were raised about the loss of practical or clinical nursing skills in nurse leaders and educators.
“It’s also about ensuring our workforce stays confident, competent and connected to the realities of patient care”
Charlotte Collings
Charlotte Collings, from the RCN Eastern board, put forward the discussion.
She noted that most nurses “begin our careers at the bedside” but, as they progressed, they were encouraged to move into roles such as leadership, research, education and policy.
She said: “With that career progression often comes a step away from patient care, and that can bring mixed emotions – a sense of growth but also a quiet concern about losing the practical skills that once felt second nature.”
Ms Collings described a “skill decay” that was leading to “a loss of confidence” in senior nurses charged with overseeing clinical decisions.
“Let me be clear, this isn’t about pushing everyone back to the bedside,” she added.
“It’s about exploring whether we can add flexibility into our roles so that we don’t have to choose between clinical credibility and professional development.
“It’s also about ensuring our workforce stays confident, competent and connected to the realities of patient care.”
Ms Collings suggested that “portfolio careers” could be part of the solution to tackle the loss of direct nursing skills in senior nurses.
A portfolio career involves holding multiple or diverse roles or jobs that combine clinical and non-clinical work.
“This isn’t a new idea,” Ms Collings explained, adding: “In both medicine and midwifery, for example, you’re expected to maintain clinical shifts and participate [in] on-call rotas, regardless of seniority. Might a similar approach work for nursing?”
“Moving away from regular hands-on practice can lead to a gradual decline in confidence”
Anastesia Nzute
Frances Baverstock, representing the RCN general practice forum, told attendees at RCN Congress that she worked with GPs “who celebrate the portfolio career”.
“It not only enables their personal growth, but I’ve also noticed that it reduces burnout, very important for us nurses here today,” she said.
Ms Baverstock argued that very experienced nurses should be encouraged “to stay in clinical areas” while also being given opportunities to lead, manage and pass on their skills to more junior staff.
The impact of losing direct nursing skills can also be seen across nurse education, congress was told.
Chinenye Ubah, a nurse lecturer at Anglia Ruskin University, said: “I know how important it is to me personally, to remain clinically up to date, because that’s part of what I do.
“However, I do this in my own time. I work five days a week, and I only have two days for rest, and then sometimes I have to, within those two days, go into practice.
“One may argue I’m not contracted to do that, however I know that personally it’s important for me to do that, to remain clinically relevant, to be able to do my job properly.”
This was echoed by Anastesia Nzute, RCN learning committee member and a nurse lecturer.
She told RCN Congress: “Moving away from regular hands-on practice can lead to a gradual decline in confidence and competence in some procedures and decision-making processes.
“This could affect not only our professional development, but also our learning experience, [and often] the learning experience of our students.”
Natasha Green, RCN student committee chair, said the loss of direct nursing skills by nurse educators was “affecting students who are going out on placement”.
Concerningly, Ms Green said she had five weeks until she would qualify as a nurse but was unable to practice cannulation or venepuncture because of a lack of staff who could support or train her.
“This is ridiculous,” she said, adding: “This affects how I’m going to qualify. It affects the fact that I’m going to be a dialysis nurse who cannot cannulate.”
She further argued: “Whether we work in an office or not, or we work on the patient-facing floor, we should be able to do our clinical skills.
“It is possible, and we need to be doing it, not just for ourselves and for our own development, but for the development of our students.”
