The Royal College of Nursing (RCN) Bladder & Bowel Forum has become aware that continence nursing is facing some serious challenges. Following yearly strategy day discussions with the committee, concerns were shared that nurses in general seem to have lost confidence in bladder and bowel care and continence assessment. Two committee members are lecturers of student nurses and qualified nurses and have both found a definite lack of confidence in continence care. This loss of confidence raises a great many questions which the Forum needs to address in the coming year, such as:  

• As continence specialists, we have been busy promoting our specialism and expertise. Has this raised continence to a level where general nurses now believe they ‘cannot do continence’, as it is a specialism and not basic nursing care?  
• Is the lack of certainty we have all been dealing with due to the pandemic, with staff being redeployed into different areas, affecting confidence in abilities?  
• Is continence taught and discussed during nurse training?  
• Are student nurses and newly qualified nurses understanding the importance of appropriate continence care?  
• If so, where is the missing link between learning and delivering?  
• As nurses, are we still performing holistic assessments of our patients? Are we still assessing our patients using the Roper, Logan and Tierney’s activities of daily living?  
• Are nurses embarrassed to ask patients about bladder and bowel issues?  

A recent round table discussion between Essity, leaders in continence, and women’s health, found that it is common for healthcare professionals to feel as embarrassed, if not more embarrassed, when asking questions about bladder and bowel issues. Indeed, Nikki Cotterill, associate professor in continence care at the University of the West of England, and a Bladder & Bowel Forum committee member, stated that her recent research shows that healthcare professionals do not know how to manage conversations about continence and then if patients disclose symptoms, clinicians are not confident in giving advice or treatment. Continence assessment has become a tick-box exercise (Agnew, 2021).  

Reflecting on these issues, the committee have decided to go ‘back to basics’ and ‘get continence out there’. 

My day-to-day role is clinical nurse specialist for continence and stoma care in the community. In Jersey, community nursing is delivered by Family Nursing and Home Care, a local charity which provides children’s nurses, school nurses, health visitors, district nurses, a tissue viability nurse and me. Despite regular training sessions and developing guidelines and competencies, there is still a distinctive lack of confidence and decision-making where bladder and bowel care is concerned. When asking my colleagues what the problem is, I’m often told that time is an issue — the workload is high and continence is not seen as a priority, whereas pressure trauma is reportable and leg ulcer care is measurable.  

The RCN Bladder & Bowel Forum’s plan for this year is to speak at nursing conferences around the country — not just conferences about continence as specialist conferences are ‘preaching to the converted’. We believe we need to be getting to the ear of healthcare professionals from all areas of health and social care. We also plan for each member of the committee to write an article for nursing journals on continence basics. 

To end the year, we are planning an online conference, which will be shared on our forum page and social media. This event will reflect the RCN’s Bladder and Bowel Learning Resource and will include (www.rcn.org.uk/clinical-topics/bladder-and-bowel-care/RCN-Bladder-and-Bowel-Learning-Resource#assessment):  

• How the bladder works and bladder problems  
• How the bowel works and bowel problems  
• Fundamentals of continence assessment  
• Catheter care essentials.  

We collectively hope that as a forum of like-minded bladder and bowel nurses, we can promote the importance of continence care and reduce embarrassment felt by healthcare professionals and the general public when taking about issues with continence.