Frontline nurses are key to ensuring quality care
Rosemary Kennedy on how to drive up care standards
Last week I spent over an hour talking to a lady who trained as a nurse and had recently been a patient in one of our major teaching hospitals. She had asked to speak to me because she was distraught about her experiences at the hands of a profession she had once been proud to call her own.
She did not wish to make a specific complaint about poor care - she was following the correct route for that directly with the trust - but wanted to speak to someone in authority as she was bewildered by ‘what had happened to basic nursing care’.
Coming so soon after several damning media reports on NHS care, I shared her feelings of disappointment, as well as a sense of shame as her story unfolded. She told me of patients being denied privacy and dignity in the mixed-sex bay of an admission ward; of the lack of compassion about patients’ fear of being in hospital, facing an unknown diagnosis; the embarrassment of having wet the bed because of poor mobility or confusion; the refusal of nurses to mop up spilt urine as it was ‘not their job’; the noise of nurses chatting and clattering around the nurses station at night depriving patients of sleep; of food being left out of reach of the patient so that it went cold and uneaten - again, ‘it’s not my job’ to feed patients. Pardon me? Since when was patient nutrition not part of a nurse’s job?
I asked my visitor where she thought we had ‘gone wrong’, and although we discussed several possibilities we did not come up with any single factor.
If you think this is several individual slip-ups cobbled together in order to make a sensational column for Nursing Times, then think again. This was my visitor’s personal experience during a 48-hour stay in a hospital where I know that many, many examples of excellent practice can be found; where the nurse executive or her team ‘walk the wards’ on a daily basis; where there are sufficient nursing staff to provide adequate care; where there is active patient and user involvement in an attempt to maintain standards and improve patient experience.
I am confident that if I had spoken with any of the nurses who had been on duty during this lady’s short stay, they would have been mortified to learn how it had felt to be a patient on their ward. We have invested heavily in the RCN Clinical Leadership programme and most of the participants would say that they have changed their practice as a result of patient stories. So how is it that these, thankfully infrequent, shameful experiences are still happening?
On my bookshelf I can see countless current policies and guidelines concerned with the sort of problems described above. There are care standards galore, strategies for creating a ‘world-class service’ in the NHS in Wales, and specific strategies aimed at the range of professional specialties in nursing and midwifery. The recently refreshed major document Designed to Realise our Potential is a beliefs and actions statement for nurses, midwives and specialist community public health nurses in Wales, built around five principal aims, including improving the environment of care and ensuring quality services for all.
‘Nursing leaders will continue to produce well-intentioned policies but without the unrelenting efforts of all members of the nursing team poor episodes of care will persist’
What is more, in 2003 a partnership between health and social care and the Community Health Councils resulted in a set of guidelines - the Fundamentals of Care. These describe the standards of care that people can expect from health and social care professionals, covering those areas that patients and clients had expressed as being of key importance. Included in this is the need to ensure good communication and information giving, rest and sleep, personal hygiene, assistance with eating and drinking if required, meeting toileting needs and, above all, showing respect for people.
In 2005 we conducted an audit to see how well these fundamentals were being met. In all of our NHS trusts, serious attention had been paid to getting this right for patients. Some trusts had appointed facilitators or coordinators of care for clinical areas to oversee the implementation of Fundamentals of Care - including the trust where my visitor had been admitted.
As part of the Free to Lead: Free to Care (2008) ministerial initiative, the emphasis is on the role that ward sisters and charge nurses play in ensuring that technical nursing skills are being delivered to the highest level and that professional personal skills are in place. Ward sisters and charge nurses will be specifically supported - and expected - to ensure that the aspirations of Designed to Realise our Potential and Fundamentals of Care are achieved for every patient, every time.
The Department of Health and nursing leaders will doubtless continue to produce a stream of well-intentioned policies and guidelines in the hope that these will have a positive influence on care. But without the unrelenting efforts of executive nurses and their teams, facilitators and coordinators of care, ward sisters and charge nurses, CHCs and patient/user groups and, most importantly, every member of the nursing team, we will continue to uncover similar episodes of poor care. Sadly, these will overshadow the deeply devoted and inspirational care provided by most nurses.
Rosemary Kennedy is Chief Nursing Officer for Wales