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Practice comment

'Professionalism is the best regulator of nursing care'

No professional nurse reading the Francis Report could fail to be concerned by the estimated number of unnecessary patient deaths in a place the public probably regarded as safe - and with nurses they thought they could trust.

Although the report highlights the failings of the repressive culture of the organisation, which enabled deviation from the primary focus of providing good care, the malpractice of nurses has contributed to this. Generalisation from the few to the nursing profession as a whole may seem unjust if the very low proportion (0.1%) of nurses receiving some form of professional disciplinary sanctions from the NMC each year is the gauge. However, as Mr Francis’ inquiry suggests, a downwards trend in the quality of nursing care has to be more widespread than that being picked up by the professional regulator.

The report has strong messages for those in nurse recruitment, retention and training to ensure high quality in registered nurses as people, as well as in terms of what they do. But the importance given to professionalism with its standards and values at all levels in the workplace is, for me, at the heart of the matter.

As registered nurses we have a professional code with standards for conduct, performance and ethics that should be both self-regulatory and useable for regulating others. In this code, the nurse is the patient’s advocate and has a duty to tell the truth about the practice of others, if a patient’s safety is compromised.

Top down, it is time for trust boards to value the professional nurse’s leadership but, equally, nurse leaders must be worthy of this. They must be visible where care takes place and accountable for its quality.

Bottom up, registered nurses in clinical practice need to believe they are crucial to revitalising the vision and mission of nursing. They should tell students, newly qualified nurses and those of longer standing that if they want to be respected as a professional, they have to live up to the code in full. They should show those who fall short of its standards how to change and, if not, inform them of the certainty of being reported. The code and its standards should be displayed in prominent places for all professions and the public to see, so everyone knows what to expect from a professional nurse. After all, it was drawn up to protect patients, not nurses.

NHS managers need to know that when employing a registered nurse, they accept the professional code and standards of nursing, and that action will be taken if this is compromised. If, as in the whistleblowing attempts made by some Mid Staffordshire nurses, professionalism is neither respected internally by management nor picked up externally (in this case by the Royal College of Nursing), there is a serious gap in our professional framework as supported by both the RCN and the Nursing and Midwifery Council. How to address this needs to be subject to early debate and resolution. Our profession needs to put its house in order to restore its credibility where it matters - with patients.

Deirdre Wild is senior research fellow (visiting), consultant R&D older people, University of the West of England, Bristol

 

Readers' comments (44)

  • "How to address this needs to be subject to early debate and resolution. Our profession needs to put its house in order to restore its credibility where it matters - with patients."

    I agree with much of your article Deidre. However, I expect you will get pelters for not being a frontline nurse!

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  • I agree but I also believe professional behaviour goes well beyond the code to how one conducts oneself and sets a good example in society. Each one of us represents our profession and needs to behave accordingly.

    There seems to be great differences of opinion on the definitions of 'professionalism' and its interpretation. Maybe this needs revisiting and bringing up to date to adapt to changes in the new century and the new generations of nurses and different ways of doing things such as communicating, storing data, etc..

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  • Nursing has been dumbed down !

    There exist many who should not be on the register. These people have "qualified" from second rate ex-polytechnics where no-one fails! The "uni" has to maintain income so therefore produces stats which point to how "successful" their students are. Nothing in the brochures about the appalling drop out rates or the fact that most of the students cannot determine how to express half a Gramme in Milligrammes!

    The problem extends beyond the "uni"
    onto wards where "mentors" refuse to identify those who are manifestly unsuited to professional nursing. Much easier to turn a blind eye !

    Do we really have well educated nurses? It would seem that we have many who, at best, are mediocre.These are the people who whing and gossip, the ones who cannot compose a decent letter or complete an incident form which by the power of language usage and the demonstration of fact will ensure follow up by "management"!

    The public (and the media) have noticed the often poor care offered. They have noticed nurses poor communication skills and they notice when drug errors lead to the coroners court.
    The whingers and gossipers will attempt to blame staff "shortages" for poor care but do little if anything in an attempt to improve the situation. These "professional" nurses refuse to support the RCN (why are they members?) even when it is in their personal interest to do so (pensions?!) but again they are vocal in their criticsm of the organisation !

    Some of you will know that I have no problem challenging what I perceive to be poor management and I have personally referred "senior nurse managers" to the NMC for fitness to practice investigation.
    I have been supportive of my collegues but I begin to lose patience.

    Poor nursing practice is I believe now institutionalised within many parts of the NHS supported by whinging, gossiping (often overweight), poorly educated and unskilled "nurses".

    Yes the time for change is long overdue and if the profession itself does not make changes, change will be forced upon nursing from outside the profession!

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  • Nursing itself is being attacked, being scapegoated by managers, by the media.

    Nurses should organise.
    Nurses need to find a voice as a profession. One reason they are being attcked and scapegoated and hurt when they complain is Nursing is disunited.

    To be a profession means behaving professionally and that means supporting and helping each other. Its no good Nurses standing aside when one complains about staffing levels or whistleblows so she/he can be hurt.

    Look at doctors. I haven't heard many complaints against doctors in the press recently. Why is this? Are they all united? Is that why? Its only against Nurses.

    Its only through organisation, setting high standards and following these can Nursing be respected. Remember, people's lives depend on these. The Code must be about speaking out when uncovering problems. The Code is to protect patients but Nurses also need protection in speaking out, when they risk their jobs to protect patients, to work without being bullied.

    Nurses need to speak with one voice. Nurses need to tell the public what is going on. Nurses need to get professional, have a code and tell the public.

    I see Nursing as a proper profession that is diverse, that is a proper career, that saves lifes.

    LOVE
    PDave ANGEL

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  • Jenny Jones | 22-Feb-2013 1:57 am

    Having read some of your other posts, I think that you must have trained in one of your 'dumbed down, second rate, ex-polytechnics'. Your spelling alone is often appalling.

    Apart from that, you are stating views which other, more eloquent commentators have expressed many times before. Your colleagues in the UK have always been lethargic and ineffective, but you appear to have come late to that realisation. Nothing new here.

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  • Anonymous | 23-Feb-2013 10:43 am

    no worries, just the online Mafia at work. and of course those who make such comments never put themselves in the negative categories. they believe they stand out well above the rest!

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  • Anonymous | 23-Feb-2013 10:43 am

    My comments are written in a style which hopefully those who have "graduated" from an ex-polytechnic will understand.

    Clearly the "eloquent" writers you seem to admire are not understood by the average product of the so-called "uni's" which are happily "educating" yet more dross with which to infect the profession.

    Regretfully my typing skills are poor and I find proof-reading any contribution I make difficult within the confines of the small yelow box the NT provides.

    In addition the NT provides no edit function.

    You, therefore, will have to put up with my typos!

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  • Jenny Jones | 23-Feb-2013 11:25 am

    You can remove the 'dross' element by retiring yourself. How many Ls in YELLOW? Probably NTs fault!

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  • Jenny Jones | 23-Feb-2013 11:25 am

    you are very heavy handed with the blame game. how about putting your skills to better use with more constructive comment which people will be motivated to read? you appear to be up to this task.

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  • Jenny Jones
    I agree with you comment.
    Some critics are more concerned about the number of Ls in yellow than about the quality of care provided by nurses. Interesting that they remain anonymous Hmm...
    Oh dear I do hope that my spelling is correct

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  • accepting one's own human failings instead of bashing everybody else and seeking ways together to improve services might be more productive.

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  • tinkerbell

    PDave Angel | 22-Feb-2013 10:57 pm

    you can lead a horse to water as they say.

    After nearly 3 years of trying to rally my colleagues in my workplace i have decided that for whatever reasons, which are no doubt numerous, it ain't gonna happen.

    I now accept that. After spending 2 years of being angry and frustrated with them, but should the tide turn and they change I will be alongside them all the way in the fight for what is right.

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  • tinkerbell

    oh we've all been dumbed down alright. When celebrity becomes more important than society.

    Life imitating art or vice versa.

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  • kathleen white | 23-Feb-2013 12:33 pm

    Jenny Jones isn't his/her real name. Hmm. Anonymity takes more than one form.

    Unfortunately, nursing owes the state it is in today to previous generations of nurses who have allowed it develop into such an almighty mess. It is left to a new generation to pick up the pieces and take the blame. Yes times have moved on since the days when an O-level and the ability to wear a silly hat were all that was required to become a doctor's handmaid.

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  • I have found the recent news, and some of the above comments really disheartening. Can you imagine what a student nurse would think, reading those comments? We are all so tired of the ongoing anxiety and stresses, of simply being a nurse, I think that sight of the real problems has been lost. No amount of aggressive rhetoric is going to change the problems in the system and it makes me sad to see nurse against nurse in this way. Those nurses that witness substandard care need support to speak out and maybe the confidential phone lines provided by various professional bodies will help, if whistleblowers (what a horrible word) more 'inhouse' routes are ineffectual. To me professionalism is doing the job i've been trained and paid for to the best of my ability. Caring for those that need my care with a good heart, being non-judgemental and open minded and, above all, kind. Consistant professionalism is what our patients expect from us, and what we should strive for, always, even at this most difficult of times. In my experience truly good nurses have it in thier core and the training gives them the skills and knowledge they need to nurse professionally. No amount of training will make the wrong candidate a good nurse.

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  • jo partington | 24-Feb-2013 3:08 pm

    i agree with you and i believe professionalism means treating everybody well and not just patients. Professionals are supposed to lead by example and demonstrate good skills in all types of communication although so many have encountered so many difficulties in their employment or in other instances where they have witnessed substandard and negligent care.

    There is a lot of anger expressed here as it is obviously much easier on an anonymous site than face to face and they may not have any other better alternatives, but I have concerns for the public who see some of the attitudes reflected here. The public are also angry and a very large number have lost confidence in the NHS and many are anxious and frightened patients or relatives of patients themselves, and we are all potential patients who would prefer to put their trust in confident, knowledgeable, competent and caring nurses reflecting professional attitudes who will look after them.

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  • Professionalism?

    If nurses are so concerned about what the public think, then why have they allowed the likes of Stafford to happen? It is precisely because they are so obsessed with 'looking bad' and not rocking the boat that hundreds of patients in one hospital alone were left to die in appalling conditions!! You may not agree with the views refected here or the way in which they are expressed. However, it is the fact that some nurses 'don't like' an argument that causes the Staffords of this world to happen again and again.

    Professionalism is not about the appearance of being polite.

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  • Anonymous | 24-Feb-2013 5:47 pm

    you raise good points and I would further argue that professionalism is about argument and rational debate. that is not the same as some of the negative attitudes reflected here and sniping at others and making personal reflections based purely on assumptions about them which often end in senseless counter attacks. how can that possibly prevent situations like mid staffs or advance any cause for patient care or the profession?

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  • if patients are to have trust and confidence in those caring for them and in the medical establishment they are attending, as well as a positive impact on their therapeutic outcomes, I would suggest that it is very important to present an attitude of professionalism. those who think otherwise are a disaster fof the profession. it is not only about being polite but possessing all of the qualities which make a professional nurse.

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  • Anonymous | 23-Feb-2013 2:41 pm

    "Yes times have moved on since the days when an O-level and the ability to wear a silly hat were all that was required to become a doctor's handmaid."

    Thanks for the epitaph for my 40 years in nursing, good to know what you think of nurses like myself.

    Can we stop this nurse eat nurse culture - THAT IS THE PROBLEM!

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