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