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9 ways the Francis report could change your nursing practice

How will the Francis report affect your nursing day? Here’s how …

  1. Allocation of key workers on every shift. Patients should be allocated a key nurse for each shift responsible for coordinating their care needs
  2. Improving of the nurse/doctor relationship.The patient’s key nurse should be present, wherever possible, at every interaction between a doctor and their patient. Nurses can advocate for the patient and coordination of care will be improved.
  3. Ward managers to come out of the office. Ward nurse managers should ensure and develop a clinical aspect to their role, working alongside staff as a role model and mentor
  4. Complexity of older people’s care recognised. The report suggests the development of the creation of a status of registered older person’s nurse.
  5. Regular rounding. Contact and interaction between nurses and patients to be systemised by regular ward rounds to improve engagement with patients.
  6. Who’s who to be clearer. Name badges and uniforms to make it clear to patients and relatives the difference between HCAs and registered nurses
  7. Testing applicants for nursing. Potential student nurses should be tested by at least three months of work experience of hands-on care, including time with the elderly and possible aptitude testing to assess caring and compassion and other professional values
  8. Keeping up to date. Nurses need to ensure they keep up to date through continuing professional development. The report recommends that nurses have an annual learning portfolio, signed by them and countersigned by their manager.
  9. Standardised training for HCAs. As well as regulation of HCAs, the report calls for a common set of national standards for the education and training of healthcare support workers. Robert Francis points out that the minicab driver who takes a patient to hospital is subject to regulation under which they can be disqualified if not a fit and proper person, but the HCA who washes the patient and accompanies him or her to the toilet is not.

Readers' comments (21)

  • I don't disagree with anything....but when do nurses have the time for all this? It would be lovely to always be there for patients. We are just too short staffed for it!! The other issue is lack of bed spaces for patients. We continue to operate on patients with no room in the hospital for them, purely so the hospital can make money. These patients are then nursed in inappropriate settings with few staff or resources to look after them!

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  • Gary Musgrove

    Fully agree with anonymous above. We have had "lean working" "skill mix" re-organisation etc which will only work if the staffing ratio per patient is increased and improvements will only take effect if resources are made available and used "appropriately". I hope when I read the Francis report it has recommendations of this nature too.

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  • I would just like to say all these things were once in place and 'the suits' took it away. Why oh why do non medical staff get employed to run the NHS into the ground. I would love to be there for everyone but unfortunately most of my time is spent on people using the NHS as a hotel as they are the ones who shout loudest because of their addictions!!! They need to be weeded out and a new firmer admission system for 'boomerang' patients needs to be implemented. Its funny how they seem to come in when they know the new junior doctors will be 'on call' so therefore will feed their habit leaving poor Doris with her fractured femer to suffer in silence THE ROT HAS TO STOP!!!

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  • Nursing will take the recommendations on board and will really try to improve things. How about the Managers involved? Will they face any sanctions at all? Well that's a big fat NO! They just get promoted out of the way with a nice big salary. Will they face charges of corporate manslaughter - NO! What about the medical staff?? Where's the justice for the victims and relatives??

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  • So, Francis wants the Ward Managers out of the office then. Well, l have news for him and it's all bad! I am a ward manager and l spend 4 days a week clinically and one day for management. I have to give that 1 day up if the ward needs me, so when do l get to do my 'management stuff' Oh, yes - l stay on after my shift to make sure my audits, sickness and absence, budgets etc etc etc are completed on time and l don't claim this as over time. So come on Francis' live in the real world and walk a mile in my shoes!!!

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  • PS As a nurse of complex older people, I also have to do CHC checklists and DST's which take up inordinate amounts of my time and l have to type them up, attend & present at panel, appeals, talk to patients & relatives whilst juggling my ward and providing hourly rounding for 17 patients of which at least 50% are demented. But l love my job!

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  • Reading through these recommendations, I recognise six of them as having been in place when I was a student in the 1990s.

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  • Anybody who has followed the debate and all of the recommendations, what has been said about adequate and appropriate staffing levels? What has been said about medical practice and what has been said about the different levels of management, what has been said about the roles of other staff working in the hospital who also contribute directly or indirectly to patient care, or was the report focussed on how nurses should practice?

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  • it's always just about the nurses, how bad we are, how we have to do this and that all the time.

    1. the named nurse system has been in place for years, it doesn't happen where I work because we all just work wherever we are needed, there is no consistency.

    2. don't really know how 2 nurses can go around with every doctor - would be nice but we have other stuff to do as well.

    3. hourly rounding - not always achieveable as we often spend at least an hour with one patient.

    4. ward manager to come out of the office, that would be nice but every day seems to be a 'management' day.

    This govt will just fluff around, they don't care. If the Francis Report recommends changes then things should change, why should it be up to the PM, he is not the one looking after people.

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  • Maybe ALL managers should come out of the office? Perhaps seeing for themselves the reality of cost cutting on the wards, ticking stupid boxes which prove nothing re care and standards just add to our ever increasing work load might actually improve patient care. But no, that won't happen ,just keep promoting numpties and blaming the nurses as usual while families demand more and more! But above all, what nurse would raise their concerns about poor care knowing that they will be bullied by senior staff and ignored. The NHS is a busted flush.

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  • In the real world, all the recommendations should be implemented. 'Key nurse on all doctor patient consultation',does this Key nurse stop what she is doing and i wont list the many tasks she is trying to carry out,so she can attend the consultation.(poor old Key nurse is another 'Super nurse' we implemented in the 90's,then got rid of most of her team because Super nurse cost so much). We try to attend study days and courses as much as we can,its an insult to say we are not. In my Trust we are paid for 2-3 hours on a S/D,the rest in our own time.,many nurses attend in their own time and not paid a penny. It gets me cross when told due to staff shortage S/D cancelled. Is Mr Francis informed of this?
    Glad he recommends bosses back on the floor and lets get students out of those colleges,tutors back on the wards (helping to reduce the moutains of written work a student brings along with her for poor Key/Super nurse to fill out, along with 500 hundred tasks) and become a team again.

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  • I trained back in the sixties when a lot of the recommendations in the Fisher report actually happened. We had fewer managers (luckily) and student nurses were part of the workforce. The Ward Sister led the nursing team and we had at least two staff nurses on each ward. We had nursing auxiliaries not HCAs and they helped with the care of the patient and other non nursing duties that had to be done.

    Having said all that, today there are far too few staff on the wards which would make implementing some of the recommendations unworkable. The constant audits, reports and other senseless paperwork needs to be reviewed because most of the time despite spending so much time on these, the results are usually filed away and become pointless exercises which is a total waste of time and money.

    The student nurses need to spend more time actually working on the wards and departments and although working as a "cadet" type of nurse before they start their training would help them (I found this immensely helpful in 1959!) how would this be implemented and paid for?

    The tutors should work on the wards with the students; not get in the way but actually do any nursing care with them which would help all round. We had Clinical Tutors who worked on the wards as well as in the school of nursing, so why not implement this again.

    The answer to todays problems is to provide extra staff and not reduce the work force. To have the proper wards again and not amalgamate specialities. Instigate the ward rounds and make sure that all staff communicate with each other. Have key workers (again!)by all means but provide them with staff to which they can delegate care of the patients to. There is no point in this without adequate staff.

    On a last point, registration of HCAs? Well we are leaning towards the reintroduction of the enrolled nurse training here and why not? There are several good nurses out there who are put off by the degree training and perhaps this would solve a lot of todays issues.



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  • It seems to be all about the ward settings, what about community nursing where the goverment want care to be given, are we not nurses as well as humanbeing?

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  • tinkerbell

    well said Winifred. I agree with you.

    Nurses should come into nursing because they want to be nurses. It is now difficult to establish that some of the students i have mentored over the past 13 years doing their nurse training actually want to be a nurse or are just on a career pathway to somewhere else. One actually told me as much many years ago, it was just a pathway to somewhere else.

    I was thinking the other day why they did away with the cadet training, one of the best nurses i ever met started out as a cadet nurse and was one of my finest role models in nursing.

    It would be great for those who want to train but not do a degree to still be nurses, so i agree different levels such as SEN and RN would help.

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  • The Staffs scandal and Francis report is now international news, reported on European tv news channels this evening, and a report about the tragic case of Ms Foster reported at length in a tabloid this morning.

    It is not good news for British nurses abroad who have to work extra hard to prove they are as able as their local counterparts, and where we were once considered as even better, and especially as people have been reminding me for years of very poor experiences they have had of the UK health services when visiting our land which colours their whole opinion of the NHS.

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  • if we are to implement changes, we need "human resources" to support matrons and sisters in being able to discipline poor performers, it is impossible to get anyone sacked, my day is spent filling out endless action plans, audits and numerous pages of pointless paper, assessments and more assessments and yet another form, all for what ? my message is leave matrons and sisters to do their jobs and support and educate junior staff and lead by example from the front, only then can we put the patient first and pointless paperwork where it belongs in the bin ! sadly i sign this anonymously as like so many we live in fear for speaking out ! i have tried and failed, I complained that staff were sleeping on night duty and was told we did not have a policy to deal with it, i wanted to disapline two HCA's who left a ward unattended to smoke outside the ward, to be asked by unison rep and HR, have I referred them to the stop smoking service or "occupational health" !!!!!!!! retirement - bring it on!

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  • These are all recommendations. I think the most important are hospitals publishing the nurse/staff ratio.Why doesn't Francis mention this?

    How much money will all these take?
    Also nurses have pointed out above a lot of these existed in the 1960s but with all the costcutting and budget cuts how many will actually be implemented?

    I think nurses are very weak politically and you need to get organised. I mean you should use this report as a weapon against all the politicians.

    You should come out and say at demonstrations, at parks and festivals, you should challenge the media's opinion with your own. A lot of people don't know what goes inside a hospital and don't know how hard, how difficult being a modern nurse is.

    The Francis report was in the news yesterday and all I got was appalling nursing and management.

    You need to tell the public what is actually going on. This report can be very powerful if you use it, if you confront the politicians with it, if you confront all the budget cutters with it.

    Me? I am not a nurse but by being here for 6 months I can see how frustrated all of you are. The public only know what they see on the news and in the newspapers

    Nursing Needs A Voice to speak up in the country and to challenge all the yuckiness and nastiness around.

    I personally know Nurses are wow and totally amazing.

    LOVE
    PDave ANGEL

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  • This won't change the culture it will simply endorsed the belief that all will be solved with more endorsement and paper work.
    Stat at the top and bottom and consider assigning jobs to whistle blowers who have been spurned. The had guts and clearly care

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  • So where is all the money coming from for these proposals then in this culture of cuts cuts cuts?? Oh how good it would be to be able to change my nursing practice for the Francis proposals.
    For future nurses :-
    1. Work for at least 3 months on a ward (you wont get paid) to prove that you are caring, compassionate and dont mind giving a patient a commode.If you then prove yourself as a potential Florence then;-
    2. Apply for a degree, as there is no other pathway at the moment.
    3. Chalk up a large student debt.
    4. Start work as a band 5 nurse doing what you were doing unpaid, with paperwork thrown in to the bargain.
    5. Try to get promotion to a band 6 (becoming more scarce due to cuts) to help pay the huge student debt.
    6. Continue to pay debt. Look for somewhere affordable to live whilst dreaming that one day you may get funding for further training that will progress your career.
    7. Continue to pay debt, struggle to juggle, live with the constant critisism that you are a degree nurse and therefore not caring, compassionate, put off having a family and home of your own as you are not paid the same as comparable educational careers......
    8. Have your NHS pension critisised as too generous so therefore cut.
    9. Regret going into nursing. Too old and confidence gone to change. Wish that you had gong into journalism/marketing/advertising/finance instead.
    10. NEVER advise any other than the offspring of the rich to ever enter nursing.

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  • The Francis Report is only stating basic nursing care...everyone just needs to do their job and be accountable for what they do...remember the NMC guidelines?

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