As an A&E nurse at Mid Staffs Helene Donnelly tried to blow the whistle on care failings but was ignored and then bullied. Sarah Calkin asks her how nursing needs to change in the wake of the Francis report
The publication of the Mid Staffordshire Foundation Trust public inquiry report earlier this month was a big moment for nursing with many of its 290 recommendations focused on the profession.
However, it’s fair to say that for one Staffordshire nurse it was more significant than for most. Helene Donnelly spent six years working at the hospital whose failings have become a byword for poor care and which sparked the public inquiry that produced the report. She was the only nurse whistleblower to appear as a witness.
A&E concerns were ignored
Ms Donnelly told the inquiry she had repeatedly raised concerns about appalling care standards in Stafford Hospital’s accident and emergency department – only for them to be ignored by management and lead to bullying and intimidation by other nurses.
She told the inquiry she’d seen people die, “needlessly in some cases”, and “certainly with a lack of dignity or respect” on a relatively frequent basis.
More than four years after leaving the trust she says her only regret is that she did not speak out earlier.
“The reason I didn’t initially was because I was a relatively junior nurse. There was also a feeling of this is just how things are done. People make you feel that if you criticise you’re being negative or not a team player,” she says.
After submitting “tens and tens” of incident forms since joining A&E in 2004, a particularly fraught shift in 2007 prompted Helene to make a formal statement setting out her anxieties about care standards to managers.
The inquiry heard her concerns involved two sisters who ran the department who encouraged falsifying of patient waiting times and created a culture of bullying and fear.
Ms Donnelly also approached her local Royal College of Nursing representative for support after she was threatened by other staff members, but was disappointed by the response she received.
“At the time you feel almost like it’s a conspiracy, which sounds a bit dramatic, but that’s how it felt. I spoke to the RCN and was told to ‘just leave it, there’s no point in rocking the boat’. You get to the point where you feel that nobody’s going to listen.”
She later found out the RCN rep was also representing the sisters she had complained about. Other nurses came forward to support her claims but did so anonymously and the trust dropped the matter.
After the events at Mid Staffordshire were exposed, the RCN subsequently took a number of steps to improve support for its members when raising concern including setting up a whistleblowing hotline.
RCN director for England Tom Sandford told Nursing Times the college now ensured each side had their own representative in a dispute between colleagues.
Need for recognised pathway for raising concerns
Ms Donnelly’s experiences have unsurprisingly left her with strong feelings about whistleblowing.
She says: “There needs to be a recognised pathway for raising concerns that tells you where to go. I would like to see posters in every ward, in every hospital setting that out. Hospitals should be proud to support the awareness of whistleblowing and that in turn would give patients confidence.”
Where nurses see something wrong, it should be “expected and accepted” that they speak out, she told Nursing Times.
“That would raise people’s professional conduct. If you think the colleague you’re working with – even if they’re a friend – is going to speak out if you’re doing something wrong, then it’s going to make you think there is going to be comeback.”
Stafford Hospital’s A&E was so short staffed during much of Helene’s four years there that there was no proper triage system. However, she is clear that while poor staffing levels can be a factor in poor quality care, they should never be an excuse for care that lacks compassion.
“Just ignoring patients and expecting them to know what’s going on isn’t appropriate and it’s unacceptable. Just by explaining to patients what’s happening, and why, can reassure them. A lot of it is down to communication and common courtesy,” she said.
“So many nurses feel so undervalued… But you cannot explain away some of the terrible things that are going on and the unprofessional behaviour: swearing, abusive comments about patients, laughing about patients, talking about what you did on a Saturday night with your mate while you’re dealing with a patient instead of talking to the patient.
“If we as nurses don’t seem to care about the profession and don’t seem to respect ourselves, how can we expect other people to?”
Ms Donnelly now works as a nurse practitioner at a walk-in centre in nearby Stoke-on-Trent where her experience has been a world away from that at Stafford Hospital. She says: “It’s completely different… The trust has been really supportive of me speaking about my experiences at Stafford.”
Some still in denial about Mid Staffs
Ms Donnelly told Nursing Times she was encouraged by many of the Francis report’s recommendations for nursing, including calls for the registration of healthcare assistants and national evidence-based tools for safe staffing levels.
She was particularly pleased the report recommended more thorough appraisals for nurses – possibly including 360 degree anonymous feedback – as this was a suggestion she made in her evidence to the public inquiry.
However, she is cautious about relying too much on recommendations for nurse education and training. The Francis report itself called for greater focus on the values of nursing recruits.
In its wake, Health Education England revealed to Nursing Times that it had plans to assess all applicants to nursing courses for their values and behaviours.
But Ms Donnelly says: “Even if you’ve had very good training, you can still come somewhere and be placed under a mentor or manager who will have an influence – and a bad influence potentially.”
She worries that some nurses are still in denial about what happened at Stafford Hospital and think the media has sensationalised its reporting of events there, which has subsequently spilled over into more negative coverage of the profession.
“I do understand that nurses are concerned about the negative press, but I really do feel – certainly in terms of Stafford – what they’re reporting is what happened.
“There are still nurses who are bad apples, who are delivering poor care, and who need to be named and shamed. The only way poor care is going to change and give patients confidence back in the profession is for good nurses to speak out.”
- DH whistleblowing hotline 0800 072 4725
- RCN whistleblowing line (members only) 0345 772 6300