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Honesty laws and HCA regulation would make NHS safer, say nurses

Calls for a legally-enforced “duty of candour” to be introduced in the NHS in order to encourage and protect whistleblowers have been overwhelmingly welcomed by nurses.

The majority of nurses also believe that regulating healthcare support workers – also known as healthcare assistants – would significantly benefit patient care.

A Nursing Times survey of just under 3,000 nurses has revealed the first snapshot of how the profession views the recommendations made in Robert Francis QC’s seminal report since it was published on 6 February.

An overwhelming majority, 95%, of survey respondents welcomed one of the Mid Staffordshire Foundation Trust public inquiry report’s key recommendations to introduce mandatory regulation for healthcare assistants, but around 94% said it should have also recommended regulation for managers.

The majority of nurses thought HCA regulation would be of significant benefit to patient care and 73% said it would be of “great benefit” to nurses in terms of improving their working day.

A further three-quarters of respondents also said it was “very important” for staff to wear badges and uniforms that clearly distinguished between HCAs and registered nurses.

Another major recommendation in the report surrounded the need for a legal “duty of candour” to encourage and protect staff to raise concerns over patient safety.

The survey indicated that 92% of nurses either “agreed” or “strongly agreed” with the idea that new laws should require all NHS staff and directors to be open and honest when mistakes occurred.

Around 80% of respondents backed the introduction of specially trained “older person’s nurses”, agreeing that they would improve care for older patients.

More popular still was the idea of assigning patients a “key nurse” on each shift to coordinate their care – though 70% thought it would be “difficult” or “very difficult” to implement in practice.  

Meanwhile, just over half of respondents, 55%, said they would like to see the Royal College of Nursing separate its role as a trade union and a professional organisation. The Francis report highlighted what it described as an “inherent conflict” between the RCN’s dual functions.

Most nurses, 77%, also liked the idea that potential nursing students should complete three months or more work experience before starting their course.

  • Full results from the survey will be published soon.

Readers' comments (11)

  • Interesting to see if potential students for nursing and medicine will be asked to complete a few months work. I've seen during the last few years more and more Sixth-formers doing a few hours voluntary work around the wards, some of them children of medics, assisting to dish out food to patients. There's still a requirement to maintain confidentiality and dignity of the patients they are helping.

    Regulation of managers is long overdue, they should also be checked to ensure they have the right experience and qualifications, as well as a good track record of looking after their staff. Chartered healthcare management accreditation by an external body immediately springs to mind. None of this few week's slap dash training and get promoted. It takes time and investment to grow good managers, just as much as in any other job, like nursing.

    Nurses already coordinate care for their patients (or try to) and isn't the "key nurse" the same as the one looking after them on the ward, am I wrong? has this come + gone?
    There probably needs to be a cultural shift in everyone's training and support to ensure each 'key nurse' is fully updated and informed when there are any interventions and changes to each of her/his patients by any member of the MDT.
    Or is it doctors who coordinate patients care?, but are around fleetingly for each patient. If so, I'd like them to be around much more. They are generally excellent, knowledgeable and skillfull at assessing, diagnosing and prescribing what the patients need.

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  • michael stone

    I seem to agree with most nurses, judging by the above.

    But I'm not sure exactly how one would regulate 'managers', as managing seems to my mind to be less easy to define than nursing and medicine. But there needs to be a way of eliminating 'the wrong type of individual' (in current parlance, that would be 'any manager, or other professional, who allows other considerations to subvert the primary objective of good patient care') from working within the NHS: and an equivalent 'concept' applied systemically, should apply to 'qualified providers' (so a private company, if shown to have compromised patient care by 'down grading it as an objective', should be disqualified from NHS work for perhaps 5 years).

    Doubtless 'finding the way' will be problematic - there isn't a series of exams, relating to 'the right attitude', so it is tricky to prove that somebody, or some organisation, lacks it: it is one of those things that most people can 'see', but defining an objective test is much harder !

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  • "The majority of nurses thought HCA regulation would be of significant benefit to patient care and 73% said it would be of “great benefit” to nurses in terms of improving their working day."

    How and why? Registration of HCAs will not change the way that they're managed or trained. If managers performed proper checks before employment and trained them appropriately, and ensured that they are suitable managed then patient care may improve. Nurses who think that registration will "improve their working day" presumably mean that HCAs then become the regulator's problem, and that's simply misguided.

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  • "The majority of nurses thought HCA regulation would be of significant benefit to patient care and 73% said it would be of “great benefit” to nurses in terms of improving their working day."

    How and why? Registration of HCAs will not change the way that they're managed or trained. If managers performed proper checks before employment and trained them appropriately, and ensured that they are suitable managed then patient care may improve. Nurses who think that registration will "improve their working day" presumably mean that HCAs then become the regulator's problem, and that's simply misguided.

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  • Florence

    I agree that Managers in the NHS should recieve more training and preparation for their roles.
    Being an exceptional Nurse for example does not mean you will automatically make the transition into a managerial role and have the skills to be effective.
    Yes some individuals have more natural leadership or managerial skills . However there is a different skill set involved in managing and leading on a continual basis.

    I do agree with regulation of HCAS. However I agree with the point made by Anonymous in the previous poster. We need our HCAS to recieve proper training and the proper checks made pre- employment.
    Our area does have a policy of having a ''Key Nurse'' for each patient for each shift. In the day time we split the ward in 3. One RGN for each team of patients. Then we have a coordinator to oversee.
    As for a '' Duty of candour''. Well Staff need to be protected and supported when they speak out at all levels whether Director, staff nurse or HCA. Its never stopped me. Its probarly only been sheer luck that I haven't been bullied or ''persuaded'' to be quiet.
    The reccomendations by the Francis report make sense.If the NHS is to become an institution which we can be proud of again, then the reccomendations need to be implemented.

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  • tinkerbell

    if it is the governments intention to recruit more HCA's rather than RN's but not regulate them then i wish they would at least be honest about their intentions. Is it that they want a cheaper workforce that are less skilled but can be trained up once in place and unregulated so they can get rid of more RN's and save even more money without any comeback?

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  • Why not press for a statutory definition of "nurse" (dependent upon registration), which accords specific privileges relating to care? At the moment, the title "nurse" can be used by anyone, whether registered or not.

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  • will a cheaper unregulated workforce not cost more in the long run if the staff lack the skills to do all of the tasks RNs currently do, and have a greater potential for errors? it is interesting to see how this workforce is going to function (although a tragedy that it could well be at the expense of the safety of patients).

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  • Completely agree, managers should be regulated, but not just ones with a clinical background. The IHM = Institute of Healthcare Managers has a good framework. It is ridiculous to have so much say in how an organisation works and not to be accountable. Or to fail and get a payoff then pop up somewhere else.
    Forgive me if I'm wrong, but don't nurses who end up as directors or CEOs remain professionally accountable as a nurse even if they no longer have a PIN?

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  • The Nobody | 20-Feb-2013 7:39 pm

    Yep, as long as they're on the register, regardless of position someone can be struck off for poor practice. A nurse director, nurse CEO, nurse teachers are still registered if they want to continue in that role.
    Eg a registered midwife who worked as a HCA was struck off a few days ago. It will be same for Chief Nurses if it was proven they were at fault.

    If they deregister, then they are no longer a registered nurse or midwife, and cannot practice or call her/himself as one. NMC will not have any jurisdiction over them. To practice without registration is not legal and other systems come into play.

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  • Just in case of confusion in comment above, the registered midwife was struck off for abuse of her patient, not because of working as a HCA.

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