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OPINION

Jan Quallington: ‘Compassion must be a central element of all nursing degree programmes’

Patients should be confident that every nurses has the right attitude towards care, says Jan Quallington

The Francis report on the inquiry into the Mid Staffordshire Foundation Trust scandal is about to be published. One of its key recommendations is likely to be that change is urgently needed in nurse education.

Nursing has come a long way as a profession since I first started out as a nurse some 30 years ago, but one area that has suffered, as the demands on hospitals and nurses have grown, is the most fundamental of all – caring and showing compassion for patients.

 As the Willis Commission concluded, there is no evidence to support the suggestion that turning nursing into an all graduate profession is in any way responsible for this. Indeed, the knowledge required of today’s nurses demands at least a degree level qualification. What we must ensure, however, is that patient care is a central element of all degree programmes. Patients should be confident that every hospital worker, be they doctors, nurses or other allied professionals, has the right attitude towards care, as well as appropriate knowledge and skills based on the most up-to-date medical and scientific knowledge.

Nurse educators, who are themselves practitioners, are acutely aware of the need to impress on students the importance of a caring approach. Care environments are more pressurised than they have been and it is essential that nurses are supported to take the time necessary to work in this way. A practice nurse friend, who was recently hospitalised, told me that during her hospital stay she “just didn’t feel cared about”. There was no sharing of information and she was made to feel by staff that she was being a nuisance if she asked for anything. As a nurse educator I was saddened to hear this. In my experience, nurses enter the profession because they want to care. How have hospitals become an environment where nurses cannot provide the kind of personal care that they would wish to give and where a patient feels like a burden?  

“A key step to developing compassionate, expert nurses who can cope in difficult circumstances is by changing the way trainees are selected”

Part of the answer is that nurses need different skills to handle the pressures they face on today’s wards. A key step to developing compassionate, expert nurses who can cope in difficult circumstances is by changing the way trainees are selected. Assessing attitudes is difficult, and in the past this has not been a feature of nurse recruitment. Francis is likely to call for this to be addressed as part of reforms to the training of nurses. At the University of Worcester, we have already made a start. The attributes of a good nurse have been identified by patients, carers, clinicians and academics so that recruiters can assess whether applicants possess these qualities, including kindness and compassion, emotional intelligence, and confidence. Selection is undertaken by panels of nurse academics, patient representatives and clinicians who must all agree that the candidate has the potential to be a good nurse.

Having selected the right trainees, we must ensure they receive the right kind of high-quality training and mentoring. Student nurses in England spend at least half of their time in the workplace, including hospitals, GP surgeries and treatment centres, and are strongly influenced by the cultures that exist in practice. Teaching and supervision in a busy ward is always challenging and sometimes difficult. Staff are under pressure and do not necessarily always meet the best clinical standards. Patient needs are becoming more complex and an increasing number have dementia alongside their physical illness. This brings new challenges and nurses need to be effectively prepared for caring responsively to these new needs.

What does this mean for student education? At Worcester our response has been to teach students to be resilient and to accept personal responsibility for making sound judgements about the care standards that they witness. We have ensured that the university provides support in the event that students raise concerns about incidences of poor care.  It is vital that students are equipped to question practice and are supported to challenge the sub-standard.

The first Francis report was highly critical of the quality of leadership at Stafford.  Good clinical leaders are essential if we are to ensure that consistently high standards and good quality care are provided at the bedside. This can only be achieved if the knowledge and skills of managers, as well as nurses, remain up to date. Professional updating and ongoing staff development are therefore essential elements that must be maintained. Nurses today face more challenges than ever before, and the level of knowledge and expertise they must acquire is growing. But as the first Francis report showed, things can go tragically wrong if compassion and the fundamental principles of patient care are missing. Everyone involved in the training and selection of nurses has a responsibility to ensure that these elements are at the core of practice among the professional workforce in all of our hospitals.

Dr Jan Quallington is head of the University of Worcester’s Institute of Health and Society. She spent almost 30 years as a practising nurse, having trained at University College Hospital London

Readers' comments (13)

  • do you think people go into nursing for the wrong reasons? do you think we should go back to the days when Matron interviewed all prospective student nurses like myself back in the 80's (I trained at UCH too).

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  • True. I can't agree less. Actually I'm sickned to death by those who have taken up this beautiful career jus for the sack of money without a thought to give back to society the basics of what is required of them late alone the massive resource and expenses that goes with their training. Personally I strongly feel something definitely needs to be done now or never to root out this evil before its too late. I think patients need more education on their rights to speak out and help weed out these parasites amoungst us.

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  • As a student nurse on placement, I have found in my current ward that health care assitants are increasingly becoming the main people the patients see. There are a lot more HCA's on my ward than nurses and the nurses are often left with lots of paperwork, drug rounds, meetings and taking obs. It comes to the HCA to do most personal care although the nurses do help when they can. When I asked them how much training they needed to become HCAs the answer was very little. Surely more regulating of HCAs would also help, to make sure they know how important care and compassion is. Some were very good but others seem to lack compassion - one was going to leave a lady sat in her hoist sling all day because it was too much of a faff putting the sling back on later - I couldn't believe it and immediately took the sling away. Where was the care? The HCA hadn't thought how uncomfortable and awkward it would be for the lady to stay sat on a sling all day but was only thinking about himself and how inconvenient it would be for him to have to put the sling back on later. Grrr!

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  • I am 55 next month, and am retiring from the NHS. I have been privileged and humbled to have nursed wonderful people. I have worked with truly good nurses, doctors, ancillary staff.Over the years I have seen great changes.
    The NHS remains a dedicated and enviable institution. But, as with most institutions today, it is time to return to basics.Nurses are kept away from patients while pursuing mostly pointless targets, filling in copious, and often duplicatious forms, computer work-the list goes on. Common sense cannot prevail! Managers are constrained from above-views of the workers are often ignored.
    Money, money, money....but a lot is wasted.
    Nusing, however technological it may become, should still focus on the holistic care of the patient, and I wonder if this is truly recognised in nurse education today? Yes, the training of yesteryear may have had its faults, but we nursed.

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  • Mindfulness in Healthcare: Bringing Intention, Attention and Reflection to Healthcare.

    I am happy to share with you that I was privileged to facilitate the above workshop at Bournemouth University this Wednesday. It was inspiring to connect with young people who are just at the beginning of their healthcare career journeys.

    We had approximately 25 Occupational Therapy students attending. The purpose of the workshop was to inspire and support healthcare students in self wellbeing and to contribute to the 6 Cs of Care, Compassion, Competence, Communication, Courage and Commitment in this way enhancing therapeutic engagement skills and self efficacy through mindfulness.

    One student said:

    This is one of the best and most informative workshops I have ever been to. This has already given me great insight into the benefits of mindfulness and I am sure this will reflect in my practice as an Occupational Therapist, thank you - KJ

    Best wishes

    Robert
    www.dorset-mindfulness.co.uk

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  • tinkerbell

    Anonymous | 18-Jan-2013 1:19 pm

    Interesting and something that could help everyone de-clutter their minds.

    Start with a fresh mind everyday. Observe without judgement.

    Of course it is ancient philosophy but still true.

    'There are two mistakes one can make along the road to truth... not going all the way, and not starting'. - Buddha

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  • Tiger Girl

    A practice nurse friend, who was recently hospitalised, told me that during her hospital stay she “just didn’t feel cared about”.

    Part of the answer is that nurses need different skills to handle the pressures they face on today’s wards.

    ............................................

    Yes Jan, however I did not see that it becomes almost impossible to 'care' if people are hugely overworked, mentioned anywhere in your piece - why no reference to 'and part of the answer might be that there are just not enough staff at times'?

    You did not investigate the apparent paradox, if caring takes up more time than non-caring brusqueness, within your sentence (because the support surely equates to less pressurised ?)-

    Care environments are more pressurised than they have been and it is essential that nurses are supported to take the time necessary to work in this way.

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  • It strikes me as outrageous that nurses need to be taught compassion. It should be an attribute that is as natural as breathing for those who choose nursing as a career. The trust I work for boasts that it will give compassionate care for all its patients but sadly is utterly lacking in this promise and more concerned about quantity than quality.

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  • I am a first year student on my first placement, but have had a previous career in community and international development and have worked for a number of organisations. The best of these had a policy of alloying staff time to discuss emotional issues we faced in our work and how we handled them. The standard of work that that organisation did meant that walking into meetings and saying where I was from gave me instant respect - despite being very young at the time. The compassion and dedication we brough to working with women in hard ot reach communities was supported by hte compassion shown to the staff by the management. I have taken this attitude into other orgnaisations I have worked for - all of which benefitted from realising that how you treat staff impacts on how they treat clients.
    This contrasts so stongly with my placement, where my mentor hasn't even been given time with in her hours for my final interview. We are on the go all day - and agency staff have said our ward is really quiet compared to some of the acute ones. The staff are caring and give time to patients despite the way they are expected to work, not because of it. Management needs to model compassion, rather than expect it to result from the threat of punishment. There need also to be enough staff on time allow patient centred care, rather than a rushed jobs list to complete.

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  • Bless you Jenny, and all good wishes for a long and happy retirement. We miss people like you. I have 2 close nursing friends who retired this month and it's been heart breaking to see them go. Back to the dictionary and Royal Marsden book of procedures for me, no one else'll have the patience to explain things to me now.....

    I'm reminded of a conference I went to, not sure how I got an invite, being only a manager, but the audience were all nurses. They had a retired matron who they were going to wheel on at the end and she was supposed to say how wonderful all this was and in her day everyone died of TB. So she listened to us talk about 6Cs and cQUINs and QIPP and no one mentioned patients. So she came up to the platform and said "I had a long speech prepared but I have decided not to give it. All I will say, is that in my day we cared for patients". And walked out. You could've heard a pin drop. Nearly as good as the slow handclap they gave Patricia Hewitt years ago.

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  • The Nobody | 22-Jan-2013 10:35 pm

    That anecdote is great. Really drives home the message and is likely to reach far more folk (who admittedly shouldn't need reminding) than any long winded speech. Ha, she sounds fab!

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  • The Nobody | 22-Jan-2013 10:35 pm

    how did she manage to walk out when she entered in a wheel chair? sounds like one of the miracles in the bible.

    great and inspirational anecdote though and my good wishes also go to Jenny for a happy retirement. There is much to life beyond nursing :-)

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  • if the teaching of nursing is delivered with compassion and the profession is managed with compassion this will help create a culture of compassion throughout the organisation, and in any case it will not cause any damage to it. you cannot expect one group to turn on compassion like a tap and nurses and anybody else will find it hard to give it consistently unless they can also feel and experience it as well.

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