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Leading nurses unveil tool to probe NHS culture

Leading nurses have developed a test to identify whether a workplace is suffering from a culture problem akin to that which contributed to the care failings at Mid Staffordshire Foundation Trust.

The “cultural barometer” can be used in any healthcare setting by individuals, nursing teams or as part of a wider organisational review.

It has been developed by a group of six leading nursing figures that came together in 2011 to call for major improvements in the profession in response to a growing number of cases of poor care.

The group includes Sir Stephen Moss, former chair of Mid Staffordshire FT, crossbench peer Baroness Emerton, King’s College London professor of nursing Anne Marie Rafferty, and Dame Elizabeth Fradd, who led the government’s health visitor taskforce.

It also includes South Tees NHS Trust deputy chief executive and director of nursing Tricia Hart and Flo Panel-Coates, former chief nurse at Maidstone and Tunbridge Wells Trust and current director of nursing at Barking, Havering and Redbridge University Hospitals Trust.

The group has drawn on their own experiences and research into 50 organisations to develop a two-page questionnaire, which aims to probe the attitude, values and culture of an organisation.

Some of the question’s in the barometer ask if staff think senior managers  have an understanding of how things “really are” and whether staff feel concerns are listened to.

Dame Elizabeth Fradd told Nursing Times the barometer was divided into sections exploring the resources, support and help available to staff to do their jobs, and their perceptions and emotions.

She said the group were convinced culture was a fundamental factor in delivering good patient care.

“The barometer is about emotions – that’s where culture comes from, what staff feel and their experiences of working in an organisation,” she said. “One thing that rarely gets attention is the culture of an organisation, we never get under the skin of an organisation.”

The National Nursing Research Unit at King’s College London will be piloting the barometer in an acute trust and a mental health trust over the next few months, with results expected in spring next year.

The group said the barometer had the support of NHS Commissioning Board’s chief nurse Jane Cummings and Viv Bennett, the Department of Health’s director of nursing.

Readers' comments (20)

  • Why not probe the attitudes, beliefs and "culture" of "Leading Nurses"?

    I can immediately think of at least 20 such "Nurses" who are contributing to poor workforce"culture" and poor moral. These are the "Leading Nurses" of the South West Pay Consortia ! As outstanding" professionals" they amongst other demands require nurses to submit to :-

    1.increased working hours
    2.Reduced holiday entitlement
    3.Reduced pay
    4.Reduced sick pay
    5.No pay progression
    6.Reduced unsocial hours payments

    I can imagine that such an agenda would have a pronounced negative effect upon workplace "culture.

    I do not need a “cultural barometer” which amounts to yet another stack of paper to inform me of the obvious.

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  • Well said my !!!. We live in a time when people only see what they want to see. The come up with red herring to try and let us thing they care about us. So not rue

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  • Anyone who thinks that nurses care about nurses has not worked as a nurse.
    We continue to have a blame culture and frequently see the most junior nurse being disciplined for things that have resulted form inasppropriate staffing and system failiure.
    The law and the NMC only look at what the nurse did for that patient at that time and do not take into account the fact that senior staff refused to put in additional help, continued to admit to the caseload/ward, and that other things were happening at the time.
    As yet the nurses can do one task at a time and if 2 old ladies fall when the meds are due, which first, you cannot be right if you have only 1 pair of hands.
    Also the pay. Agenda was a cynical execise to reduce nurses pay, they feel undervalued and this exercise proved it.
    What happened to doctors pay in the same time period. Bet you it did not go down as well.
    I don't know how we recruit nurses at all.

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  • The barometer would have engendered more confidence had it included some nurses from the 'bedside'. An annual confidential survey of employee attitudes if carefully designed should detect cultural decline and corruption but it would have to be open and independent of senior management.
    Anon 8.05 shows that 'leading nurses' may not be in touch will the real world according to the pioneering 'businessmen' in the SW peninsula.

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  • So what is the purpose of the NHS annual staff survey? does that not deal with issues such as being "listened to " " consulted with" and a multiplicity of other issues that effect the day to day running of an NHS Trust.

    Smack of yet another exercise for the sake of it.

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  • Poor workplace culture is a major problem and I'd agree that it has to change or we won't have a nursing profession. Or an NHS either.

    Florence was right in that inadequate nursing education, feeble leadership, disrespect, poor pay and lousy work conditions are no basis for a profession of nursing. But does this really account for the bullying by senior nurses and the absolute cruelty of patient neglect and abuse by some nurses at the beside?

    Some of the most lazy, smug nurses I've ever met were on trust boards. Many didn't even get off their backsides to go and look at what was going on in their trust services, let alone listen to staff with concerns about standards of care. They behaved as though their appointments were a reward, rather than a formidable challenge!

    I think we've been too keen to recruit and retain clinical nurses who are incompetent or simply not decent enough people to be in our profession. In a system which allows box ticking to replace proper scrutiny of patient care, senior staff have failed to tackle nursing quality problems effectively. It's for them easier to ignore a problem than make a fuss about bad practice and get their employer unwanted media attention.

    If I'm right, this means that both sides of the problem need sorting out. Goodness knows if these 'Leading nurses' are up to the job, but it's time somebody had a go.

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  • michael stone

    H Wood | 23-Oct-2012 3:02 pm

    With no direct experience of my own, as you presumably do have, your post 'looks right' to me.

    'Some of the most lazy, smug nurses I've ever met were on trust boards. Many didn't even get off their backsides to go and look at what was going on in their trust services, let alone listen to staff with concerns about standards of care. They behaved as though their appointments were a reward, rather than a formidable challenge!'

    Perhaps, nurses who are on trust boards, should still be required to do some on-the-wards nursing (perhaps one day per week) ? To 'stay in touch' ?

    'In a system which allows box ticking to replace proper scrutiny of patient care, senior staff have failed' has to be right - but, you got all of those 'tick boxes' for various reasons, one of which was an attempt to use less-skilled (which is to say, cheaper to employ) staff (the balance is staff expertise multiplied by the degree of tick-box prescription: incease staff skills, decreas tick-box, and the reverse).

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  • The following report is in the public domain and makes me wonder if this is informing the process.

    Check out Appendix B - it's full of typos, but looks like it's moving in an interesting direction.

    https://www.kcl.ac.uk/nursing/research/nnru/publications/Reports/RN4Cast-Nurse-survey-report-27-6-12-FINAL.pdf

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  • Culture barometer. Don't make me laugh!
    It must point to forever chilly in most Trusts/Health Boards.

    As far as I'm concerned pensions (as a way out) are the main topic of conversation for anyone over 40 with the great count down of years commencing from 45 depending how many years service you have in. Luckily I can go at 55 and so I'm off in 5 glorious years and still 'young' enough to go crazy and start enjoying life!

    I've never come across so many unhappy, disillusioned people within one organisation. Pay freezes, poor management,ineffective leadership, inadequate staffing, downgrading of some staff, whilst others receive uplifts without HR processes...

    Get me out of this inept, unjust system that doesn't deserve my commitment and hard work.

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  • You can't leave the problems of the weakened and demoralised system behind, even if you leave your current job situation at 55. Pensioned or not, we all get old and so do our parents and relations. We need our healthcare system to work effectively for us all.

    For me, that means a tax based system with everyone paying according to their income and receiving effective health care when they need it & wherever they live in UK.

    The US system is insane: it depends on restricted access for most insured people and a massive health underclass comprising the uninsured and the poor. The suffering that results from poverty and lack of health care access has to be seen to be believed.

    Only a government as crazy and right wing as this would follow such a lousy example. They'll trash the NHS if they stay in government.

    It's important to look beyond the immediate hassles of an unhappy & badly managed workplace and see the bigger picture.

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  • Anonymous

    It seems to me, that at last parts of Mid Staffs must have had such an 'appalling culture' that it should have been obvious WITHOUT 'a tool' - as JH tends to say on Radio 4: "Why wasn't this obvious to everyone ?!"

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  • I, too, am just waiting for the pension now, having been exposed to far too many freezing points on the cultural barometer. But how can young healthcare workers learn proper attitudes to patient care? Which examples are they following? How can they be mentored properly? How does organisational culture help or hinder this?
    I hope I don't get sick anytime soon ...

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  • Anonymous | 23-Oct-2012 8:00 pm

    I think we must work for the same Trust because I recognise all that you have described.
    Oh hang on, it`s the same wherever you are in the NHS at the moment.

    I`m on the last 5 years as well.

    Hope we can both survive long enough to get some benefit from the years we`ve put in.

    Fingers Crossed !!!!!!!!!!!!!!!!!

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  • Oh and I forgot to say:

    If I ever meet any of these "Leading Nurses" I will have a suggestion or two about where they can put their Barometer !!!!!!!!!!!!!!

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  • We work very hard in the South West , at least some of us. The staffing level is not intelligently linked to the amount of work. Leadership on the wards is mainly poor.
    When there is an inspection we know about it weeks in advance. On one ward I worked, before it was inspected, the sister put on an extra staff to go through all the patients notes and ensure the assessment tools are updated. The inspector sat in the sisters office mainly and when he walked around the sister was with him.
    He never had any private meeting with any of the staff to ask them how they felt.
    I look after patients who need two for moving and handling on my own, I have to share a carer with another nurse.
    This barometer does it find out how long a patient have to wait to get on and off the bed pan?

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  • I believe we do not need another tool we need to relate to each other we are supposed to be the caring Profession. all these patients charters are what have ruined a wonderful profession. we need team work. we need listening skills ,we need to go back to caring. Patients always received the care they needed. Salmon has a lot to answer for .

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  • tinkerbell

    all this nonsensical talk about 'tools' is wearing me down.

    What you need is effective, moral leadership where staff and patients are treated with respect.

    You don't need 'tools' unless you a bit of a tool yourself.

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  • Good to see one of these leading lights was the former chair of Mid-Staffs, if anyone knows how to organise a piss-up in a brewery, its him... ( Googles mid staffs)...oh, wait!

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  • Is the questionnaire available now from anywhere?

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  • I was interviewed recently for Band 5. The questions were about tools! They don't want intelligent independent minded nurses, they want puppets who do what they are told to cover someone else's job criteria. The Matron said 'nutrition is high on Our agenda and you didn't mention, stickers and some other things. I said if you don't eat and drink your going to be very poorly period. She said it is not common sense? what! they are missing great nurses, because We can use common sense without a box to tick! period.

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