EDITOR’S COMMENT

'Don’t let horror stories put you off speaking out'

25 October, 2011 | By Jenni Middleton

The nursing profession has been dogged by stories of poor care recently, but the health sector relies on nursesthemselves to speak out when they see unacceptable care.

However, nurses who have been called as witnesses in fitness to practise hearings in the past have told me they found the experience traumatic. Facing the person they are providing evidence against and being questioned about what they claim to have seen or heard is obviously a recipe for anxiety.

As if to prove the point, the General Medical Council has decided to offer independent emotional support to those giving evidence in GMC hearings before and during the day of the hearing. The regulator and Victim Support have launched a joint initiative to offer the service to anyone making a complaint to the GMC as well as to all witnesses giving evidence at hearings.

I imagine nurses would welcome a similar scheme, but it’s unlikely to happen because the fees paid to the Nursing and Midwifery Council are considerably less than those paid to the GMC.

That said, the NMC has been making moves to offer more support to witnesses. Staff are now available to look after witnesses on the day of the hearing, and more formal venues are also available to hear cases, which witnesses say they prefer.

The advice from nurses who have been through the process is to keep detailed records if you are worried about a colleague’s performance, noting the date, times and details of your concerns. This will help you to decide if they are valid and ensure you are able to justify them.

In short, if you see something that needs referral, don’t be put off by the horror stories of old but do make sure you are prepared to discuss it. If nursing is to be put under the spotlight it would be better for the profession if nurses are the ones shining the light.

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Readers' comments (19)

DH Agent - as if ! | 25-Oct-2011 10:35 am
'In short, if you see something that needs referral, don’t be put off by the horror stories of old but do make sure you are prepared to discuss it. If nursing is to be put under the spotlight it would be better for the profession if nurses are the ones shining the light.'

Well, pretty obviously true on empirical, logical, grounds.

But currently 'whistle-blowers' are treated punitively if they are working in 'bad' institutions and enviroments, and until that is properly addressed the appeal you are making will probably fall, in some cases, on 'deaf ears'.

This is VERY OLD GROUND !
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Anonymous | 25-Oct-2011 2:17 pm
No matter how well they are treated by the organisation whistle blowers will always come out of the experience badly. From personal experience, one of my HCA staff reported an RN for inappropriate behaviour for which the RN was suspended pending investigation. This didn't stop the RN from contacting all who would listen, posting on Facebook and making the brave HCA out to be the rogue in the story. She was devastated when she realised that she would have to sit in the same room as the RN for the investigation. Fortunately this didn't happen as the RN resigned but the HCA was left with serious doubt and guilt about what she had done and the RN with her followers (who I'm sure never knew the full story) left behind to make the HCA feel uncomfortable. I don't know what the answer is but some 'gagging order' of the accused might be required, espcially with all the social networking sites now available!
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Anonymous | 25-Oct-2011 3:54 pm
This article has some sound advice. US orientated but relevant and useful for UK nurses too I would say. Worth a read if anyone considering speaking out, also in supporting those who are brave enough to have done so.

http://www.npjournal.org/article/S1555-4155%2811%2900342-4/fulltext
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mike | 25-Oct-2011 8:12 pm
Whilst I agree in principle Jenni, I wholly understand those who refuse to. It is far too easy to say 'ignore the horror stories'. At the end of the day, Nurses to face at worst the loss of their profession, at best a culture of bullying stress and intimidation or the loss of their job. Who would choose to take that on? I have before, and came off worse for it despite my resilience.

Oh, and the fees paid to the NMC are MORE than adequate for the non existent service they (don't) provide.
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DH Agent - as if ! | 26-Oct-2011 10:25 am
Anonymous | 25-Oct-2011 2:17 pm

I am oldish, male, and somewhat anti-social: I don't even have a mobile phone, let alone engage in social media.

So I had not considered the problem you raise - it is not obvious to me, how that could be addressed, except by the people who were contacted by the RN coming back with 'I don't want to know - this is not any of my business', and I assume the RN's friends, are unlikely to have done that.

But if that happens a lot, it is a huge problem ! Thank you for pointing out the issue.
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Anonymous | 26-Oct-2011 5:27 pm
I put in a fitness to practice complaint about a fellow student who I felt was behaving incredibly inappropriately and raised it with my personal tutor. Being put before the head of school about why I had raised the issue and why I thought it was appropriate for me to do so was scary enough, coupled with the girl being told who had made the complaint and why and her telling all of her friends making me feel isolated and scared about going to University. It was upsetting and stressful and I lost friends because of it. The girl was thrown off the course after being given specific action plans and a disciplinary warning because of her behaviour, but I felt guilty and scared after making the complaint. This wasn't even in front of the NMC and was in a completely different environment, I cannot imagine how real whistleblowers feel. It's all well and good to say ignore the horror stories, but it's a bit harder to put into practice.
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DH Agent - as if ! | 27-Oct-2011 10:17 am
Anonymous | 26-Oct-2011 5:27 pm

Thank you for posting that - I think this issue definitely needs to be thought about, to see if there is a practicable solution.
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mike | 27-Oct-2011 11:59 am
Anonymous | 26-Oct-2011 5:27 pm that is a horrible incident, but is far from rare I am afraid to say.

I have to say I have both been the target of and seen happen to others the negative effects of 'whistleblowing' (I hate that term) because of the culture talked about above. I have to say though that there is the other side of the coin too, where Nurses are wrongfully accused of something and subjected to the same horrific treatment and bullying, because that is in essence what it is; and I have seen this happen too.

It is just a horrendous situation, and is all the more shocking in a 'caring' profession, where it seems that care does not apply to each other.

For many Nurses, every single shift does feel like a battlefield, where you are watching your back 24/7 whilst banging your head against a brick wall trying to be a patient advocate.

Is it any wonder Jenni, that Nurses are put off from speaking out?
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DH Agent - as if ! | 27-Oct-2011 3:22 pm
mike | 27-Oct-2011 11:59 am

But if nurses often do that to each other, what is the solution ?

The CQC did identify various factors which prevent 'whistle-blowing' or 'raising of concerns', and various factors which might contribute to poor care. But I am not aware of any reports, which have raised 'bullying each other' as a serious issue - and it appears to be, a very serious barrier to 'doing the right thing' !
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Anonymous | 28-Oct-2011 8:43 am
This recent press release from PCAW (Public Concern at Work) highlights the difficulties for people who report their concerns.
http://www.pcaw.co.uk/news_attachments/FECITT%20draft%20press%20releaseFINAL%202.0.pdf
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DH Agent - as if ! | 28-Oct-2011 11:09 am
Anonymous | 28-Oct-2011 8:43 am

I ask you what I asked mike (sorry, but I am too involved in a different debate with the NHS, to have the time to read your report) about intra-staff bullying:

But if nurses often do that to each other, what is the solution ?
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Anonymous | 28-Oct-2011 11:24 am
And this is the nature of bullying isn't it? Hidden, debilitating and an effective way to silence most people thereby presenting no challenge to the status quo, and those heavily invested in that.
If this is the enduring underlying culture how can anyone expect that it will not be reflected in relationships with patients?
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Anonymous | 28-Oct-2011 12:17 pm
BTW Jenni, with all due respect, these 'horror stories' are not 'of old', they are very much current. They are not only about colleagues performance and although emotional support is invaluable it is the support of the employers themselves that is fundamental, and it seems so lacking.
I have watched colleagues go through a horrendous process recently, both finding themselves in a situation where because of recent education guilelessly questioned a certain practice. This practice it turns out was widespread and involved all levels of the team. The cases went right to the top of the trust and at all points management were staggeringly not just not supportive but bullying and scapegoating. These colleagues are now unable, and frankly quite wisely, unwilling to apply for any other post in this particular trust.
This is not unusual Jenni. What you are asking people to do here is pay a very high price, alone, without even the goodwill of the media or public.
What I would suggest your columns would be better doing is lobbying for improving managerial education and competence, a less carnivorous philosophy from the government and unions that are effective.
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Anonymous | 28-Oct-2011 2:53 pm
I must admit, I no longer put my head above the parapet but 'escalate' my concerns to the next level usually by e mail (timed and dated and receipted).

Having explained to this next level person that I have fulfilled my legal and ethical obligations by escalating the issue to them - I move on refreshed to the next potential disaster.
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DH Agent - as if ! | 28-Oct-2011 2:57 pm
Going back to mike's 'the CQC is toothless' points, the latest CQC report (see for example the Independent, today page 2) makes it clear that he is right, but the CQC is also 'onside'. We can read:

'The trust has a deficit of £118m, and has set a target to cut 850 jobs by 2013. The CQC said the planned cuts were 'worrying' when the number of patients treated 'continues to rise''.

The CQC does not tell managers how to improve services, it assesses the service provided, and identifies failings.
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mike | 28-Oct-2011 6:18 pm
Michael, as for the bullying question earlier, I don't know what the answer is. I wish I did.

As for the CQC, that is why many of us have very little faith in it.
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Jenni Middleton | 29-Oct-2011 6:35 am
Anonymous | 28-Oct-2011 12:17 pm

Thank you for your comments - thank you all of you for comments. Specifically to you, though, Anonymous | 28-Oct-2011 12:17 pm, I have written lots of previous columns about whistleblowing and the importance of creating cultures that are conducive to nurses speaking out. If you look back on this site, you'll find them. I am well aware that this is very much a live and current issue. The column, though, was referring specifically to NMC Fitness to Practise cases, the running of which has become more focused on the witnesses of late.
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DH Agent - as if ! | 29-Oct-2011 11:07 am
'mike | 28-Oct-2011 6:18 pm

Michael, as for the bullying question earlier, I don't know what the answer is. I wish I did'

I'm sure a lot of people who have thought about this, share your wish !
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Anonymous | 25-Jan-2012 5:09 pm
I have always raised care concerns, carefully, constructively and with detailed, evidence based reports. It's pretty futile with today's self serving managers because they just want to manage impressions through denial and hope problems will go away.

It's certainly not easy. The responses have been dismissive. Action wasn't taken for years and then only when external private consultants came in at great expense and told them exactly the same as my reports. I should feel pleased that my concerns were justified, but instead I'm just frustrated it took so long for them to listen while more patients suffered needlessly.

In return, I always find myself high on the list whenever redundancies come around and I've been made redundant 3 times now, but at least I know I tried.
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