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'My revolutionary moment came when I threw out the back trolley'


Deputy practice editor, Eileen Shepherd, thinks the debate on intentional rounding has highlighted that something is fundamentally wrong with the model we use to provide care

I love the idea of an armchair revolution. I shout at the television and argue with the Today programme. In my youth I went on the odd CND march but never made it to Greenham. I was in Trafalgar Square at the start of the poll tax riot (but went to the pictures before the real trouble started).

My career in nursing was different. As a new ward sister in the 1980s I made many grand gestures in a bid to overturn task-based care and replace it with something more thoughtful, compassionate and patient-focused - primary nursing. My revolutionary moment came when I threw out the back trolley.

After a sharp intake of breath from my team, we had a ball. We ripped up the rule book that had defined the organisation of care for decades. Along with the back trolley, out went bowel and bath charts and regimented two-hourly rounds.

My team aimed to provide personalised care based on the needs of the patient, rather than on the needs of the organisation or staff. We worked to change practice from the bottom up and questioned and challenged everything that stood for the old order.

The symbols of new nursing - multicoloured name badges and colour-coordinated teams - were essential accessories. However the ideals of primary nursing became diluted as debate about how care was organised became more important than the underpinning philosophy. Nurses argued about whether one team was answering another team’s buzzer and the real issue about the fundamental role of the nurse was lost.

I am now watching the debate about intentional rounding in Behind The Rituals with great interest. Some argue it is a return to the dark ages of task allocation and it undermines the autonomy of the nurse. I am not sure I understand this.

Looking back, the bone of contention on my ward was getting rid of the back trolley. Rather than liberating my team and enabling us to move upwards to a higher, more sophisticated level of practice, we were left with the problem of where to put everything. Eventually I had to admit that we needed a mix of the old and new. What mattered was the guiding philosophy that underpinned care.

We all need structures to work with and intentional rounding is a framework nurses can use to negotiate how and when care is delivered.  Patients need certainty, to know when they can call a nurse, what will happen next. This is just one way of meeting that need. It is up to nurses to use this tool appropriately.

What we can’t ignore is the crisis at the heart of nursing and intentional rounding will not fix it. There is something fundamentally wrong with the model we use to provide care. It simply doesn’t work. I think nurses know it doesn’t work but feel angry and disempowered. How do you deal with a problem this big?

Perhaps the legacy of new nursing is that it showed the potential of clinical nurses to bring about change. What nurses need to think about now is the “best way” to provide care in the future. We have to have a debate that transcends organisational constraints if we are going to climb out of the hole we are in.

What are the boundaries of the nursing role? How does this relate to the HCA role? Who is responsible for essential nursing care? What really matters to you and your patients?  How can we do this better?

By having a collective vision of what nursing means to us we can then argue clearly and effectively about what we need to achieve our goals.

The only person who really knows the answer to these questions is you.


Readers' comments (7)

  • Very well said! My team could do with binning the rule books (and then bringing back the rules that really help patients) too!

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  • I agree very much to what you are saying, I started nursing at about the time we were all banning the back rounds etc, and then followed the issues you have described, (not my patient etc.)
    There does need to be a combination of the two, two hourly checks on patients can only be done with a regime.
    A radical idea I just had is that individuality can never work well in a hospital or any other community setting, and we need to accept that.
    The answer is either keeping people at home as much as possible, (expensive in some aspects,) and accept that we cannot treat everyone individually, some people will have to accept that as in a restaurant, when a meal has been prepared to an order, it is not easy to change that, and we cannot always use the loo or get pain relief immediately we demand it.
    But most importantly, as nurses we can treat everyone with love, respect and dignity.

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  • what is the purpose of a 4-hourly obs book when the senior staff nurse sits at the desk and fills it in before the ward manager comes on duty so that she does not see the juniors still going round the ward taking obs. when they should have finished all the work for their shift in time for report? this was in the mid 70s at a London Teaching Hospital.

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  • So with intentional rounding, say every hour will the pastients be put off asking for a nurse inbetween the rounds!
    How many will wait in pain or discomfort for the next round!

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    i wonder if this decision was to the detriment of the patients ,back rounds were mandatory ,for a good reason not just to be regimental ,i believe we had less pressure sores and patients had more interaction with the nurses. Meal times were also controlled and i believe very few patients went without a meal never mined starved.

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  • May we send complimentary invites for social media learning events for your sector? Were TrainOK

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  • Hi Team Nursing Times - Thanks for this useful community! I messaged you a few days ago. We would like to invite you & your community members to our complimentary learning sessions for your sector re using digital social & mobile channels. We want to share useful knowledge in tough times & help grow our industries. Here is our website - we are TrainOK! & we have been organising learning events for 10+ years. Anyone interested is welcome to add their details to the guestlist on our website. Hope thats ok?
    Kind regards, Zori - Organiser TrainOK!

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