OPINION

'It may confuse bean counters but it’s time to invest in caring'

25 October, 2011 | By Mark Radcliffe

I was reading an article about a young man with a genetic abnormality recently.

It was a reasonably predictable piece about adversity, resilience and hope. Towards the end he talked about having a girlfriend who made things better. “She is a nurse,” he said. “Which means she is naturally caring.”

This reminds us of the underpinning assumption of nursing - yes, nurses will be trained in certain skills and educated to apply knowledge but also they will have certain qualities that shape and drive the application of those abilities. This is a third dimension if you like and, let’s be clear, nurses will not be taught these qualities or how to articulate, value, sustain or protect them. Rather the qualities will be assumed, depended upon, demanded. And therein lies the crisis facing nursing.

Mark Radcliffe is next weeks’ guest editor of nursingtimes.net 2 November 2011 - join him then for his webchat at 1pm

Last week the news was dominated by the “alarming” findings by the Care Quality Commission after unscheduled visits to 100 hospitals. It announced cause for concern in 55 hospitals and that a fifth of hospitals may be breaking the law because of low standards of care. Among nurses I have found anger, embarrassment and disappointment. I have not come across too much surprise.

Now, from here on I could write about anything from the failures of nurse leadership to this government’s assault on NHS resources. Or I could suggest union leaders might do well to begin to articulate that striking is not just about pensions but about services themselves - a strategy that worked well when nurses went on strike in 1989. Or I could light a torch, grab a pitchfork and run mindlessly up the hill claiming nursing is in crisis because the newer nurses are being made to have a degree. In so doing, I could collude with the nonsense that bad nursing is only ever done by new nurses and being academically capable somehow drives the capacity to be kind from your body.

But when I heard and later read the CQC reports my reaction was the same as it was to Mid Staffordshire. How long will we go on imagining the human quality of “care” is a bottomless resource that does not require attention, thought or replenishment?

The fundamental problems in care are not due to students, or degrees or the ridiculous idea that training a mind robs the heart. They may have something to do with the expedient and simplistic idea that nursing is a science and so we don’t have to address its required artfulness. But we need to stop looking at lazy solutions to profound problems, particularly as, too often, those solutions are about blame and divisiveness. The capacity to bring empathy, regard, attention and care to patients recurrently needs educational investment - and not just in pre-registration courses but as part of everyone’s continuing professional development.

Why is it that trusts will update everything from fire training to manual handling, invest in “leadership” courses and policy updates but not provide mandatory education in or around how nurses care? We can call it whatever you like, from reflection to replenishment - and, goodness knows, because it doesn’t look “technical” or measurable some bean counter somewhere will be confused - but if we want caring services we have to invest in caring. Let’s not say such things are too hard or too vague; that demonstrates a lack of will and a limited imagination. But it doesn’t indicate a lack of capability.

Reconstituting the best of nursing means investing in the emotional sustenance, professional nourishment and humanity of all nurses. Now where is the political will or courage to take that on?

Mark Radcliffe is a senior lecturer and author of Gabriel’s Angel.

Readers' comments (7)

mike | 25-Oct-2011 8:04 pm
Well said, I have said before in another thread that (and again, I am paraphrasing horribly from another source) that to have a world class health service, then you HAVE to invest heavily in it, and Nursing, no matter the expense, is WORTH IT.
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Anonymous | 25-Oct-2011 9:25 pm
The bean counters don't see it,
the paperwork & stats are eroding it,
the Uni's don't teach it,
it's what keeps so many of us staying behind for free and going that extra mile,
being worked to the bone depletes it,
the new "standards/goals/outcomes" and cutbacks and pressure will erode it further...
then will come the complaints from management and patients who expect perfection!
sorry to be so negative but I've just seen the video "wake up call" about the Health & Social Care Bill"
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Anonymous | 26-Oct-2011 9:17 am
I teach nurses 'customer care' and feedback is along the lines of:
* we know that
* this isn't an hotel
* this is insulting

But the reason we teach it is because of the number of complaints we get....

Good luck to anyone trying to teach nurses about caring,,,,
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Anonymous | 26-Oct-2011 10:49 am
Anonymous | 26-Oct-2011 9:17 am

"But the reason we teach it is because of the number of complaints we get...."

Probably a proper investigation into the real reasons for complaints; eg. lack of staff, lack of resources, unworkable and unreasonable demands placed on Nusring staff, might be more effective in reducing complaints, than simply assuming the entire problem is due to Nursing staff, as usual.

"Good luck to anyone trying to teach nurses about caring,,,,"

Good luck to the Nurses being "taught caring" within a framework of such arrogance, condescension and complete lack of understanding!
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Anonymous | 26-Oct-2011 7:41 pm
Anonymous 25-10-2011 9.25pm
Anonymous 26-10-2011 10.49am

I agree without sufficient appropriate staff we cannot care as we would like. You need time to give adequate care and not just rush around skimming the surface. When will they work it out. They need to see why the care is not being given, are the nurses sat there with their feet up or are they running around trying to do their best. Can 30 dependant patients be washed and fed at the same by 6 staff. We need reports that are truthful with the true picture. I would imagine if nurses were sent back to learn how to care we would be shown how to wash, toilet, feed, talk to patients etc but everything would be done properly with TIME spent which unfortunately we do not have the priviledge to have or the other 20 patients would be left unattended.
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mike | 26-Oct-2011 9:35 pm
Anonymous | 26-Oct-2011 9:17 am perhaps part of the problem is your approach of teaching 'CUSTOMER care?'

We do not have CUSTOMERS, we have PATIENTS!!!!!

The NHS is NOT a business, no matter how much you and your ilk try to instil business models onto it, and should never be run as such. Many of the problems we have apart from what has been stated above is borne of this business model being forced and imposed ONTO us!!! Customer care my arse! I'd rather spend the time caring for my patients!
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Andrew Fishburn | 27-Oct-2011 4:46 pm
Anon 9.17am
Oxford English Dictionary defines a customer as "A person who buys goods or services from a shop or business".
...but I guess you know that, and it is insulting to even suggest you don't... a bit like how those nurses feel at the end of your sessions.

The reason you teach it is because of the complaints you get!
Trouble is, you clearly don't understand what a customer is (no-one gets ill to 'purchase' healthcare from the NHS).

If nurses are telling you that:

* we know that
* this isn't an hotel
* this is insulting

Maybe you have to ask *why* nurses don't behave in the way needed to reduce 'customer' complaints? Could it possibly be a little more complex than your assumption that it is all the nurses fault?

Could:

1. Poor nurse - patient ratios
2. High untrained - trained nurse ratios
3. Additional unpaid hours, week in, week out
4. Frequently missing meal breaks
5. Damaging shift pattens
6. Frequent organisational change
7. High stress levels
8. High manager - patient ratios
9. Appalling pay when compared to other, less-well educated public sector workers
10. Threats to pension (smaller pension in return for working significantly longer)
11. Demands to meet organisational objectives that bring us into conflict with 'customers' needs and wants
12. Poor representation from some unions
13. Inadequate teaching of 'customer' care
14. Two year pay freeze
etc etc etc

...have anything to do with why 'customers' feel they are not getting the service they are 'buying'?

I don't condone bad practice, or poor patient experience, but I do demand that those asking why it goes on use intelligence rather than assuming it is all the nurses fault. That particular tactic, whilst a favourite of right wing tabloids, will not give us an answer.

A more intelligent approach may be to ask why some nurses have had that altuistic caring quality beaten out of them, or what are the effects on nurses of poor nurse - patient ratios?

The trouble with trying to impose a psuedo-business model on the NHS is, as any business model will tell you, if you don't invest correctly in your core infrasructure (ie trained nursing staff) then the end product will suffer.

Teaching a bit of 'customer' care will not rectify that, nor will the sleepwalking into an even higher untrained-trained ratio.

Most nurses just want to give excellent patient care: if we wanted to serve 'customers' we would have worked in a shop.
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