'Lansley must listen to nurses on the front line' 
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Mary is a sister on a surgical ward. She was told a few months ago that theatres no longer have staff to escort patients back to the ward after 5pm, so ward nurses now have to collect them. Mary only has four staff on a late shift and queried how they will manage, but the business manager said there is no alternative. On the first evening of the new system two nurses went off on escort, buzzers started ringing and a patient complained about having to wait 15 minutes for a bedpan. A problem solved in theatre created a new one on the ward.
Does this sound familiar? We work in silos, one directorate competing with another for resources. Solving a problem in one area often means it is just pushed onto another service - and all too often nurses are expected to absorb change and get on with it. These artificial boundaries create systems that may work well for the organisation but are not always best for patients.
Like Mary, many nurses have no part in decision-making processes that directly impact on patient care and I wonder if anyone ever measures the ripple effect of change on other wards, departments and services.
We talk a lot about patient stories informing care. I would argue that nurses’ experiences are powerful too. You are at the front line and witnessing day to day the positive and negative effects of changes in services.
So my New Year wish it is that nurses’ stories become part of the quality agenda. I am not talking about staff satisfaction surveys but the actual words you use to describe what happens to you and your patients. Your voices must be listened to because ultimately you see and know what matters to and works for patients. Your voices coupled with patient voices are a powerful force and should be used to shape services for the better.
Happy 2012.
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Readers' comments (18)
DH Agent - as if ! | 28-Dec-2011 10:59 am
'We talk a lot about patient stories informing care. I would argue that nurses’ experiences are powerful too. You are at the front line and witnessing day to day the positive and negative effects of changes in services.'
'Your voices coupled with patient voices are a powerful force and should be used to shape services for the better.'
EVERYONE INVOLVED IN SOMETHING SHOULD CONTRIBUTE TO 'ITS IMPROVEMENT' - the fact that various 'legitimately invovled parties' are commonly excluded from NHS decision-making is in my opinion a problem, and that is true for all groups of people. Of course nurses should be listened to, and involved, and so should patients, the relatives of patients, doctors, cleaners, managers, etc - everyone needs to properly understand 'how things look from 'other people's perspectives''.
All too commonly, this does not seem to happen !
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Anonymous | 28-Dec-2011 11:53 am
what is the point of nurses putting themselves through lengthy and costly training if they are not allowed to question patient care, voice their opinions and advocate for safety (cf NMC code of professional conduct). the more advanced their training becomes, the more they are going to continue to question the system and the quality and safety of the services provided to and which they expect and are expected to provide to patients. Such questioning seems to be at variance with the mores of management. Maybe the solution is to turn all the nurses into clinical managers but leaving little skilled care at the bedside!
What would the system then look like then?
What effects would this have on costs, and the safety and quality of care and other core considerations of a health service?
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George Kuchanny | 29-Dec-2011 2:21 pm
"So my New Year wish it is that nurses’ stories become part of the quality agenda." Quite so. OK RCN, stop pratting about with pseudo politics and get on with representing your members please. I would think that Militant Nurse might like to fire a broadside in support on this very subject.
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Anonymous | 29-Dec-2011 9:38 pm
Patient as guest, customer or passenger?
How about this folks?
In Switzerland, from January 1, 2012 Swiss patients will be allowed to choose which hospital they attend for treatment across the land under their insurance scheme and according to their level of cover. Previously with basic insurance they could only attend one in their own canton. To this end hospitals are trying out different marketing strategies to attract their custom:
Hospital 1: patient as passenger - staff sent on an airline cabin course to learn how the crew welcome their passengers and deliver cabin service such as serving meals and refreshments.
Hospital 2: patient as customer - Ten year guarantee offered for any intervention. If the patient has to return with a related problem before it has expired the costs are taken care of by the hospital.
Hospital 3 – patient as guest – silver hotel service – hotel staff come round with a trolley for afternoon tea with a selection of mouthwatering cakes but it depends on the patient’s level of insurance cover how much they are charged for this service or whether they are included.
I expect further new ideas will emerge and wonder whether there are similar concepts in the NHS?
Good idea or not, time will tell, but at least initiatives such as these and competition between the hospitals should encourage them to maintain high standards as bed occupancy will depend largely upon their reputation.
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tiritega mawaka | 29-Dec-2011 10:03 pm
"So my New Year wish it is that nurses’ stories become part of the quality agenda. I am not talking about staff satisfaction surveys but the actual words you use to describe what happens to you and your patients. Your voices must be listened to because ultimately you see and know what matters to and works for patients. Your voices coupled with patient voices are a powerful force and should be used to shape services for the better."
in the ideal world everyone's vocies/stories should be listened too....reality aint gonna happen..
first of all nurses and nurse manager dont have the real power to make the decisions that make a difference to the real quality and real experiences of patients...when it comes down to it, in the board room or in the exec team meetings its quality vs resources and mostly the finance director wins...
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Anonymous | 29-Dec-2011 10:22 pm
tiritega mawaka | 29-Dec-2011 10:03 pm
the NHS used to work so well before the advent of General Management from the USA and run as a business. The clinical staff had professional autonomy and did their jobs as they thought fit without having to think about costs, competition, etc. and they had time to listen and were also listened to with respect.
...but then we can't go back and I guess it is no good dwelling on those good old days. They were not perfect either but they were good and I trained to be a nurse and not an administrator, paper pusher or business manager even though I do have an MSc in Healthcare Management as well.
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Sarah Stanley | 30-Dec-2011 1:15 pm
I think the role of Director Of Nursing in Hospital trusts has become defunct they have no power and seem to be fugure heads only. The Chief Execs might as well be honest about that fact and axe the role and save us all some money.As for Nurses being listened to about patient care forget it, not even Consultants are listened to anymore. The only people with power are the number crunchers. The DOH know this and don't care after all it suits them.
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Mags | 30-Dec-2011 4:52 pm
Well said Eileen. However, we have to take some responsiblity for the situation in which we find ourselves. Why (in relation to the NHS, in particular) does the largest and (potentially) most powerful branch of the workforce have "no part in decision-making processes that directly impact on patient care"? It is well past time for this to change and it is up to us, as nurses, to change it.
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Anonymous | 30-Dec-2011 5:32 pm
I agree Mags. As the largest workforce in the UK and in Europe we must no longer put up with it. we are the best placed and the most qualified to make decisions on what affects patient care and the services we directly deliver to our patients. If patient care is to improve this nonsense must no longer be tolerate.
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Anonymous | 30-Dec-2011 5:34 pm
above, obviously should read 'tolerated' at the end of the last sentence.
why is there still no opportunity here to edit text once it has been submitted NT?
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DH Agent - as if ! | 31-Dec-2011 10:42 am
The comment by Sarah Stanley | 30-Dec-2011 1:15 pm gets to the core of the issue: the fundamental problem, in this as in most other things, is that the NHS is an organisation and not an individual.
So a hospital's senior managers, are blamed for both poor clinical perfomance (league tables) and for poor use of resources (ie spending money badly), yet the clinical expertise lays with other individuals (the clinicians), and questions of 'patient satisfaction with my experience' rest with individual patients (because the question is wider than clinical, and involves 'my feelings about what happened to me').
Nobody is keen on being blamed, for things other people did, or over which no direct control can be exercised. So there is inevitably a tension, between the people who 'sign off the money' and others who, for example, believe 'we can't do our job properly, unless there are more of us'.
It isn't necessarily that the DH doesn't want to improve things - it is bloody tricky, effecting the improvements ! And there is also a tension between devolving decision-making to opertional levels (allowing people to use their own expertise when doing their jobs) yet also 'controlling behaviour so that incompetence, where it is present, cannot lead to bad outcomes' - currently the DH seems to be trying to adopt a policy of promoting lower-level decision-making.
But more extensive, and more honest, discussion of the problems, between different groups (between 'management' and clinicians, etc) seems a sensible starting point, because even if everyone has 'good will and good intentions' it isn't helpful if people do not have a reasonable understanding of the problems as a whole, and 'what the problem is' sometimes looks very different when viewed from different perspectives !
Of course, almost everbody who works inside the NHS, is so busy with their everyday workloads, that finding the time to talk properly to people with different jobs, seems problematic !
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Anonymous | 31-Dec-2011 10:53 am
what about those who seem to spend most of their working lives in meetings engaged for a large part of their time in unproductive discussions when more hands on labour is required to ensure safety, effectiveness and standards of care? I am sure we could all command large salaries just to sit and talk.
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Anonymous | 31-Dec-2011 2:38 pm
michael stone | 31-Dec-2011 10:42 am
No. The DoH is not at all interested in your well-being, never mind 'my feelings about what happened to me.'!! Really!
The issue here is that EVERYONE else EXCEPT Nurses has a voice within the NHS. Nurses, however, are pushed to front when the blame is being dished out. As has been said, it is time to change that. The article is spot on and this imbalance needs to be addressed. Nurses have to take responsibility for changing the situation.
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Anonymous | 31-Dec-2011 4:26 pm
what does M. Stone believe he is contributing to these discussions between hc professionals with his constant misplaced comments?
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Anonymous | 31-Dec-2011 4:27 pm
"...contributing of any value...", the above should read!
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Anonymous | 4-Jan-2012 4:30 pm
It seems to me (a nurse) that nurses have lost any "power" that we once had. Firstly, the sister on the ward ought not merely to be "told" that theatres no longer have staff to escort patients back to the ward. Why wasn't she involved in any meetins regarding the cuts? Had she been involved she could then have said "no" - nurses cannot escort patients back to the ward. The nurses responsibility lies on the ward not anywhere in between. Providing this is a real life scenario, why not just say "no". I would bet good money that if doctors were asked to do similar they would say just that. I would also ask did anyone consult the RCN on this? If nurses say no, the hosp management would have no choice but to look elsewhere for "escorts".
As nurses we need to step into our power and not be afraid of what will happen when we say "NO". Saying "no" is not a negative thing when it can bring about positive changes which benefit patients and staff alike.
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judy taylor | 5-Jan-2012 9:24 am
Perhaps we need to say - NO - even politely (!) when asked to take on another job' that different departments can no longer do.
I refer to the the theatre after hours escort. If the nurses can't collect patients because of the duties within the ward - some solution would have to be found. As long as we say yes and do what is impossibly imposed upon us people will continue to expect the impossible from us.
It devalues nursing if we keep taking on other poeple's tasks. What we do is so important. How was it ever remotely possible that it could be diluted with other deparments moving what they do on to us because they have staff problems?
Excellent article about this sort of thing : Constraied by impossible ideals' Nursing Standard - care campaign 7th December 2011- briliant every nurse should read it - short and powerful.
J
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Anonymous | 5-Jan-2012 11:50 am
little thought by other healthcare workers may be given to the full nature of nursing and the skills and concentration involved in many complex situations. other departments may simply perceive it as a 24 hour service where nurses appear to be available to perform any tasks concerned with their patients with no perception or realisation of the constraints of staffing levels in the relation to the number of patients and all their varying needs at any one time of day or of the dangers of leaving the ward with too few nurses present.
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