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Practice comment

"Be bold and take action to improve the care we provide"

A nursing and midwifery career gives us incredible experiences and privileges.

We provide care, health promotion advice as well as treatment for ill health. We support the people in our care and their families when they are at their most vulnerable and when clinical expertise, care and compassion matter most. There is hardly an intervention, treatment or care programme in which we do not play a significant part.

Like many others, I started out in my career with one main aim - to help the people in my care. Back then, as now, I wanted to make a difference and to keep on improving my skills.

This commitment to improve and make a difference through the care we provide is the touchstone of our nursing midwifery and caregiving vision and strategy. At the heart are six areas that define nursing: care, compassion, courage, commitment, communications and competence. These 6 Cs are behaviours and values that encapsulate what we in the caring professions do.

Both Viv Bennett, director of nursing at the Department of Health, and I are passionate about this vision and strategy. It looks at how nurses, midwives and caregivers can be supported to provide excellent care. It examines ways to help us improve this care and take action when required. We need to make visions a reality, and we are committed to supporting staff to enable them to provide compassionate care.

An increased respect for our profession coupled with an increased pride in what we do is crucial. There have been too many stories about the lack of care, compassion and competence in the last few years. This is why it is vital for all of us to discuss, debate and share with one another how we can put patients at the heart of what we do. We need to show the public that we are committed to delivering care with knowledge, skill and compassion. We must be bold and take action to improve the care we provide.

We all have the opportunity to make a significant difference by ensuring the 6 Cs inform and influence everything we do.

Care sits at the heart of our profession. People have a right to quality care and expect it to be consistent day in and day out.

Compassion relates to the way we provide care and how patients see us. Our relationships should demonstrate empathy, kindness, respect and dignity.

Competence is having the knowledge, skills and capability to do our job to the highest possible standards.

Communication is vital in our role as active listeners with our patients, their support networks, our teams and our leaders.

Courage means we should always do the right thing, make the right decisions and speak up when we have good ideas.

Commitment will make our vision for the person receiving care, our teams and our profession happen. We need to commit to take action to achieve this.

Every decision we take has an impact on those we look after. Collectively if we work together and use the power we have we can really make a difference.

  • Find out more about our vision and tell us what you think here.

Jane Cummings is chief nursing officer, NHS Commissioning Board

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Readers' comments (14)

  • Ms Cummings

    Do you live in the real world ? Have you met the "Senior Nurses" who are party to the under-staffing of wards and depts.

    These are the same "nurses" who destroy the concept of a safe skill mix and continue to support the employment of unqualified staff to the exclusion of Registered Nurses.

    Please stop preaching to us ------give us adequate staffing levels made up of a majority of qualified staff and patients will be very well cared for.

    You may by chance have read about the Bristol Hospital censured by the CQC for having insufficient and inappropriately qualified nursing staff. Just the most recent example of many ! When will you take notice ?

    Its not clinical nurses who fail ! The responsibility for poor care rests with you and your "Senior" colleagues

    I have some advise for you ---- get back to the wards ! ----Learn about the difficulties faced by your "junior" colleagues.

    The juniors" do not need be told how to nurse ---- they know and deserve to be supported by people such as yourself

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  • What a dreadful load of old b*ll*cks spouted in this article!

    "Be bold and take action to improve the care we provide"

    The best way to do that would be for the nursing profession to take immediate and effective industrial action against the worst excesses of this government's (and their puppets) onslaught on the NHS, patients and staff.

    You have no vision. You don't even know where the problems lie.

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  • tinkerbell

    mags | 3-Nov-2012 7:41 am

    Well said Mags, especially 'the load of old bollocks' bit. Sounds like a right old load to me. How tired i am of it all. Time to tell it like it is, once and for all stop all this bullshit verbal diarrhoea without any action.

    Come on nurses step up to the plate, don't worry about how scared you feel or how much your knees are aknocking, stand your ground and speak out. Industrial action is the only way forward now to stop this decimation of the nursing profession and all we stand for. The only weapon we have left now is our democratic right to say 'NO' loud and clear. Let's start warming up our vocal chords.

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  • Typical wishy-washy management speak. I'd hate to live in these peoples houses. English translation in brackets.
    'Whats for tea, Mum?'
    'Well, working with our associate partnership ( Tescos) we have endeavoured to provide a service that is suitable for all in this demographic area ( the home) a range of products that are fit for purpose,( anything you want, love) that are time sensitive but suitable for a modern dynamic organisation ( Why not have them sausages before they go out of date?). Working through the paradigm we encourage interagency dependancy ( you have to do the dishes before you can go out and play football).

    As for putting 'patients at the heart of what we do' what are we meant to do? Are there any nurses here who work in a teddy-bear hospital or Miss Tiggywinkles? Are there nurses who put Drs before the patients? Or do you refer to those senior clip-board carriers ( and there are always 2 of them, either because clip-boards are so heavy or for protection in numbers) who haven't touched a patient for a score of years who don't give two flying fecks for the patients, who willingly dilute the nursing pot in areas under their care so they can look good to other senior bastards.
    To paraphrase St Paul, don't worry about the splinter in your brothers eye worry about the plank in your own, Jane.

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  • Cummings

    "Be Bold and Take Action"

    How about demonstrating your wondrous skills. knowledge and expertise.

    Come on be Bold ! Get out of that office !

    Practise some real nursing ! In a clinical setting of my choice ! For one whole working week.

    As you are a Registered Nurse we will arrange to redeploy an RN from the clinical area I choose because as you know times are hard and we must not have excess RN's in clinical areas.

    So are you going to do it? --- please let us know.

    Please don't disappoint us we have so much to learn from you !

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  • tinkerbell

    all the teddybears and miss tiggywinkle send their love from my hospital.

    What are patients?

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  • tinkerbell

    But seriously, if i can be? Yes you will need commitment and courage, they're a given mandatory requirement. To survive a career in nursing and put patients first from my experience you will need certain other attributes too not listed above.

    You will need to develop the hide of a rhinoceros and not care too much about whether people 'like' you, cos you know you are acting in the patients best interests.

    You will need to develop the growl of a rotweiller who has found the last bone on the block. (not sure how to spell rotweiller so make that a german shepherd). Well some kind of a ferocious dog anyway.

    You will need to do the right thing regardless of being hounded for doing the right thing when managers tell you to do the opposite.

    You will need the heart of a lion even if you are not physically that strong.

    You will need a bullshit barometer for your 'tool kit'. Vital piece of kit, i say VITAL.

    You will need to be able to put your case forward without becoming violent, so you will need to learn restraint.

    You will need to be able to use your own initiative and be told to do one thing and then go off and do your own things cos what you were told to do was a load of old bollocks by someone who doesn't even know what the shopfloor or frontline nursing is anymore and they have been promoted beyond their competence level and no longer even know what a patient looks like.

    You will then need to be able to stand there and take a good dressing down whilst quietly smiling inside to yourself but looking as though you have taken the message 'on board'. You will therefore need to be a good actress/actor.

    You will need to be able to stand up to bullies. If you haven't already learned to do this as a child you are at a disadvantage as it will come as a bit of a shocker when you become a nurse that it exists in nursing. But basically you just stand your ground and ask 'who wants to be first?'

    You will need to understand that some of your colleagues are damaged people who lack self awareness & have unresolved 'issues' they are bringing to the workplace. Try to work alongside them with understanding as if they were another caseload. They may have some kind of professional jealousy towards you as they are feeling 'inadequate' and 'frightened' of the perceived threat you pose. This will usually turn into a bun fight where they oppose everything you suggest. Be gentle with them if possible and try not become violent because you will also meet some nurses who are kinder and better than you and an inspiration to you that helps you become better and not bitter.

    You will be keen to pass on your knowledge and understanding to newly qualified staff and have a sense who amongst them are 'teachable' and those who are 'unteachable' and then focus on the teachable ones and keep a sharp eye on the unteachable ones. One day they will land everyone in the do dah but hopefully not on your shift.

    When you go to bed at night you will need to place a soft coathanger in your mouth so that you can wake up with a smile on your face to go back into battle again the next day.

    You will get burnt out, of course you will, but after many years of being burnt out you will recognise the signs and symptoms, basically you will either become a screaming banshee or start suffering from clinical depression. Either way try to spot the symptoms sooner so you recover faster. Be gentle with yourself too. What good are we to patients or anyone if we can't take care of ourselves.



    All these skills will take many years to acquire at one level or another and then you should be canonised. Unfortunately despite all these insights i ain't no saint yet and sometimes resort to the odd swear word whilst trying to get the message across when i was doing so well at being restrained and not being violent i let my guard down but it is better than being violent. Don't whatever you do become violent. It might be the only thing i have achieved, i have never become violent.

    These skills will not be learned at attending a workshop in 'leardership skills' but only in the field.

    And try not to eat yellow snow.

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  • Tinkerbell
    Remember that song 'Sunscreen' from a few years ago? Get Morgan Freeman to do the vocals, you'd have a smash hit on your hands!

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  • Let's have another discussion, another debate.

    Why not, we have all the time in the world to go round in circles when the obvious solution would be to have more qualified nurses on the wards who have the specialist skills to work in the area of their choice.

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  • the word 'we' keeps cropping up in this article. "we" don't need to do anything.

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  • Anonymous | 5-Nov-2012 10:12 am

    I take your point. But I think that "we" do need to do something. Strike!

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  • Well said Redpaddy & Tinkerbell! I salute you for your very clear and insightful dissection of what is indeed, utter cobblers
    written by our somewhat deluded author.

    I for one will personally escort complaining relatives and patients to the offices of those who put ward nurses in this position and invite them to explain in person just what is going on and why they are not doing more to help.

    it will keep them out from under my feet whilst I am busy trying to do too much with too little!

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  • Florence

    I would love to take complaining relatives to our Matrons office. Or even higher up to explain why they wont act on our problems. And explain why they do turn a blind eye or blame ward nurses.
    I remember I had to deal with a relative who had some very serious complaints. Not all related to our ward and nursing care. But problems that had occured in a previous ward. There were issues relating to our poor staffing which compounded part of the problem on our ward.
    I spent about an hour on the phone sorting this out. When I fed back to our Band 7 Manager about the issues she was not interested. She said '' I dont really need to know I know you will have handled it well''.
    Was she joking ??? This is her ward and if I was a Band 7 I would want to know what was going on.
    Anyway my Manager ended up having to meet with this relatives and then complained that no one had alerted her how serious the issues were.
    That was nonsense. I was so glad that my actions & documentation proved I had done everything correctly. It was almost worth going off an hour and a half late for.
    Its always about passing the buck.

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  • Florence

    And as for striking. Ive always said I'd never do it.
    However Im very tempted to do so now.
    And yes Jane Cummings and other senior nurses DO need to come back to the wards. I loved Tinkerbells post from 4th Nov.
    I honestly have little faith in any managment above Matron level in our Trust.

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