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Compassion affected by 'draining' nature of nursing, CNO tells MPs

It is difficult for nurses to remain “compassionate all the time” given the emotionally draining nature of the job, the chief nursing officer for England has told MPs.

NHS Commissioning Board CNO Jane Cummings gave evidence last week to the Commons health select committee on the state of nursing.

Along with Department of Health director of nursing Professor Viv Bennett, she fielded a broad range of questions from MPs on staffing levels, patient safety, use of technology and the “6Cs” nursing strategy.  

Andrew George, Liberal Democrat MP for St Ives, asked whether there a “conflict” between two of the 6Cs – competence and compassion. He suggested that “sometimes in order to be professional you need to be dispassionate”.

But Ms Cummings said: “You can be a highly competent, experienced, professional nurse and still be compassionate.”

“Nursing is a very emotionally draining job, it’s hard work; it’s physically hard; it’s emotionally hard,” she said. “There is something about how we look after staff and how we give them the time and the space when necessary to take a step back and have a bit of breathing space.”

Ms Cummings highlighted that when nurses were very busy “day-in day-out” dealing with very complex tasks “it can be quite difficult to remain compassionate all the time”.

Her comments follow concerns raised repeatedly in the media that the increasingly professional nature of registered nursing had in some way detracted from its compassionate side.  

Representatives from the Patients Association and Age UK also gave evidence to the committee and appeared to agree with Ms Cummings.  

Joanna Parker, South West project manager for the Patients Association, said: “Nursing is not a simple set of tasks, its’ far more complex than that and can be emotionally draining.

“Those staff need to be cared for as well and I think there are organisational issues, cultural issues that need to be addressed to support nursing staff.”

Readers' comments (48)

  • Hopefully this will raise the Health + Well-being focus to look after all nursing staff. Being pushed to the limits, having to prioritise, juggling conflicting demands + interruptions is challenging and something will be easily missed.

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  • rovergirl6@hotmail.com

    I believe we should return to nurse training in our hospitals and leave the education era nurses need training .they should also pay student nurses a living wage . Re -open schools of nursing attached to our General hospitals. compassion is a two way street our nurses do not recieve compassion from the managment ,they are on their own if they make a mistake. they should be supported be a true member of a multidisiplinary team, working for the good of the patients.

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  • to have the ability to care for others with compassion, don't you need to also be treated with compassion? Maybe it just doesn't only work effectively one way.

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  • Politicalnurse

    Being compassionate includes having the knowledge and experience to understand the other person. Education and time is what nurses need to help them do that and not being ignored as simply a 'pair of hands' is a good place to start.

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  • And this government want nurses to work into their 70's?!

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  • Anonymous | 28-Jan-2013 1:44 pm

    perhaps we should extend our compassion and the six 'C's to the politicians, and managers while we are at it and see if we can change that.

    To be more accurate I think it was the late 60s although many may need to carry on to make ends meet.

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  • I have been a compassionate nurse for 35 years and have finally succummed to anti depressants, due to the fact I am sick of telling managers how short staffed, overworked and undervalued we are. It is so frustrating and draining.

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  • There have been warning signs in the last decade ie:ukcc changing to the nmc, staffing levels - which is the first indication of financial trouble for the nhs. I qualified 10 yrs ago and year by year its got worse. Gradually the culture, morale etc gets you down. I am shocked and disappointed that as time passes with these issues compassion in some instances has gone. There are also some people who enter nursing for the wrong reasons and their background is overlooked by the universities or employer. At this moment I know of some new starters at university as it was discussed in my local corner shop in the queue. One whom has a mother who is a smack head, the girl regularly gets into brawls, wears her uniform in public despite novovirus and flu outbreaks and as loud as day boasts " yeah I started me training, its boss apart from the 12 hr shifts". I know if I was a member of public I wouldnt want a chav or scally looking after my relative. Im classed by some students now as being 'old school' and I don't care what they think because I know the training that I recieved 10 years ago was far better than it id today, mentors had time for their students to educate, the sisters facilitated 50% of that education on placement. We were moulded and manufacturerd into the professionals that rightfully earned the honour to have a pin number.

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  • why didn't she say this before 46m quid was spent on such initiatives as the 6c. That money could have helped employ nurses so that we could do our jobs properly.

    Is it time that the govt stopped introducing 'initiatives' and paying management consultants to tell us what we already know.

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  • Am I the only person who says this is a bit much? I have been nursing for over 30 years and still manage to be compassionate.. (I am told this by patients I care for and the patient feedback, so don't shout me down.) As professionals we should be able to be compassionate for people even if the organisation seems to be less than compassionate themselves. We should lead by example. Compassion is inate although can also be learnt so I agree in having good training and more ward based. However, compassion should be part of human nature. Some people have more, some less and some lack it anyway. I need to read all of the CNO's comments to find out why she thinks this. I can say that I am tired, angry and weary of the bureacracy and the endless loop of 'improvement measures 'that are revamping things that previous governments 'broke' when not broken in the first place. I am angry about all the NHS terms and conditions being stripped from hard working and dedicated NHS staff. Yes, those things but I do not lack the compassion required to be a good nurse. The patients are the saving grace in our jobs. Surely that is why we nurse in the first place? We should not EVER take our frustrations out on the patients and lack the compassion they deserve.

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  • "We should not EVER take our frustrations out on the patients and lack the compassion they deserve."

    nor our colleagues, especially our peers, our families or anybody else!

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  • I maintain compassion and have been able to do so on a daily basis since 1978. What I lack is the willingness to deal with some of the bullsh*t ticklists foisted on us by managers who should know better.
    I believe we need to spend more time caring and less time filling in paper work to [allegedly] prove we have provided care.
    Perhaps less emphasis on some of the 'degree' level stuff and more on caring skills would be useful.

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  • 'COMPASSION: (n) Deep awareness of the suffering of another coupled with the wish to relieve it.'

    I am addressing this question to anyone who thinks they can answer it, but perhaps specifically to those who have stated that they are compassionate. If nurses are so compassionate (and I really do believe that the majority are), why do they accept the circumstances and environments in which they are caring for their patients? We all read here daily about nurses working massive amounts of extra hours, not having the time to care because there are not enough staff, box loads of paperwork that take them away from the bedside, impossible targets to meet, etc. There are too many well documented and accurate (I'm not talking about the majority of dross in the Dailys Telegraph and Mail) reports and accounts of poor care. So if nurses are all so compassionate, what is their response to this if they are to 'relieve' suffering? I don't think compassion is demonstrated by this mute acceptance of the current situation. I don't think compassion is only smiling and 'being kind' to patients. A truly compassionate nurse should be someone who is not prepared to tolerate poor staffing levels, poor skill mixes, pointless, time consuming paperwork and any other barrier to good care. Someone who is prepared to do something about it.

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  • Florence

    Anonymous 29- Jan- 2013 1:07pm
    I don't know if I can answer your question but I do agree with the definition of compassion you have posted.
    In order to demonstrate compassion you need to have a high level of self- awareness. So you can be perceptive enough to acknowledge and act on what others are telling you they need. To give compassion you also need to have a healthy level of self esteem and self respect. As I know from my own experience its challenging to meet the needs of others when you are feeling low yourself.Compassion starts with being compassionate to yourself. Not in a self- centered way. But in a healthy way.And that does often involve taking action.
    As I understand it. Demonstrating compassion is about taking action to change the discomfort,pain, stress, difficulties of another.
    And we have to be able to address these in our own situations before we can demonstrate similar toothers.
    As Nurses we are not consistent at taking action to challenge our issues professionlly.
    I understand why as after 21 years in nursing I am exhausted raising the same issues with little effect.
    However the day I stop speaking up for what my patients and colleagues need will be the day Ive lost my compassion for myself and others.
    I think Ive got a bit more to offer the world of nursing yet !!!!

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  • Florence | 29-Jan-2013 2:38 pm

    Anonymous 29- Jan- 2013 1:07pm

    two interesting posts with excellent points. let's hope some answers can be found.

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  • I watched some of the giving of evidence to te Health Committee, the geek that I am, and a member suggested a 7th C should be included...Comprehenve care. Caused a bit of flumox and stuttering!

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  • Anonymous | 29-Jan-2013 4:55 pm

    I started watching it too and found it very interesting. the problem is it was rather long and there is not indication of its length so I earmarked it to watch later but like all these things other things come up and things move on, and ..............

    not quite sure what the mean by 'comprehensive care' would that be the same as holistic which is what i would like to think patients get anyway, apart from the large numbers of very unfortunate cases reported in the media.

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  • If managers truly believed that compassionate care is important (and I am one) then we should
    (1) seriously think about shorter shifts, say 3 or 4 hours in some emotionally draining or high intensity services
    (2) make a serious investment in staffing that doesn't involve filling in forms to work out dependency levels
    (3) take a stand against unsafe levels of staff and close beds if needs be
    (4) get all of the executive not just to walk about in clinical areas but actually spend a day a month on different wards and see how hard it is
    (5) get rid of zero hour contracts and the idiocy that specialist nurses just get rotated around general medical wards when there's not enough staff
    (6) use staff surveys properly to see why stress levels are so high and act on the feedback - making sure people get breaks, have time for education and training, have peer support and aren't blamed for things out of their control, like a 28 bedded unit only having 2 loos, they didn't build the hospital.......
    (7) stop fiddling with A4C
    (8) give people more control over their working environment. Hundreds of studies show that a lack of control is a major contributor to stress
    (9) tackle the bullying climate of fear that so many live in, where nurses who're often the major breadwinner come to work when unwell because they are afraid of the consequences of calling in sick
    (10) LISTEN to your most valuable asset, the people who care for our patients

    I'm sure there's more but this is my starter for ten

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  • Compassion is a wonderful old fashioned attribute, or gift, which hardly exists any more in the hectic modern world, where nobody has time to foster good interpersonal relations any longer, and where so much information and brief personal communications are exchanged in a cold, clinical and impersonal manner electronically. These often lead to misunderstandings, some of which can be serious, and social isolation and difficulties in families so how can nurses be expected to be an exception.

    those with severe difficulties in experiencing compassion and suffer from the effects of social isolation often present themselves in desperation at their GPs surgery, hospital or even A&E in an attempt to find some warmth and sympathy through human contact. Such encounters with the health services are also brief, electronic and sometimes confrontational and clinical as staff no longer have time to listen to any of real needs and concerns of their patients which are often not overtly expressed within the first few minutes of a first encounter. Patients will often have another pretext for their visit and need time to build up a relationship of trust before expressing their innermost problems. Their affliction is not like a physical complaint which may have some visible signs to show the practitioner they are consulting. They may be sent home with a prescription for psychotropic drugs and some advice which may not be a solution to their problems, and without adequate follow ups may lead to dependence or abuse. others end up more dramatically in MH services and all of this because society fails to offer the compassion they need when they are hurting and may no longer be able to reach out and show compassion of their own!

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  • michael stone

    'Politicalnurse | 28-Jan-2013 1:19 pm

    Being compassionate includes having the knowledge and experience to understand the other person.'

    I suspect that it takes time and experience (= age) to be able to 'understand many other people': if I'm right about that, and ignoring issues around 'burnout', older nurses are likely to best possess that particular skill, but I'm not sure that older nurses are best equipped to copew ith some of the physical demands placed on nurses ?

    The Nobody | 29-Jan-2013 11:22 pm

    I think a good list to start with - but I think you can somewhat combine 4 and 6, if when managers were actually on wards (and preferably not altering behaviour) the managers 'looked at things, and decided if staff looked to be under a lot of stress' ? Although surveying staff about stress, is obviosuly also good.

    11 LISTEN to patients and their relatives.

    It was about compassionate care - meaning, in fact, of patients: but obviously nurses also need to be treated decently as well (and, even - managers !).


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