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Will the Francis report recommendation to introduce key nurses improve patient care?

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12 February, 2013

The Francis report has recommended that “patients should be allocated for each shift a named key nurse responsible for coordinating the provision of the care needs for allocated patient. The named key nurse on duty should, whenever possible, be present at every interaction between a doctor and an allocated patient”.

What do you think?

Is this a return to the named nurse policy introduced in the 1990s?

Will this recommendation ensure that the nurse patient relationship is valued in organisations?

Francis calls for ‘key nurse’ to coordinate each patient’s care

Readers' comments (14)

  • What happens when you're the named nurse for 16 people and there are four ward rounds going on?

    It's a good idea but worthless without a minimum staffing ratio. 1:8 or ideally 1:6 must become law to ensure patient safety!

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  • I agree with anon 12:06

    Sounds good in theory, but in practise impossible with the current patient ratios. I am sure most of what has happened at mid staffs is down to impossible staffing...how do you ensure everyone is fed and watered on a ward of 30, with 3 or 4 staff and surgeries, and emergencies occuring?
    Minimum staffing ratios have to be introduced in this country for the level of care to improve.

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  • Having just returned to practice after 20 years, this practice of having docs drifting in and out as and when, sometimes communicating sometimes not, depending on the availabilty of the nurses who often weren't expecting them then/on break/busy with another patient etc is definitely a problem (not a nursing problem - a management one). Old School Medical Team 'ownership' of a ward area would change this but bed occupancy as a percentage would probably drop. If you maximise the use of one resource in a system you reduce efficiency in another area, I think. What do we want most if we can't have it all? The slower older system had a different type of rationing and long waiting lists.

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  • Believe it or not the answer is really simple, we do not need any complex systems, audits, documents or quality control measures to be put in place; we simply need more staff on the wards, on each shift to deliver the care we should all be able to expect and receive.
    I am not denying the need for training, strong leadership, specialist skills and many other facets, however without sufficient work force the latter is irrelevant.

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  • Is this 'named key nurse', the same as a patient's 'named nurse' on each shift; or is it one 'key nurse' like a ward coordinator, to collecting information not only from doctors but from the mdt of all the patients on the ward, including nurses?
    I'm confused with yet more jargon. Just tell me or leave me a message, ideally typed or legibly written (if I'm busy elsewhere) if there's any changes or updates to the care of any of my patients. I hate it when people ghost in + out changing the plans + then moan later when they realise that my psychic / telepathic abilities wasn't working due to being a bit more tired than usual.
    Also forget about multitasking, it doesn't exist except for computers with multiple processors, and don't attempt it if safe patient care is the objective. For better quality care, try nurse:patients ratios of 1:4 or better. Still challenging at meal + personal care/hygiene times, especially when people's biorhythms seems to be synchronized.
    Too expensive? How much is a patient's life worth?

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  • nursing will soon no longer be nursing at all but another kind of job involved with meeting the needs of patients - not sure yet what and how that will be? Maybe managing patient data and a team of robots just like the robotic cuddly seal popular with the elderly suffering from dementia in Japan.

    Maybe we will all be sitting in a NASA like control room at the heart of the hospital, one RN for each ward, communicating between patients, doctors, the robotic teams, managers if we haven't managed to eliminate all of these, and anybody else involved in their care, and with their visitors to do all the basic nursing. Each bed could have some sort of electronic food and drink delivery system to assist them when their visitors are not available. There could be electronic back scratchers and machines programmed to turn the bed bound regularly to avoid pressure sores, record their obs., and machines for most other aspects of their care and some robotic seals and teddy bears to deliver compassion and listen to and record their concerns to relay them back to base!

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  • Oh dear! Been there done that! The "named nurse" by another title!!
    As has been said man, MANY times before, "Staff the wards with adequate levels of appropriately trained staff and care quality will improve".
    Remove the bullshit, audits and unrealistic targets that everyone gets so fixated with and patient's will receive the care the deserve and should expect!!
    I think it is time that Cameron et al spend some time on the "shop floor", and not one that is done up with all the "nice" patients sat at the their bed sides, water jug filled to brimming, but on a true everyday ward where staff go without breaks are asked to stretch themselves even further to see how it really is!!

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  • Anonymous | 14-Feb-2013 9:35 am

    and issue the ministers with NHS glasses to enable them to see beyond their targets and figures on the balance sheets. they obviously suffer from some type of myopia.

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  • Sir David Nicholson, the head of the NHS should resign for presiding over the ‘appalling care’ that led to at least 1,200 patient deaths at Stafford Hospital
    Sign the petition

    http://epetitions.direct.gov.uk/petitions/45576

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  • Get all nurses back on the floor away from record keeping , computers, audits, providing patients with the care they need especially with basic hygiene care .and meals ,if all nurses were hands on care would improve and all staff would feel more valued and less sressed

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  • Sir David Nicholson, the head of the NHS should resign for presiding over the ‘appalling care’ that led to at least 1,200 patient deaths at Stafford Hospital
    Sign the petition

    http://epetitions.direct.gov.uk/petitions/45576

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  • Anonymous | 16-Feb-2013 2:17 pm

    Get all nurses back on the floor away from record keeping , computers, audits, providing patients with the care they need especially with basic hygiene care .and meals ,if all nurses were hands on care would improve and all staff would feel more valued and less sressed

    So true. I confronted our matron about excessive paperwork getting in the way of patient care and she admitted those "at the top " insisted on it. There is no hope.
    The Francis report will be forgotten about in a few weeks and Nicholson and the like will continue to dictate from their ivory towers doing the governments bidding which is cost cutting. Hunt is a hypocrite. If he wanted Nicholson to go he could sack him. Look how easy it was for Cameron to get rid of Mitchell.

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  • one wonders already whether the whole Francis and parliamentary exercise was really worth it. Maybe Cameron would have been more at home and happier discussing foreign aid, wars, cars, road or railways, etc or anything else which doesn't really concern us.

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  • 1967 'San's Everything' A case to answer

    The history of yesterday is the history of tomorrow

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