'New forum must focus on the future and not look backwards'

Based on recent news coverage, we can safely say nursing has finally shed its angelic image. In itself, that is no bad thing, but now nurses are being pilloried for lacking in basic humanity and compassion. They have gone from being angels who can do no wrong, to devils who can do little right.

One consequence is that the government is paying serious attention to nursing, with David Cameron announcing a Nursing and Care Quality Forum to promote best practice. Again, no bad thing. He identified solutions to the perceived problems of nursing, including the Productive Ward programme and hourly nursing rounds, both of which seem to be intrinsically good ideas - certainly when I was involved in the evaluation of the Productive Ward, people’s enthusiasm for it was impressive.

On the face of it, the aim of the Productive Ward - “Releasing Time to Care” - captures the problem and the solution. We should give nurses more time to care, and all will be well. Except it is not that simple. I remain sceptical of the claims for the amount of time released by the scheme. Also there is a clear implication in much of the criticism that nurses are just not caring in the first place, that we need to return to some golden age of the past where all was well and matron ruled the roost.

“I remain sceptical of the claims for the amount of time released by the Productive Ward”

I remember a description by the late Claire Rayner of a simple act of caring from when she was a practising nurse. She used to tap the wrist of one patient every day when taking his pulse, just so he knew all was well - providing reassurance through a simple, compassionate act. Why, she wondered, can’t today’s nurses do the same? You might ask why she didn’t just talk to him. I imagine that was because, in those days, nurses weren’t permitted to routinely talk to patients. Patients were expected to be compliant and unquestioning.

The nature of the relationship required to establish such an elaborate code should not be dismissed lightly: I think Ms Rayner did not give herself full credit for the ingenious way she solved the problem caused by a system that often failed to treat patients with “humanity” as we now understand it. But one advantage she would have had was time to get to know her patient as even simple conditions resulted in long hospital stays.

The challenges to care and compassion in those days were different, but they were there. The solutions were tailored to the times. Today’s nurses face huge challenges in caring for patients with ever greater levels of acuity who experience short stays in hospital. Expectations placed on nurses are greater and the opportunity to build relationships over time is no longer there.

This is not an excuse for poor care, but is the challenge hospital nurses face today. It is clear that, at times - for example when trying to care for frail and cognitively impaired patients in acute hospitals - the profession fails. As a whole, it has to come up with new solutions to delivering humane care in these new circumstances. This is why we need to train professional nurses - so they can manage technical care and still have capacity to ensure that care is humane and individualised when there are so many demands on limited time.

To declare the problem too difficult to solve is not an option, it would be an admission that the profession is not fit for the future. So I welcome the prime minister’s interest and the Nursing and Care Quality Forum. Look to simple solutions to release time to care by all means - but offer solutions to tomorrow’s problems, not those of the past. The golden age, if it ever existed, was very different and is long past. It cannot offer us solutions to the challenges we now face.

Peter Griffiths is chair of health services research at the University of Southampton and executive editor
of the International Journal of Nursing Studies

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