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EDITOR’S COMMENT

'Nursing strategy success depends on everyone'

The profession needs to acknowledge that there are problems in nursing - but recognise that instances of poor care delivery that are so often reported by the media are the exceptions. That was the message at the Chief Nursing Officers’ Conference last week, where nearly 400 senior nursing leaders gathered in Manchester to applaud or constructively dissect the nursing strategy presented by CNO for England Jane Cummings and director of nursing for the Department of Health Viv Bennett.

Ms Cummings had been interrogated by the media during the first day of the conference, and eloquently and powerfully told them that those nurses who failed to care for their patients were betraying their excellent peers in the profession.

She is right. Every nurse is having to shoulder the shared guilt of the terrible failings of the few. This isn’t good for individual morale, or the standing and status of the profession as a whole.

This was a point picked up by health secretary Jeremy Hunt on the second day. He said although poor care was rare, it could not be brushed aside. It had happened, and the public needed reassurance that the government - and the profession - was sorting it out.

Nurses need support from the top to ensure their “courage” in speaking out about poor care will not be met with derision, bullying or even disciplinary action

NHS chief executive Sir David Nicholson, via video message, also suggested that those nurses neglecting their patients and their duty of care would be rooted out.

Unequivocally, then, the message comes right from the top that there shall be a zero tolerance approach to those who are wilfully flouting the values outlined by the 6Cs nursing vision of care, compassion, courage, commitment, competence and communication.

While the 6Cs met with universal approval at the event, let’s be clear that the profession should not live these values in isolation.

Indeed, many a GP, hospital consultant, physio or OT could benefit from adhering to them. While nursing must own those Cs, it is wrong to suggest the onus for providing compassionate care lies solely with nurses. It will also make it harder for them to live the 6Cs if they are the only health professionals aware of them.

The very best nurses need support from the top to ensure that their “courage” in speaking out about poor care will not be met with derision, bullying or even disciplinary action - as has been the case all too often. Nurses must live by the 6Cs, but their managers must understand them too, and offer every bit of support to ensure they can be achieved in real-life situations, not cast aside to save a few pounds or cut out when resources are tight. If nurses agree those values are to save the future NHS, let’s all show them some respect.

Jenni Middleton, editor

jenni.middleton@emap.com. Follow me on Twitter @nursingtimesed

Readers' comments (79)

  • Jane Cummings Report “Compassion in Practice” has so far been a disaster for nurses. It has resulted in some of the worst media coverage ever over the past week. She has given the press a stick to beat nurses by suggesting that nurses are lacking in care in compassion. I would suggest that Jane Cummings would fail her own five”Cs”. Certainly her communication has been a disaster. The RCN had to appear on Radio 4 on the day of her pronouncement and face very hostile questions. To their credit they did concentrate on lack of adequate staffing as being of utmost importance. In the same week as Ms Cummings made her speech the NHS watchdog, Dr Foster, released a report saying that hospitals were full to bursting point and staff were rushed of their feet. How can staff provide adequate care and compassion in such circumstances? Jane Cummings failed to mention this report in her speech, I wonder why? I would suggest that she and the government do not want to draw attention to the real causes of poor care and it much easier to scapegoat and demonise nurses. This is similar to the way they are demonising the poor and unemployed as being workshy and feckless,” lying in bed with their curtains closed whilst other people go to work”. So we now get the feckless, lazy, uncaring and un-compassionate nurses as being the cause of all the ills in the health service.
    I would urge Jane Cummings to read some of the reports below, although I would have thought she should have been aware of them already. It seems she has chosen to ignore them and concentrate to her simplistic five C formula. Much easier that looking at the real causes and no doubt much more acceptable to her masters in government.
    “Hospitals are 'full to bursting' and patient care is being put at risk, report warns”
    Hospitals are 'full to bursting' and patient care is being put at risk, report warns. Dr Foster, the NHS watchdog, found 12 trusts have 'worryingly high' death rates for 48 weeks of the year most hospitals are more than 90 per cent full, 'jeopardising patient care'. A third of beds are taken by patients who could be cared for elsewhere. He added: “With bed occupancy of 95 per cent to 100 per cent for much of the year for many of the hospitals, there are too often no beds available, staff are rushed off their feet, patients are not cared for properly, infection rates rise and mistakes occur.”
    “Hospitals on the edge? The time for action”
    A potential crisis in hospital care is widely reported in the media today, with BBC News reporting that standards of hospital care are slipping throughout England. The Daily Mail states that elderly patients are being shunted between beds “like parcels”.
    The headlines are based on a new report by the Royal College of Physicians (RCP) of London, which warns that acute hospital care is under pressure, leading to “unnecessary pain, indignity and distress”. Many stories lead with the frightening claim that NHS hospitals could be on the brink of “collapse” – a term that the RCP’s report does not use, but which is present in its accompanying press release.
    The title of the report is Hospitals on the edge? The time for action
    “NHS Choices-Thursday September 13 2012”
    “Short-staffing nurses leads to care not being done “ October/December 2006 -- When nurses are short-staffed, a research study:"Missed Nursing Care: A Qualitative Study"found that much of necessary patient care was just not being done. Beatrice Kalisch, Past-President of the Center, published her findings in theJournal of Nursing Care Quality. The qualitative, focus group study of RNs, LPNs and nursing assistants found that care was being missed in 9 major areas including surveillance, discharge planning, patient teaching, ambulation, turning, feedings, emotional support, hygiene and intake and output documentation. One RN in the study stated: "People want to give good care and it bothers all of us when we can't do it. You are pulled in 10 directions, and you can't give quality care to your patients. It really bothers me.” And another said: “We don't let ourselves think about [the care not being done]. It is the way we cope. Underneath we don't feel good about it

    “Adequately staffed nurses with good administrative support and good relations with physicians have more satisfied patients”
    February 2004 -- Patients were more than twice as likely to report high satisfaction with their care and nurses reported less burnout when nurses worked in conditions with adequate staff, good administrative support for nursing care, and good relations between themselves and physicians. It was a study of 820 nurses and 621 patients from 40 units in 20 US urban hospitals. See: Vahey DC, Aiken LH, Sloane DM, Clarke SP, Vargas D. (2004). Nurse burnout and patient satisfaction.Medical Care2004; 42(2):II-57-II-66.



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  • My six-point comment on Cummings's formula

    Crass
    Careless
    Cliche'ed
    Condescending
    Clueless
    Contemptible

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  • tinkerbell

    'The very best nurses need support from the top to ensure that their “courage” in speaking out about poor care will not be met with derision, bullying or even disciplinary action - as has been the case all too often'

    This is good news and a step in the right direction at last.

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  • tinkerbell | 11-Dec-2012 3:58 pm

    'The very best nurses need support from the top to ensure that their “courage” in speaking out about poor care will not be met with derision, bullying or even disciplinary action - as has been the case all too often'

    This is good news and a step in the right direction at last.

    It would be if it were true, but I'm afraid there is little chance of it happening under this government and Ms Cummings watch

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  • Does Jenni Middleton really believe what she has written? It is either wishful thinking or "their all in together"

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  • tinkerbell

    Anonymous | 11-Dec-2012 4:48 pm

    What? Have i been duped into believing they might actually mean what they say? Must have let my guard down for a moment.

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  • Anonymous | 11-Dec-2012 4:52 pm

    it is journalism with which one earns one's bread and butter

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  • tinkerbell | 11-Dec-2012 3:58 pm

    It is your good heart and hopeful nature that means you still look at things with better eyes than some of us. Don't let it happen again!! You're going to end up looking like someone who cares. We can't be having any of that nonsense! But I have to agree with Anonymous | 11-Dec-2012 4:48 pm.

    There is nothing new in this 'nursing strategy'. Nothing new at all. Most nurses live by these six Cs and much more on every single shift they work. That is why the NHS has not collapsed completely.

    This 'strategy' is the vilest, most condescending load of claptrap I have heard in a long time. It seems to have fooled everyone but nurses themselves. Not one solution in sight.

    Anonymous | 11-Dec-2012 12:59 pm

    Absobloodylutely!

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  • tinkerbell

    mags | 11-Dec-2012 10:41 pm

    Yes but Mags you and many others posting here care passionately too, it encourages me to hear their dedication that we're not all badduns but does this mean that we can no longer believe a word the heirarchy say in relation to nursing. If that's the case i feel a weeping coming on. We're done for. I don't want to believe we're done for, all that's good and kind in our society which is reflected on a daily basis within what was OUR NHS. It's so vitally important that we don't lose compassionate care for ALL. No-one's asking for a medal just want them to stop this relentless assault on the majority of good staff.

    I am quite happy to take some action but there's no action going on. It is so frustrating that we feel so impotent in the face of this pasting when we could be a force to be reckoned with if we just had enough belief in our value to society as a compassionate society. Once our NHS is gone heaven help us all, it will be dog eat dog.

    I feel we don't need gimmicks or cards to remind us of 6 c's. It might be a reference point but caring nurses have been doing this without putting names to it all.

    I have seen and worked with some wonderful nurses and i have also seen and worked with some of the dregs but i feel so sad that nursing and good nurses are being dragged through the mud big time by a heartless government who have demonised nurses for their own money making agenda. Shame on them for the way they have tried to drag ALL nurses through the mud.

    Sometimes i find it hard to believe that it has come to this so you may be right I am looking for someone honest (hellooooo is there anybody there?) to believe in that might put nursing back on track and who really cares about what happens to the patients rather than them just being a pawn in a game.

    I am concerned because i now realise also that nurses aren't going to take the stand that is required to give this unelected government a bloody nose.We're just going to take it lying down or leave.

    Perhaps we are going to be destroyed and have to start again or just become a distant memory of the way things were and all the good thrown away with the bad but there was more good than bad.

    Must go can feel some swearing coming on.

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  • Nursing in this country is at an all time low.
    The two stupid, ambitious DJ'S and their boss has put a spot light on nursing in England.

    We are Receptionist, due to cut backs
    We are Porters, pushing beds to various places as not enough porters
    We are Physiotherapists as they are telling us we have to assess the patients moving first before they start moving the patients. They also are not doing enough chest physio so we end up putting on more nebulisers.
    We are tea ladies as the wards has done away with the House Keepers. Our health care assistants are taken away from us to do house keeping and filling out patients menu sheets so
    We are Health Care Assistants
    We are Cleaners as the cleaners' time cut to save money.
    We have to stop doing the medication and do the meals first as not enough staff. Medication is now given too late or too early.
    We have to stop our work every 5 minutes to answer the phone as relatives call 24/7.
    We are Ward Clerks as no ward clerk from 2:00 pm.
    We have little support from the ward sister/manager because they are stuck in the office doing paper work or pretending to do urgent paper work.
    We are not getting appraisals from the Ward Sister we are only called in the office to be told to do more or for a telling off.
    We are told that we cannot get our A/Leave as requested as no staff
    We are told we should not be fat and that we should smile more.
    Even the patients relatives give us work to do by leaving their chairs by the bed, we have to put their chairs away.
    We are managed by senior people who have't got a clue how to manage.

    God help us

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  • tinkerbell



    I have come up with a plan to include EVERYONE.

    How about this for a strategy and a 'vision for the future'.

    1. Nursing directors start commenting on this site and answer some questions.

    2. From the top down, yes that CE's too have to complete a compulsory time on the wards as part of the team, with hands on. This could be for 2 or 3 months of the year where they work an early or late shift. They cannot be signed off unless they have reached a competency level by the NIC of the ward and they cannot register with NMC if they fall below the standard required.Use it or lose it.

    I would feel much better about their input and flights of fancy if they were actually leading by example and putting their wealth of wisdom into practice.

    They may bleat that they've had their time in the trenches but it can't have been for that long otherwise they wouldn't have risen to such dizzy heights would they?

    The first thing i would ask you to do when you pitch up for a shift on my ward where i use to work is to put your mobile phone away as you won't have time to be fiddling with that until your 20 minute break if you get one. You're gonna hit the ground running. Let's see you do more with les

    oh and if they say they can't be spared then myself or another colleague will go and cover your post for the 2 or 3 months you're away on a tour of duty. When we get back we can swap stories of how it went. How was it for you?


    Salary will depend upon experience


    ...

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  • I’ve got a spiffing idea; let’s think up a new nursing strategy to launch my career. Let’s thinks of words beginning in the letters ABC. No, on second thoughts let’s just have one of those letters. Now which one will it be, lets see… eeny, meeny, miny –“ C” it is then. Now let’s think of how many words we can come up with beginning with the letter C. There’s ; Care, Compassion, Courage, Communication, Commitment, Competence. I think that’s enough, spiffing, job done. Well call it Compassion in Practice or the six C’s for short. Jolly hockey sticks; let’s have a conference to launch it. That nice Mr. Hunt will be impressed; he might recommend me for a Damehood. Onwards and upwards.

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  • Anonymous | 11-Dec-2012 1:52 pm

    My six-point comment on Cummings's formula

    Crass
    Careless
    Cliche'ed
    Condescending
    Clueless
    Contemptible

    Brilliant, well said.

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  • In some areas things are obviously not right, however I am becoming increasingly concerened about the vast amount of anonymous comments posted on NT and HSJ etc...does this not clearly demonstarte that there is still a culture of fear within the NHS? And will anything ever change while people are apparently too scared to stand by their comments and beliefs?

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  • Peter Goble

    I usually add my name to posts and I am happy to say now that I authored the 6 C's above. I resigned my PIN a couple of weeks ago, I earned my first qualification in 1956, and I'm not sorry to have given it up.

    It grieves me to read the embittered comments colleagues write but they are are fully justified, wholly appropriate and - as has always been the case - totally ignored by politicians and their craven minions in the 'upper echelons' of NHS bureaucracy and hospital management.

    The intention seems to be: more managerial oppression; more bullying, more strident and public exhortations to increased'competence' and/or 'efficiency'; more pages in the Daily Mail given over to relentless scapegoating and bad-mouthing nurses; more cliched PR claptrap from CEOs and the CNO.

    The result will be an attenuated, run-down and defeated profession, an enfeebled and unpopular health service, leading to a calculateed but naked bid to franchise the whole NHS brand out to private tender by anonymous private equity bucaneers from God knows where.

    You all know this so why, I ask myself wryly, am I bothering to comment? It reads as a pathetic epitaph on a 55 year career.

    If there's a remedy to stop the rot I can't call it up in my still fertile political imagination, and I fear for my children and their children's future.

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  • tinkerbell

    Peter Goble | 12-Dec-2012 7:34 pm

    Peter thank you.

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  • Thank you Peter, our only hope is if the NHS can last until the next election we can vote this rotten government out.
    Perhaps we need a boycott of Nursing Times. For Jenni Middelton to write such a glowing report on this rotten strategy would seem to suggest that Nursing Times is no friend to Nurses.

    "400 senior nursing leaders gathered in Manchester to applaud or constructively dissect the nursing strategy presented by CNO for England Jane Cummings"
    What a waste of tax payers money. They would be better off working a shift on the wards where they might get in touch with the reality of nursing today rather spending the day in la la land.
    It is time that Nursing Times gave some leadership and gave in-depth examination of the problems facing nursing today, rather that slavishly praising the ignorant utterances of the CNO

    "Ms Cummings had been interrogated by the media during the first day of the conference, and eloquently and powerfully told them that those nurses who failed to care for their patients were betraying their excellent peers in the profession".

    What about the failings of government and managers, who make nurses work in understaffed wards and poor working environments. It has been well reported that staff working under continual pressure will suffer from burn out and the only way to survive is to become hardened and less caring, if you know it is not humanly possible to give care at the standard required.

    Extract from the Royal College of Nursing Document 2012.
    ".Morale and motivation in the NHS workforce"
    Respondents were asked about workplace morale and whether it had improved or
    deteriorated over the last 12 months. Two thirds stated that morale had worsened, with a fifth (22%) stating it was a ‘lot worse’ and double that number stating it was ‘worse’ (44%).
    In 2010, just over half (55%) told us that morale and motivation had got worse over the previous year.  
    A high proportion of nursing staff (63%) attribute falling morale and motivation to a feeling of dissatisfaction with the quality of care they feel able to provide, compared to just under half (46%) of the general group. This is reinforced in further findings, as set out in Table 1, showing that two-fifths (40%) of all nursing respondents state they are dissatisfied with their ability to carry out their job to a high standard.
    The main reason (83%) given for declining morale is increased levels of stress. This is echoed in the National Nursing Research Unit report which found that two-fifths (42%) of nurses surveyed are suffering from emotional exhaustion and are ‘burnt out’. It also found that nurses with higher levels of emotional exhaustion are more likely to be dissatisfied with their Jobs".

    Why is Ms Cummings not campaigning on this issue? One can only suspect that she is quite happy to see nurses blamed for the governments failing in the Health Service and she is happy to see nurses used as sacrificial lambs to distract the public's attention from government cutbacks. Disgraceful.

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  • tinkerbell

    Peter Goble | 12-Dec-2012 7:34 pm'The intention seems to be: more managerial oppression; more bullying, more strident and public exhortations to increased'competence' and/or 'efficiency'; more pages in the Daily Mail given over to relentless scapegoating and bad-mouthing nurses; more cliched PR claptrap from CEOs and the CNO.

    The result will be an attenuated, run-down and defeated profession, an enfeebled and unpopular health service, leading to a calculateed but naked bid to franchise the whole NHS brand out to private tender by anonymous private equity bucaneers from God knows where'.

    I had hoped that the nursing profession and CNO's coming up with these ideas were trying to raise us up but if it is their deceitful intention to drag up further down into hell
    then i can only hope and pray that they are their own undoing. That given enough rope they will hang themselves and that one day nursing will find itself again and start over renewed with genuine good intentions and purpose.

    This bastardising of beautiful words apparently coming out of the mouths of liars and deceivers nearly had me believing they actually cared.

    Surely we must have a few good men/women left at the top who can speak out against this and stop it from happening, but it seems not at the moment.

    I feel sorry for us ALL.



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  • Anonymous | 13-Dec-2012 0:01 am

    Oh bloody well said!

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  • Tink. Did we just post 'in sync'?!

    As always....I totally agree with your thoughts on the staus quo.

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