All posts from: October 2011
The media storm following publication of the latest CQC report on hospital care of older people has abated has left health professionals – and particularly nurses – feeling bruised and battered.
Of course some extreme examples described in the report were simply unacceptable. No one should have to lie in excrement for two hours, and it is hardly something staff could have been unaware of.
However, the commentary once again got hijacked by the people who think nurse education shouldn’t extend far beyond wiping bottoms, making perfect hospital corners and mopping fevered brows. What these people fail to realise is that healthcare is a totally different landscape from the time when nurses’ responsibilities were primarily what we now variously call basic, fundamental or essential care.
Nurses have moved into territory once occupied by medics, not in a power-hungry land grab, but because their education has equipped them for this - and because there simply aren’t enough doctors to take on the increasingly complex tasks and responsibilities modern healthcare demands. Would those who want nurses to return to what they see as a golden age that probably looks like 1950 also be prepared to accept the technology and medical interventions available at that time?
But however much the nursing role has changed, the fact remains increasingly vulnerable patients, with increasingly complex healthcare needs, don’t always get the care and compassion they need. So how can healthcare providers address this?
Of course there’s no single answer, but giving clinical staff the right support and leadership would go a long way. And this needs organisational commitment rather than expecting hard-pressed ward managers and team leaders to carry the entire burden. So here’s one option: originating in the US and brought to the UK by TheKings Fund, Schwartz Centre Rounds give staff from across a hospital a forum to discuss non-clinical aspects of patient care - the emotional and social aspects of their jobs. Typically taking place once a month, with lunch provided, the one-hour meetings take a single patient story, presented by the team who provided care, and discuss emerging issues.
A Kings Fund evaluation revealed that staff value the Rounds enormously for providing space to reflect on their work and support in dealing with the emotional challenges associated with caring for increasingly frail patients. It’s probably too much to ask that the mass media acknowledge the changed demands of healthcare, but the organisations employing nurses and other professionals in their increasingly demanding roles must do so - and offer them real leadership and support in fulfilling their responsibilities.
She described this as her survival technique on a ward where she knew she couldn’t be in three places at once. “When I realised I no longer felt their pain, I knew it was time to leave” she said.
That same day I had the pleasure of visiting a unit in Nottingham who care for people with personality disorders. I was really heartened by their approach to patient care - and how they care for their staff.
In the Ansel Clinic they aim to ensure that every interaction with a patient is a therapeutic one.
It rolls off the tongue easily - but how do they actually do it?
The clinic uses an operational framework based on social therapy so that staff at all levels - consultants to cleaners - are supported to work within such challenging an environment as this. Systems are in place for regular debriefing, reflective practice and supervision.
It was interesting to hear how staff from all disciplines, including managers, work alongside each other - and even those working in cleaning and hotel services have training to help them to understand personality disorder, enabling them to function as part of the team.
I was struck by how these ideas could be adapted and used by nurses - particularly those in acute care and care of older people settings.
All nurses need to have time to stop and think about what they are doing, how they are doing it and why. Sadly, many are not given this chance.
No nurse should ever feel as my friend felt. Staff have to be supported to give effective care and to work out solutions when things start to go wrong. Those who need extra support can then be identified. This requires staff at all levels to share the same objectives for their service.
So who looks after your team to ensure every interaction with patients is a therapeutic one?
There are countless pressures and incidents that require your patience throughout the nursing shift.
Not being able to find the right equipment that you need to carry out tasks. Interactions with members of your team including members of other professions who may not always understand your role. The reality of being a nurse – dirty uniforms, not being able to go to a party because of your shifts, paying to park your car at work and of course the inevitable NHS reorganisation.
And most importantly you need patience with those that you care for, even those for whatever reason you find difficult. Patience with the man who is continually calling out for a nurse. Patience with the elderly woman who keeps sliding down the bed and needs repositioning. And with relatives who don’t seem to appreciate that there are other patients on the ward and expect instant action from nursing staff.
Yes that’s your job but it does require patience.
Where do you find it?
I would be interested to know. Is it from support from your manager? Is it from chat and jokes with your colleagues? Or is it coming from some invisible internal source? Are you born with it or do you have to train yourself in this quality?
We have many problems and they all need to be addressed if we want to get nursing back on track. I don’t claim to be an expert but I have pulled together my top 10 suggestions. Please change, adapt, disagree as you see fit - I can take it. But let’s have a clinically focused conversation about what really matters to nurses and their patients. So, with a deep breath and in no particular order:
My top 10
- Wards should have staffing levels and skill mix based on patient dependency, not on numbers of beds. Nurses need time to provide the care their patients need.
- We need strong clinical leadership on wards. Free ward sisters from management tasks and allow them to lead clinical care by giving them clerical and housekeeping support. They become ward sisters because of their clinical and leadership skills, but do not have the time to use them or share them.
- Nurses should be managed by nurses, not by general managers. Trust chief nurses should manage their nursing workforce directly.
- We need nursing degree courses that ensure graduates feel confident to practise. Clever people can make good nurses!
- We need to reintroduce second-level nurses (SENs). HCSWs give nursing care, so why not put nursing into the title, standardise training and regulate the role?
- All newly qualified nurses must have a compulsory preceptorship programme to help them adapt to their new role. Qualifying is only the beginning of becoming a nurse.
- All nurses must have protected time for training to ensure they stay up to date.
- We need a robust system of re-registration that ensures nurses are competent to continue in practice. There needs to be a fair and effective way of dealing with those who do not meet professional standards.
- Nurses need a work environment that is well equipped and promotes patient dignity. Patient care should never be compromised by a lack of resources.
- We need nurse leaders with influence and real power on trust and commissioning boards - and in the Department of Health. The nursing voice must be heard at a local and national level.
Too often the direction of the profession has been dictated not by patient need but by the demands of health services, and these are not always compatible. We need the building blocks that allow nurses to feel confident and able to deliver safe and effective care to every patient, every day, on every ward, on every shift in every hospital.
It’s not rocket science, but I think we are going to need a 21st-century Florence Nightingale to take on the establishment. Any volunteers?