Nursing needs its leaders to respond to FrancisPractice blog
All posts from: January 2013
'Punitive financial penalties won't produce the results that patients deserve'
Pressure ulcer reduction is one of the latest targets directed at nurses, as reported by Nursing Times last week. New rules linking them to trust funding mean you will face increased pressure to hit targets on reducing pressure ulcers this year.
The problem of pressure ulcers has always been with us. When I was a student nurse 30 years ago we saw pressure ulcers, sometime terrible ones, particularly in long-stay geriatric wards. But other than turning, an ineffective ripple mattress or a matted sheepskin there wasn’t much we could do. We didn’t know how many patients had pressure ulcers or how to describe or classify them and had no effective dressings to heal them.
In 2013 we have a wealth of knowledge and equipment at our fingertips, yet pressure ulcers are the biggest single cause of avoidable harm to NHS patients.
While targets may help to focus attention on the extent of the problem I am not sure punitive financial penalties will necessarily produce results that patients deserve. In fact they may actually encourage under-reporting. Tissue viability teams across the country are already making efforts to improve pressure ulcer rates without the stick of financial penalties, and these innovations need to be shared and celebrated.
On 7 February we are holding a NTclinical webchat with Vanessa McDonagh and Amy Oldfield, tissue viability clinical nurse specialists from University Hospitals Coventry and Warwickshire Trust. They set up a campaign to raise awareness of pressure ulcers and motivate wards to become free of hospital-acquired pressure ulcers.
Their “100 Days Free” campaign motivated nurses to take control and ensure their areas were free of pressure ulcers for that length of time and beyond. The campaign has reduced hospital-acquired pressure ulcers by 69.5% and saved £600,000. In a recent article in Nursing Times Vanessa said, “We did it because we are passionate about harm-free care.”
Vanessa and Amy are happy to share their experience with you so please join us on 7 February at 4pm. Go to the home page at www.nursingtimes.net and you will be directed to the chat. If you would like to submit a question in advance please email it to eileen.shepherd@emap.com
You can also update you knowledge on pressure ulcer prevention by completing our Nursing Times Learning unit on Pressure Ulcer Prevention.
It will teach you:
- Factors that increase a patient’s risk of developing pressure ulcers
- How to undertake a pressure ulcer risk and skin assessment
- A variety of techniques that can be used to minimise a patient’s risk of pressure ulcer development
- How different pressure-relieving/reducing equipment can help to prevent the development of pressure ulcers
- How ongoing pressure ulcer prevention should be addressed when transferring or discharging at risk patient’s
- To identify causes and the classifications of pressure ulcers
Do you remember your first week in nursing?
It’s freshers’ week and all over the country student nurses will be starting out on a training that will contain experiences and challenges that will be with them for the rest of their life. Nurse training changes your life – not just in career terms but also personally.
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I feel excited that they are at the beginning of a journey where they will learn the skills of how to look after patients with fundamental care at its heart. I think many of us will remember the difficulties and the challenges of learning procedures, the anxiety about if you are doing it right. The first time you gave an injection, flushed an IV line, changed a dressing or helped someone walk to the toilet. And remember the enjoyment of being able to care and support patients at a time when they need care.
But I think the way that nurse training changes you in a personal way is the experience of meeting patients. However many years ago that is was that you trained, I imagine you will still remember some of the patients you met during your training, especially in the early days.
The conversations that you had with them about their condition and about their life. The opportunity that nursing gave you to meet people from all ages and from all backgrounds. And the trust they placed in you to help them get better or at least to be made comfortable.
So I feel quite excited on the new student’s behalf – wishing I could turn the clock back and go through again some, if not all, of the variety, challenges and real life experience that nurse training offers.
And don’t forget that student nurses can be supported by the resources for freshers’ week at studentnursingtimes.net which will help with tips on essay writing and the first placement and much more.
And a student subscription is only 70p a week.
Nursing must not carry the can for Mid Staffs
While there can be few groups within the NHS looking forward to the Francis report into Mid Staffordshire Trust, the nursing profession appears to have most to fear. Large swathes of the general media already seem to assume that the largest proportion of blame rests with nurses.
They will almost certainly report numerous distressing stories of neglect and appalling practice among nurses at the hospital. They will also doubtless demand major changes to nurse education, question once more the move to degree-only entry, and accuse nurses of becoming at best box-ticking robots and at worst cruel sadists who cannot be bothered to cross a ward to help a patient in distress.
There is, of course, no excuse for what happened in Stafford, and it is crucial that lessons are learned so it can never be repeated. And yes, some nurses are individually culpable. But that is far from the whole story – other individuals and professions played their part in these tragic events, so why is nursing being singled out for such vilification? Why is there an assumption that nursing is broken and that all the failings can be laid at its door?
The Daily Telegraph has been particularly keen to accuse the profession, yet its sister paper the Sunday Telegraph reported that complaints had been received about 41 doctors and ‘at least’ 29 nurses at the trust. Given the ratio of doctors to nurses, it would be reasonable to assume that by far the greater proportion of complaints would be about nurses, yet I don’t hear doctors being attacked so vociferously.
Nursing cannot be allowed to carry the can for all the wrongs at Mid Staffordshire. Yes, it must hold up its hands and accept its share of the blame, but other professions must do the same. Nurses cannot fail so spectacularly in a vacuum – it takes an entire hospital and numerous failures in regulatory systems to allow up to 1,200 people to die unnecessarily.
If the NHS is to learn from Mid Staffordshire, the Francis report must be considered in an even-handed manner with a willingness to make changes wherever they are needed rather than focusing on one profession.
And the government must be willing to take a constructive approach to addressing any resource issues that this raises. Anything less is unfair to the nursing profession and, more importantly, an insult to the people who died needlessly and the families they left behind.
Are nurses born or made?
Everyone has an opinion on what makes a good nurse. Words such as kind, caring, empathetic, patient, efficient, compassionate, organised, giving and thoughtful trip off the tongue – and then there are the thorny question of cleverness and vocation.
Funny thing is, whatever words are used to describe a good nurse we all know one when we meet them.
In my experience good nurses are good people.
This was brought home to me when a friend died on Boxing Day after a long illness. She was a nurse and loved her job. I never worked with her but in her life she portrayed the all the characteristics of a good nurse. She had an endless capacity to give of herself and her time, she was always there when people in her community needed help, visiting the sick and recently bereaved. She motivated people to get involved and helped to raise huge amounts of money for charities and good causes.
Most of all, my friend cared about people. She noticed when those around her looked sad, discouraged or unwell. She touched everyone with her kindness.
So I am left wondering, are nurses born or can they be taught to be caring and compassionate? What makes a good nurse?
No one should be in any doubt that nurses need a high level of education and training, but they also need to come to the job with qualities that help them translate this education meaningfully into practice.
You can teach the elements of nursing but I am not convinced you can teach the compassion, empathy, kindness and care required to deliver good care. And there lies the challenge. We all know people who would make great nurses but don’t have the qualification to get in, and others who could easily pass the theoretical part of a course but lack qualities that a nurse should have.
In 2013, nursing is facing probably its most difficult time in decades. Publication of the Francis report on care at Mid Staffordshire will focus again on nurses’ failings and I suspect we will be engulfed in another debate about degrees and who is “too posh to wash”.
Although the report is likely to make for painful reading, the profession can ensure that it has a positive effect by using it to rebuild nursing. Perhaps the first step is to ensure our recruits to nursing have the right qualities and values and the NHS is prepared to support them to use these in practice.
