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'It is hard to hear criticism of the nursing profession'

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6 February, 2013

For those of you out there who are striving every day to deliver compassionate and high-quality care to your patients within the current resource and staffing constraints of the current NHS, this is an even more difficult day than usual. It is hard to hear criticism of the profession.

Without a doubt there was poor nursing care at Mid Staffordshire and at other hospitals around the country. Some of that was the result of particular individuals but as Robert Francis makes clear the problem was more organisational factors including culture, staffing levels and staff skill mix also played a significant part.

But although this is a dark day, it is also the day that brings hope that the problems in the health service which you live everyday will start to be addressed.

In his report Robert Francis makes 290 recommendations which offer a way forward for nursing in particular. The breadth and significance of these recommendations is huge for both nursing and the delivery of healthcare.

The central tenet is that “the patients must be the first priority in all of what the NHS does”.  

For nurses a key recommendation is for each patient to be allocated for each shift a key nurse responsible for their care and for this nurse should be present at every interaction between the patient and the doctor.  

There are recommendations for the implementation of quality metrics and the need for evidence-based tools to establish appropriate minimum staff numbers and skill mix.

Regulation and standardised  training of healthcare assistants and a strengthening of the clinical role of ward managers are important steps. As is the formalisation of the nurses’ continuing professional development with an annual appraisal and portfolio to be signed by nurse and countersigned by their manager.

For these change and improvements we need both will and resources from the government to ensure that the recommendations from the report are carried through.  Nurses now have a platform to articulate their concerns and have their voices heard. We need to grasp this opportunity and ensure the appalling neglect and care at Mid Staffordshire Hospital never happens again.

Readers' comments (20)

  • no matter how difficult the situation was it is still impossible to imagine how registered nurses or anybody else involved in patient care could allow what happened to some of their patients and how they could have ignored even their most basic needs.

    let's hope what has happened can now be put behind everybody working in the NHS and they can move on towards better understanding of what can go so badly wrong at all levels and provide a stronger, safer and more reassuring service for their patients.

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  • alisha limbu

    though changes are painful but if it is for good let us stand firm in our standard values

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  • There we have it the truth finally exposed. It is extremely difficult to hear and the reality is that to some extent evey trust has something in common with mid staffs. . . . You see we all know as nurses what our expectations are and the quality we want to deliver. However, money or should I say lack of it has caused this. In some shape or form we have all witnessed it. Ward closures, lack of resources, shortage of staff + lack of support = burnout and poor patient care, leadership issues. This is living proof that running a business like this and implementation of policies which were taken from david blunkett and his reforms with police a few years ago just does not work. Ultimately patients and public have been failed greatly. The culture that mangers have mutated sickens me. There needs to be one hell of a shake up and I dont have faith in the nmc or cqc and it wasnt easy to say that. I am worried for our profession, students entering a career that is nurse eat nurse at times. What a bloody mess!

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  • tinkerbell

    It is much harder to lose a loved one from neglect/incompetence/money saving.

    This is why this appalling scandal needed to be exposed. As a human being first and foremost & then a nurse i feel relieved it has been exposed. Injustice must be exposed and justice must be seen to be done.

    I would much rather deal with the criticism that nursing is experiencing however hard to hear than for this to be repeated around the country because nothing has been done. We need action NOW and to take this forward to every hospital in the land.

    I have always been proud and felt privileged to be a nurse and i remain so regardless. I have worked with some dross but mostly I have worked with and seen some wonderful nurses.

    We now need to use this report to ensure that nurses feel 'safe' and 'supported' to speak up about bad practice and it is nurses who can lead the way as they have the most contact with patients. Patients and nurses should unite in exposing dreadful care.

    That is the only way we can truly say that leassons have been learned, when we know this is not going to happen where i work because it will not be tolerated.

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  • I do hope this doesn't solely just become another nurse-bashing. How can a DoH not know what goes on at grass roots, shame on them and every level involved. Patient care is a team effort, or so I thought. It is easy to criticise on the outside. The majority of the nurses must have been in despair, and someone is responsible for allowing the lack of care to be imbedded in hospital culture. I hope there are managers and politicians quaking in their shoes all across the UK. Obviously nurses are not totally blameless, but don't let us accept all the blame, and as Anonymous | 6-Feb-2013 6:37 pm states, let us stop this nurse eat nurse culture once and for all.

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  • Well, this is what you get doing as you are told. Can you imagine Bob Crow and the RMT; allowing their members to work under conditions similar to ours? What do you think the answer would be? Listen boys and girls its time to take more control of our working environment. Don't be afraid to get political, actually get very political. As long as we keep pretending others have Service's best interest at heart we will continue suffer these tragedies. We know, with a few noble exceptions, our 'leaders' are not up to the job. Lets be bloody minded, lets be pernickety, lets strike for the sake of small things. Remember small things all add up. It is not acceptable to keep quiet, not rock the boat or believe passivity is a virtue.

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  • tinkerbell

    Anonymous | 7-Feb-2013 8:07 pm

    Exactly. If something is wrong and not allowing you to act in your patients best interests now more than any other time we have a been given 'permission' if you like to speak up. Use that permission if permission is what you need.

    Use your own mind to make that decision and then take action and stand your ground. If you don't stand for something then you will fall for anything.

    Don't get into the position where someone can say to you 'i'm trying to build an idiot, can i borrow your mind?

    No more exuses to go along with the system for a quiet life.

    Be true to yourselves.

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  • I watched this week's programme about the Stafford hospital and I felt very saddened, almost as if it had happened to a family member of mine. However, the root of the problem is the culture of putting money above people, of poor management. This filtered down to become a cultural norm on the "floor". The programme showed a woman who had been dropped after being lifted by a lone HCA. This is appalling in itself but the question wasn't asked "why was the HCA lifting alone?" IF it was asked the answer I am sure would be "because there was no-one else to help me". Nurses have little power to change things from the bottom. Systemic failings start at the top and work down. A recent study shows that there is a direct correlation between the number of qualified nurses and the outcome of patient care. Nurse have always known this but no-one listens to us. Mr Cameron start listening to the people who deliver patient care, implement what they are telling they need to deliver effective patient care, and it's highly unlikely that you will experience a repeat of this appalling tragedy. There is no price on patient care, scrap the business model and implement the NURSING model.

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  • Sad that everyone blames the nurses while everybody knows the truth. It is kind of funny when all the politicians , directors, doctors and managers points their fingers at the poor nurses for all the problems. Hope they wont tell nurses have to arrange funding to take adequate staff and resources next.

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  • Nurses take the flack here - sometimes we were at fault - but those who left us to function in that mess and refused to acknowledge or put right this dreadful mess are even more responsible. I hope the public gets to see the faces of the senior management who did nothing to stop this from happening. They should be prepared to answer some very searching questions in public and see what kind of reception that brings.

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  • I think there has been too much politicization of the
    NHS. I think in part this has been responsible for quite a lot failure in standards in hospital care across the board. The original post war N.H.S of the 'old Labour Party seemed to have a much more humanitarian vision for the health of people in this country and I'm sorry that there has been such an abject betrayal of this at mid staffs. Nursing is representative of humanitarian principles and should be pretty well politically neutral when engaged with the profession its' disciplines and responsibilities to the public . Nursing is a strict discipline and the training can be tough but it is important to be motivated and like engaging with people of all ages and dispositions. Denial of poor standards of care, or making excuses for an inability to meet the basic needs of patients can never be excused ! I'm deeply saddened and ashamed .

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  • If this leads to more nurse bashing, by others and by nurses, then its not welcome. We'll end up with nurses leaving due to cuts, natural wastage, as well as from demoralization. It will make recruiting + retaining nurses for safe staffing levels practically impossible. A severe lack of Social Workers developed after Baby P's case, + nobody wanted to train to be a Social Worker. Numbers are slowly going back as people forget about all the negative press about social workers.

    If this finally gets nurses to fully advocate for their patients as well as improving overall conditions, then that's very welcome. Rather than moaning and generally getting nowhere, take personal responsibility + actions to help get things changed. If your union is rubbish, you have a choice; you can leave (why are you in one?), to join another or not be in one at all; or become a rep (to help improving yourself + others with your skills + passion); or remain doing nothing extra and leave it to others to sort out.
    To help change things for what we want, we have to do it ourselves otherwise we don't get a say as we're not there. If we miss out, don't hear or not aware, why's that? Others have + are taking the opportunity to make things better.

    This report has exposed that regardless of profession, grade or role, everybody has to stamp out abuse. The nurses, after years of training + experience, who did this aren't nurses, they're co-abusers.
    The cultures + attitudes of society, can be driven by government positively. But they're not taking their responsibilities and only in their jobs to line their own pockets.

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  • Nurses are amazing.
    I once fell over and hurt myself and who looked after me? Once the ambulance and the paramedics had got me to hospital the nurses looked after me and I am sooo greatful.

    When my children need injections, we have some wonderful patient, caring nurses who look after them.

    I am proud of you, I simply am.

    All over the country, thousands of nurrses are looking after patients 24 hours a day.

    Use the Francis Report as a weapon to confront all the politicians and all the NHS management.
    Nurses, This Is Your Time

    You finally need to speak up about your profession and where it is going.
    You finally need to tell the public what is going on.

    Yes, there was abuse at Mid-Staffs and there may be at other hospitals but if you do not speak out, it may get worse. There must have been some brilliant nurses and doctors there doing their very, very best.

    Me? I am proud of nursing. I can only help you by
    writing a play. You have to make the public think about what is happening. Nursing is a sophisticated, modern profession to be proud of. That's what I believe

    LOVE
    PDAVE ANGEL

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  • NurseInEastMids

    I have felt a bit as if I need to defend what I do for a living, of late... However I have also had far more people thank me and praise the 'service' my team has given them. I'd like to believe the vast majority of public see us as we are, hard working and often striving to make the best of an often bad situation.

    I do need to add that I beleive being short staffed and having loads of paper work is NEVER EVER a good enough excuse for poor nursing care :(

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  • I want you to go anywhere and say "I am proud to be a nurse" and see everybody's respect

    LOVE
    PDave ANGEL

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  • michael stone

    Kathryn wrote:

    'There are recommendations for the implementation of quality metrics and the need for evidence-based tools to establish appropriate minimum staff numbers and skill mix.

    Regulation and standardised training of healthcare assistants and a strengthening of the clinical role of ward managers are important steps. As is the formalisation of the nurses’ continuing professional development with an annual appraisal and portfolio to be signed by nurse and countersigned by their manager.'

    I can see lots of 'NHS formal-speak' in there:
    'quality metrics', 'regulation', 'formalisation', 'continuining professional development'.

    But Philip Collins wrote in The Times a few days ago:

    'For the most shocking revelation of the Francis report is in the written and oral evidence from patients and relatives. For years they had been telling the hospital that it was a disgrace. But the hospital management didn't count personal stories as real knowledge. They were treated with arrogance and disdain. Instead, managers preferred the carefully collected benchmarks and star ratings that came with the imprimatur of the Healthcare Commission. The hospital's chief executive dismissed its high level of mortality as a coding error.’

    What you need, to counter-balance the inevitable drift towards simply following 'processes', is to formalise a requirement that when patients and their relatives comment to front-line staff (good or bad comments) this feedback is somehow harvested and fed upwards towards senior management: not more meetings with patient groups, nor more surveys of patients, simply properly listening to what patients and relatives are telling staff, as they interact day-to-day.

    That is the only approach, which would strengthen the patient voice properly: it would also formalise nurses as the principal channel for this type of feedback, simply on 'nurses have most contact' grounds.

    By concentrating on 'defined formal procedures' you end up where Mike Nicholls recently pointe dout you reach, on the KF website:

    ‘I was a county councilor for 20 years and for much of that time I was responsible- for social care and health matters …….. One area that it is right to question is the modern trend for box ticking. One sometimes feels that there are people, who on being shown a new hospital wing will not believe in its existence, until they have seen the tick in the box’.'

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  • michael stone

    Anonymous | 8-Feb-2013 11:12 am

    Francis blamed almost every professional group he looked at, not just nurses.

    Jim Edwards has recently posted on the King's Fund 'site:

    'Every organisation seems to be reacting to this report by agreeing how terrible the situation at Stafford was and agreeing with all the recommendations except the ones which directly threaten their own organizations.'

    So nursing has got lessons to learn from this, but not in isolation from the lessons to be learnt about the behaviour of all of the other professionals - but if you ask me 'will nursing get 'beaten up' the most over this', then my gut instinct is to say 'quite possibly - nursing has to fight its corner about staffing ratios, managers hardly ever replying to concerns raised, 'whistleblowers' being harassed, etc.

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  • michael stone

    'Patients and nurses should unite in exposing dreadful care.' - from Tink's earlier post.

    I've said that before, Tink - nurses AND patients TOGETHER, seems to be the only way to introduce a 'bottom-up' element to counter this target-based top-down lunacy !

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  • I think a major problem with the RCN had been their reluctance to take strike action as "they did not want patients to suffer". Yet they were quite happy to stand by and watch patients suffer and die through staff shortages over many years. If the RCN was prepared to say "enough is enough" and called a strike, staffing levels would have been improved in months and these deaths prevented. Saying "you do not want patients to suffer" and lack of action, actually means that in fact patients will end up suffering and dying.

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  • hear hear to anon 11.2.13 6.10 pm. We need a union that actually sticks up for us not the govt. We need to strike to show patients that we are doing it for them! We need to reinstate the confidence that people used to have in the NHS.

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