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Sarah Kendal: 'Media attacks on nurses are unfair'

The idea that university education erodes the compassion out of student nurses is ludicrous, argues Sarah Kendal

Apparently, nurses lack compassion. To address the problem, the chief nursing officer (CNO), has launched Compassion in Practice, a strategy to restore the nursing values of compassion, care, competence, communication, courage and commitment. She has been present in the media, tactfully responding to journalists who tell her that the root of the problem is nurses having a university education. She has rightly argued that while compassion is the current issue, nurses need real depth of knowledge to deliver care in a complex, rapidly changing environment.

Is it so shocking that a nurse should go to university?

 

“The everyday lunacies facing NHS staff can be like a surreal comedy”

I have always thought it a strange idea that university education might stop someone from being kind. In her blog, “Nurses need compassion, not a degree”, journalist Christina Odone scoffs at a previous CNO initiative focusing on nurses’ confidence. Odone argues:

“Who needs a ‘confident practitioner’ when they’re lying immobile on a hospital bed, dying (literally) of thirst because “a confident practitioner” is ignoring their calls for water? Who needs a “confident practitioner” when they’re soaked in their own urine because their pleas for fresh linen have gone unanswered?”

Of course, we need compassionate nurses. But haranguing the profession is hardly the answer. We know enough about human behaviour to understand that being supportive to a person helps them to be supportive to others. Kindness breeds kindness. And constant criticism is unlikely to generate compassion.

It is hard to deliver the high standards of care that a patient deserves, if resources of time, skill, equipment, opportunity, energy and so on are lacking. The everyday lunacies facing NHS staff can be like a surreal comedy. Purchasing decisions are made by people who do not understand what they are buying; space is organised by people who do not know how many patients will need to sit down at one time; expensive equipment is delivered to the wrong department, or abandoned in a holding area because no one knows it has arrived. Such situations are rarely created by clinical nurses and these nurses usually have very little influence over them.

Shorter inpatient stays mean constant admission and discharge, with few patients on a ward who are not acutely ill. Overcrowding and rapid throughput increases the risk of infection. Low morale contributes to sickness and staffing problems. Relying on agency nurses puts a greater onus on the permanent staff who are assigned to each shift. With regard to providing emotional comfort to patients, work is often organised so that the few qualified staff do the work that only they can do, and other work, such as personal care, falls to other staff (who are also under pressure).

How then can poor care be attributed to university education?

The idea that university education erodes the compassion out of student nurses is ludicrous. Across the UK, nursing curricula are designed, written, approved and studied by people who are passionate about the nursing values outlined in the CNO’s strategy.

Blaming nurses is easy, but unfair. What we do need to attend to is the context that nurses work in. Responsibility for this sits with the lines of management that can be traced from ward managers to the cabinet office. In a way, nurses are carrying a message about contemporary health politics. Please don’t shoot the messengers.   

Sarah Kendal is lecturer in School of Nursing, Midwifery and Social Work, University of Manchester

Readers' comments (67)

  • please let's not have another debate about degre vs degree nurses. not another 'too posh to wash' argument surely - mind you it did result in some very amusing ditties.

    the problem many people have is that nursing is difficult to get into now, that is why we don't agree it should be a degree course, there are many people without academic qualifications that would make great nurses.

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  • The current crisis, if that is what we are calling it, has absolutely nothing to do with the level of education of our nurses.

    It has everything to do with the culture within which we work.

    Compassion and culture are the responsibility of everyone within an organisation and ultimately, the buck stops at the top.

    We need to stop the bullying behaviour that filters down from the DH to Trusts via the various channels and from there to Matrons and ward managers.

    We need to be unafraid of knocking the negative stories straight on the head, if care was as bad as some of the media stories made out at the level they make it out to be, then hardly anyone would emerge from any kind of treatment or hospital stay unharmed.

    The reality is, far more people get good care but we chose not to highlight this but instead allow the negative stories to become the whole story.

    Of course, when things go wrong we need to do something about it, but the problem is no-one wants to pay for the solution, which is more people to deliver safe and quality care.

    Keep on cutting posts and demoralising nurses (and others) by downgrading posts will only make it worse. As the author rightly says, people who know they are valued are more likely to be able to then value others. It's not rocket science, its basic human need.

    Forget the superflous arguements, the real campaign needs to highlight the impact of cuts on quality of care and hold those to account who are not listening, not the nurses who are trying really hard but quite understandably, sometimes don't quite pull it off.

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  • michael stone

    'The everyday lunacies facing NHS staff can be like a surreal comedy.'

    I was confronted by 'lunacy', albeit probably far from 'everyday', when my mother died - it afflicts patients and relatives, as well as NHS staff.

    But ignoring The Mail (my usual policy), there are so many angered relatives (often bereaved) 'out there', that something must be triggering that anger on a fairly significant scale.

    I know that a lot of problems are down to too few staff, and obviously annoyed people make more noise than the more-satisfied ones: also, blaming nurses for things outside of their control isn't the solution, but sweeping the problem under the carpet by downplaying its prevalence won't help in its elimination, will it ?

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  • yes realy, Nurse should strive for thier profession.

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  • Hi.
    After 22 years as a nurse I took on a degree course which I successfully completed 6 years ago.
    One thing education has taught me is that change is urgently needed in the NHS.
    It appears that a lot of old school staff
    are frightened of change, and as such do things as they have always done them, right or wrong. i.e. lack of modern education?????
    So in my opinion everyone in nursing should be compelled to take a certain amount of modern education, whether a degree or whatever.
    As for compassion, I obviously cannot speak for others, but I would not be in nursing if I lacked compassion.


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  • Many people enjoy good outcomes from the NHS equally some have to endure the most apalling standards of care.

    The most recent involves midwives who failed to recognise a probem , did not seek medical assistance resulting in the death of a baby.

    We all I hope remember the horrors of the Stafford debacle. There was the case invoving a young man with diabetes insipidus killed as a result of ignorance and neglect

    Iam sure anyone reading this can add to the list without difficulty.

    The ongoing debate about the LCP would appear to have its roots firmy planted in health care professionals arrogance and refusal to undertake essential communication

    All of these issues when combined with persistant reports of the "neglect" of older patients will, not surprisingly generate adverse media comment. Relatives will fear for the well being of their family members. They will be vigelent and critical of care which fails to meet expectations.

    The profession has got a problem which needs to be acknowledged.

    Much of the difficulty is associated with unrealistic work loads and the admission of elderly demented people to unsuitable wards which are not staffed to met the needs of this highly dependent group of patients.

    So as individuals what do you do about the probem? Do you always report inadequate staffing levels?

    Have you telephoned the CQC "whistle blowing" service to report the risk your patients are being exposed to?

    Do you demand assistance from your trade union or professional organization?

    Remember when it all goes wrong it is you who will be blamed. Senior managers (including Directors of Nursing and their office bound flunkies) will dodge criticism but you as a disposable RN will find yourself exposed and said to be in need of futher training!

    Wake up and take the initatve for your own well being and that of your patients.

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  • michael stone

    Jenny Jones | 21-Dec-2012 2:31 am

    Yes, I agree with your post. There seem to be endless problems generated by what you described as:

    'The ongoing debate about the LCP would appear to have its roots firmy planted in health care professionals arrogance and refusal to undertake essential communication'

    and as well as resourcing issues, there are singificant issues around decision making, and clinicians failing to adopt an 'us & us' attitude instead of a fairly common 'us & them' attitude - this is, of course, getting into the discussion about 'culture change'.

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  • It's the persistent negative criticisms by the media that encourages people to attack nurses. The constant barrage of negativity is one of the fastest ways of reducing morale + compassion in staff who work very hard, in challenging situations, with limited resources.
    If there's no higher training + education standards, we would accept whatever treatment is prescribed, not questioning if its right, wrong , uptodate, safe or effective. If asked 'what do you think?' the reply might be 'dunno, not enough knowledge to be useful, got basic training, but I can empathise, deliver care, tlc + show you compassion. Can't find more experienced / knowledgeable nurses to help as they've all quit, retired, off sick, mostly on day shifts, or the few about are already stretched. Doctors, also hard to find + already busy too, some knowing less than nurses, consultants are limited + practice other specialisms and most of them 'won't know you or your case'. Is there anything I can do, that I can competently + safely do to help while im here?'
    Imagine telling any other profession, eg physicians, surgeons, lawyers, teachers, pharmacists, physios, etc, that they don't need a degree level education, just more compassion in their work to people they're looking after. If anything we all need further + continuing development. Grade + academic levels inflation, from Gcses to post-doctorate level, has been happening for years, to make it tougher for applicants, + for employers 'to recruit the best'

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  • If much training is not required, can Cameron et al, chief execs + directors, refresh themselves by spending 2 weeks as an auxiliary delivering frontline care + compassion, and show us amateurs how's it done. Please practice what you preach.

    We don't get bonuses to wipe up poo, d+v, + mopped up pee off patients to prevent + reduce risks of infection, we do it as we do care, have compassion. But a fat-cat yearly bonuses would really help and might see a positive culture change.

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  • it is curious that nurses trying to do their jobs to the best of their ability with limited and often very poor quality resources have received so much negative and often venomous press whereas bankers, who have caused immeasurable scandals bringing the whole global economy to its knees, putting many of its citizens, often through no fault of their own, under equally immeasurable stress, with more scandals being revealed almost daily, carry on almost unscathed by the press.

    sorry in haste, poor grammar, but I think the sentiments are quite clear.

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  • Anonymous | 21-Dec-2012 1:56 pm

    Bankers got lots of criticism, but whether or not people 'emerge unscathed' seems to hinge on 'power issues': and goverments think banks have got more power than nurses, one suspects.

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  • tinkerbell

    sadly in the CAMPAIGN, cos that's what it was in my opinion, mostly promoted by the Daily Maul, to demonise ALL nurses, the good got thrown out with the bad. The baby got thrown out with the bathwater and all the good nursing that goes on was drowned too.

    This campaign was the build up to ensuring that when they got rid of a lot of nurses the propaganda machine was in full swing and the public had been turned against ALL nurses, not just the badduns.

    So we all got tarred with the same brush as uncaring and lacking in any compassion.

    Let's hand it to them, they done a good smear job on ALL of us.

    Obviously we now all deserve what we get.

    Sadly the kick back from this will be that there will be even less good nurses to provide any quality care, so we will be left in dire straights without any care or compassion as it is now all about money and getting things done as cheaply as possible surrounded by a lot of rhetoric. Very much like the Kings Clothes, everyone has now been fooled.

    Who's going to suffer, all of us ordinary folk who don't have a bulging bank balance or shares in the private sector or private health care insurance already in place.

    Want some timely medical intervention without the above, get to the back of the queue.

    It will get worse and worse between 2013/14 when the full horror of it all finally dawns on the nation, that they have been well and truly taken to the cleaners/shafted.

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  • Well said Rudolf/Tink

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  • Sadly the Telegraph is reporting on a Trust who has been abusing patints for a number of years. Here is the link

    http://www.telegraph.co.uk/health/heal-our-hospitals/9762987/Hospital-apologises-to-38-families-for-appalling-care-that-saw-a-patient-starve-to-death.html

    As I said previously nursing does have a problem and to deny the problem is disingenuous.

    Ask yourselves -- Are you 100% sure that your patients are recieving good care 24/7?

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  • My father's care in our local hospital 2 weeks ago.

    He is in his 80's, has dementia (quietly confused, not disruptive), but otherwise normally physically fit. Following a nasty cold, he developed a productive cough and spiked a high temperature. The GP visited and felt that hospital admission would be best. We arrived in A&E at around 11.30pm, my father was triaged by nurse, left in a draughty corridor outside the Acute Assessment Unit for an hour, before a nurse, who didn't even look at us, informed us that we wouldn't have to wait for much longer. Another hour later, we were brought into the unit. Long story short, we waited for 6 hours before my Dad saw a Doc, who diagnosed pneumonia and prescribed IV antibiotics. In total, no treatment, not even an anti-pyretic, was commenced until 8 hours after his arrival. I spoke to staff on several occasions about my concerns, but nothing was done. Dad was transferred to the AMU for almost 3 days before a bed was found for him elsewhere. By the time he arrived in a rehab ward, his U&Es showed he was dehydrated, he had lost weight, was unshaven and a urinary catheter had been inserted (then removed) for no reason. Two days later, he was sent home....with a high temperature. When we called out the GP again on the day of his discharge, we told her that we did not want my father being returned to hospital. He had been harmed enough.

    There is much more that I have left out. At every stage during his time in hospital we as his family, spoke to staff and raised concerns about my father's care. Chillingly, all but one of the staff we spoke to, seemed to be slightly puzzled at the reasons for our concerns. They simply weren't aware of his needs and didn't care.
    In a week, and in several different locations within the one hospital, my father was failed by predominantly the nursing staff looking after him.

    This profession has big problems and they are not all to do with staffing and resources. We need to stop blaming the media, start owning up to some difficult truths and take responsibility for fixing things. That means we need to fight whoever and whatever comes between our patients and their best interests.

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  • I have just been reading the readers comments on the Telegraph article.

    Many are calling for visable action to be taken.

    Many believe that nurses, doctors and "mangers" associated with the delivery of poor care should be sacked and prevented from undertakin any future "professionall" practice.

    I agree and would go further. I believe the Police should always be required to investigate these instances of abuse/neglect with a view toward charging involved individuals with criminal behavior.

    I am ashamed to admit that I am am an NHS nurse. Retirement cannot come to soon. Something is rotten at the core of the profession.




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  • Anonymous | 23-Dec-2012 1:56 am

    excellent comment but it should go further to expose all of the problems encountered and not only here for reflection but where it will really be heard at the top.

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  • Anonymous | 23-Dec-2012 7:23 am

    I should have mentioned that, since my father's discharge, I have now spoken by phone to the managers of all the areas where my father was treated to inform them of our concerns and ask questions. Also, we have lodged a formal and very detailed complaint to the NHS hospital trust.

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  • Anonymous | 23-Dec-2012 9:56 am

    from Anonymous | 23-Dec-2012 7:23 am

    I hope it is taken heed of and acted upon for the benefit of other and future patients and the education and training of staff. No patient should be subject to negligence or inadequate or unsafe treatment and care and it is very sad and inexcusable that your father was exposed to this.

    As for staff if it an organisational cultural problem as well as the fault of individuals immediate measures must be taken to remedy this so that staff are, and made to feel, valued and treated with respect for the skilled and competent individuals they should be. If they are not and repeatedly deliver poor practice (which includes communication skills in dealing with patients, colleagues and the public and whoever else they come into contact with professionally) there should be no place for them in the organisation.

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  • Anonymous | 23-Dec-2012 11:17 am
    from
    Anonymous | 23-Dec-2012 9:56 am

    I agree with you. I did ask the managers I spoke to about staffing levels in each area at the time of my father's hospital stay and was told that they were fully staffed. Of course, we all have a view on what constitutes adequate staffing levels and I may have had a different answer from staff on the frontline. However, many of the issues I have with my father's care were caused by failures in simple care and communication. There are no excuses for them. In the last ward he was admitted to, there were plenty of staff about, but they mostly hung around the nurses station, chatting amongst themselves, avoiding eye contact with patients and visitors. For many years, I was a frontline nurse and I know the challenges of a busy ward, but I have been stunned at the culture of casual neglect that existed for the duration of my father's admission.

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