Practice team blog
What makes people want to go into nursing?
Compassion? A wish to make a difference? A recent article in the Independent suggested something far less positive. The article reported on a study examining the effects of parents’ gender roles at home on their children’s aspirations, and proclaimed that the daughters of men who do their share of household chores are more likely to want to become doctors and accountants rather than nurses or teachers. It went on to equate careers in medicine and accountancy with ambition and, by implication, nursing and teaching with lack of ambition.
My first instinct was to lambast the researchers – who were they to decide that nursing (or teaching for that matter) was a career for the unambitious? They had obviously not bothered to look at the career opportunities open to nurses, or the influence the profession now wields.
But when I looked at the original study it didn’t mention specific careers, or use the word ‘ambition’ – that interpretation was all the journalist’s own work, and seemed to be based largely on earning potential. The study simply examined how parents’ roles in the home predict children’s aspirations. A key finding was that daughters of fathers in more egalitarian households express a greater interest in non-stereotypical roles, and the researchers concluded that a more balanced division of labour among parents might promote greater workplace equality in the future. Nothing about nursing, and nothing about ambition – lots about equality at home and at work.
I’ve come to expect some sections of the press to use nursing as shorthand for many insults, but what has The Independent got against two professions that contribute so much? Its attitude can be summarised as ‘why make a difference when you can make money?’ People who go into nursing are ambitious – they just don’t limit their ambition to whatever does most for their bank balance.
The policy message has been transmitted and understood. Delivery of care needs to shift from the hospital setting into the community. Where possible, it is best for patients to be cared for in their own home. Shorter stays in hospital, delivering what patients want, enhances recovery, reduces risk of hospital-acquired infection.
This all makes sense. If you were in charge of this policy what would your first step be? How is care delivered? By nurses of course. So you would increase not only the number of nurses delivering care in the community but also ensure that they had sufficient skills and training to give increasingly complex care. And to do that you would strengthen and reinforce the backbone of community nursing – district nurses. How hard is that? Well impossible apparently.
A major new survey has found that community nurse teams report they lack staff with the right skills and qualifications to deliver care needed by patients.
The Queen’s Nursing Institute survey of 1,035 community nurses found less than a third thought their teams were adequate for the work that they cover. And compared with five years ago, 36% said the proportion of qualified nurses on their team had fallen, 54% said it had stayed about the same, while just 10% said it had increased.
The number of district nurses has fallen by 44% between 1999 and 2012, down from 11,500 to 6,400. This decline has taken place as care has shifted into the community. This is so obviously going to impact negatively on the care that patients receive that it is hard to believe. But this is the reality. More community care – fewer community nurses. Action needs to be taken urgently to address what any thinking person can see is madness.
How many of us watched Jamie Oliver taking on school lunches and wished he’d do the same for hospitals?
We all know the important role nutrition plays in recovery, and if meals look or taste unappetising, of course our patients are going to either eat less or resort to other sources to satisfy their hunger. This could result in a slower recovery and more time in hospital. It’s not rocket science.
When I worked on an acute mental health ward, it was so frustrating to see patients ordering take aways every evening because they (often understandably, in my opinion) couldn’t stomach the food we were serving them. I’m sure I’m not the only nurse to look at the food trolley and wonder where the hospital managers’ priorities lie.
With budgets being cut, catering teams are having to do more with less, but opting for cheaper meals can often mean losing out on nutrition.
So is it possible to make a nutritious, appetising meal that suits the NHS budget?
NHS Scotland is on a mission to find out. Some of the pictures on this BBC News story are enough to turn your stomach, and it’s difficult to imagine eating these meals when you’re well, let alone when you’re already feeling rotten.
The NHS Good Food Challenge 2014 challenges chefs and catering teams to provide locally sourced meals for 100 people that meet nutritional guidelines. The winning menu is then going to be rolled out across the whole of NHS Scotland.
Granted, many hospitals provide meals for more than 10 times that many people on a daily basis, so the logistics of this mammoth task are questionable. But at least positive steps are being taken to provide consistent standards, something that can only benefit patients. Let’s hope this initiative finds more lasting success than similar ones in the past. [changed this because the NHS has had numerous initiatives before that were then quietly dropped]
What do you think of this “Masterchef-style” competition?
As part of my job I get out to conferences and meet nurses who have taken some time out to learn and network with others. I also spend too much time looking at Twitter, which gives the impression that everyone who works in the NHS spends most of their time at conferences.
So it was a stark reminder when a nurse recently told me that it cost her £700 to take her asthma diploma – and she had to do it in her own time.
For many nurses the opportunity to spend a couple of days at a conference is unlikely. Even getting an afternoon off to attend a link nurse session is a luxury and many do these roles in their own time. While dedication should be applauded, and as professionals perhaps it is accepted that some study is done in our own time, I wonder if the “good will” approach is sustainable.
Since the Francis Report there has been a considerable amount of rhetoric around education and staffing levels but very little in terms of tangible change. The results of our survey published a few weeks ago showed that nurses still feel undervalued overworked and underpaid.
The problem is that as trusts throw money at increasing nursing numbers and addressing training needs, demand on services continue to rise and we are just running to catch up.
Nursing numbers and training opportunities have been forced up the list of priorities in many trusts but the reality is they are often paid for at the expense of another part of the service because, let’s face it, there is no additional money.
So where does this leave my friend who is paying £700 for her asthma course?
To be honest, I’m not sure. It is possible to argue that training not only benefits the service you work in but is also part of personal professional development and the financial cost and time should be shared.
An interesting argument if salaries keep pace with inflation, but I am sure many of you have felt the pinch in the last few years.
So what is the alternative? I would be interested to hear.
If it feels like governments have been discussing the shift towards providing a greater proportion of healthcare outside of hospitals for years, that’s because they have.
When Labour came into power in 1997 it set out to give primary care a lead role in commissioning and providing services with Our Health, Our Care, Our Say. Nine years later it tried again with Transforming Community Services; like its predecessor, this initiative failed to achieve the government’s aims.
Fast forward to today and the latest government initiative, the Better Care Fund, is in trouble before it has even launched. The Cabinet Office has demanded more robust evidence on how the promised cost savings will be achieved.
I don’t underestimate the enormity of the task of shifting services out of hospitals – particularly if social care is also to be integrated, but it mustn’t be dropped because it’s too difficult.
We know hospital care is expensive, we know patients prefer to receive care at home where possible, and we know that the lines between health care and social care are often blurred. Properly integrated care provided wherever is most appropriate would be cost-effective and popular with patients and their families.
However, “cost-effective” doesn’t necessarily mean cheaper, particularly in the short term when new services need to be up and running before the old ones can be remodelled or dispensed with. And it’s not just about where you put the money – expanded community services need more staff to run them. So why did the district nursing workforce shrink by 40% in a decade while successive governments talked about expanding community services? Surely these nurses will be crucial, however new services might be configured?
The revision process for the Better Care Fund should include an investigation into how to rebuild community nursing services. If care really does transfer into the community, unless they have the support of these highly skilled practitioners patients with long-term conditions will simply end up needing hospital care that no longer exists.
I must admit, when I first saw the headlines about the health atlas – a map showing which areas are most affected by certain illnesses and conditions – I was intrigued.
The map has been developed by researchers at Imperial College London to show an area’s health risks compared with an average for the rest of England and Wales.
So it shows how likely we are to develop certain conditions, right? Wrong.
The researchers state: “It is important to note that we are not making direct causal links between the mapped environmental agents and disease outcomes.”
Ok, fair enough: this isn’t a tool to predict my own personal health outcomes, but the statement “Relative Risk above average” certainly sounds like it.
I like to think I’m fairly calm about health scares – I’m not the type to read about an illness and declare I have every symptom – but I found this map strangely addictive. My “quick look” turned into an hour of me mentally clocking my likelihood of becoming unwell; thinking things like “good, so I’m not going to get skin cancer”– dangerous thinking for someone prone to sun burn at the best of times.
I can’t be the only person to read it in this way. I even wonder if, despite the reminders that the researchers are not making causal links, this will trigger hypochondria in some people and result in increased pressure on health services as the general public turn to them for reassurance.
Perhaps I’m being overly dramatic. Perhaps everyone who stumbles across it will see it merely as an interesting piece of research with no real relation to them. Then again, perhaps being overly dramatic is human nature.
One night you can manage but after a few nights short of sleep you feel jaded and don’t think and respond as well as you would like.
Sleep is important and even more so when you are ill. A recent study found that patients with heart failure who had a history of sleeping badly had a doubled risk of being admitted to hospital compared to those with a normal sleep pattern.
This Swedish study presented at the European Society of Cardiology meeting earlier this month concluded that we should be asking patients more about how they sleep as it is an important part of their recovery. Those identified as bad sleepers need to have the reasons explored and help with sleep hygiene including how they prepare to sleep. Otherwise poor sleeping may be linked to stress or worry or to medication, issues which can be addressed
As well as asking patients about their sleep history, nurses can help patients in hospital to sleep as well as they can with many small but effective measures. Making sure that wards are kept quiet, that staff talk and walk softly, that visitors to the ward are respectful of patients’ rest, and that patients are left to sleep in if they can and want to. Most people would not get up at 6am every morning so why would they want to do it in hospital? This study confirms that poor sleep hampers recovery. We all know the importance of sleep – let’s make sure we act on it.
After Mr Benn’s death was announced a few weeks ago I thought about that conversation and was struck by how my experience compared to so many others. Mr Benn had an amazing ability to listen, ask relevant questions and appear genuinely interested in my answers. When he got off the train I realised that he had said very little about himself and why he was on a train to Leicester but he had found out a lot about me.
This experience brings me to the NHS. I talk to a lot of nurses about their working lives and what I hear from them is that no one really listens to what they have to say. Many describe the board visit to the ward, the chief exec doing a walk round or staff meetings with managers as frustrating interaction. Staff are left with a feeling that people are going through the motions of appearing to be interested when they are in fact rushing to be elsewhere.
The only way managers can really know what is happening to patients is to talk to them but also to those who care for them. Engagement with clinical staff has to be more than popping in for a quick chat or rolling your sleeves up for the odd shift. It has to be continuous cycle of mindful listening and feedback. Until this happens staffing will continue to feel “done to”.
Tony Benn made a huge impact with his life and I wonder if part of this was due to his ability to listen and absorb information which he was able to assimilate and reflect back to his audience. I am sure that NHS managers could make good use of his listening skills to make proper use of the information that the staff on the frontline are feeding to them.
News that heavy drinkers are to be considered for liver transplants led to a predictable flurry of comments on national press websites. Many were along the lines of “it’s a waste of a liver”, “why should I fund surgery that just lets them carry on drinking”, or “the NHS shouldn’t offer this to people who have brought it on themselves”.
The less responsible media (yes you, Daily Mail) didn’t bother to mention that the NHS Blood and Transplant pilot scheme will involve only 20 patients and is designed to assess the benefits or otherwise of offering transplants to people with severe alcohol-associated hepatitis in some fairly tightly defined circumstances. But then, the image of hordes of rampaging drunks storming transplant centres across the UK and stealing livers from “deserving” recipients will attract more comments and clicks.
There are some aspects of healthcare that will raise debates about whether finite NHS resources should be spent on them – and treatments for conditions related to alcohol, tobacco or drug use top the list. But if you start making judgements about whether people “deserve” treatments, where do you draw the line?
Did I deserve a knee operation to repair damage sustained while skiing? Should someone who falls and sustains a fracture while drunk pay for their own treatment? And what about IVF – should the NHS fund that? It’s not like there’s a shortage of babies is there?
In a world of infinite demand for healthcare and finite resources, decisions about who receives treatment involve hard choices and inevitable losers. But these decisions should be based on evidence of costs and benefit rather than moral judgement.
Not wanting to miss out on the excitement, I took my laptop to reception and based myself there to meet our shortlist.
It wasn’t difficult to spot who was there to present to our judges. They all wore a uniform nervous smile and immediately reached for a copy of Nursing Times on seeing the strategically placed pile in the waiting area.
Within about an hour I suddenly became incredibly grateful that as a member of the Nursing Times team I have no say over who wins. Although I didn’t sit in on the actual judging, if the enthusiasm coming through the waiting area was anything to go by, the judges were not going to have an easy decision.
As nerve-wracking as the judging process can be, not one of the students, mentors or teams I spoke to failed to say how grateful they were to be shortlisted.
Student nurses work so hard and make an important contribution to the healthcare team. When they go above and beyond and show immense promise this needs to be recognised.
I’m not saying we should give an award to every student nurse who has gone out of their way to make a difference to a patient or taken initiative to bring something new to their placement area. Being noticed for working hard gives student nurses the motivation they need to get through what is undoubtedly an incredibly tough course.
Our way of saying thank you to student nurses is to run Student Nursing Times Awards, how do you thank your students?
As we know nursing is a 24-hour job. Patients that need care require it just as much at two o’clock in the morning as they do at three in the afternoon. And they need it as much at weekends as they do during the week.
The requirements for the nursing profession to deliver are relentless with increasing numbers of older and frailer patients with many comorbidities. Healthcare is becoming more and more complex as is the technology required to deliver it.
It is the relentlessness that makes it difficult for nurses to be able to take time out for training. Possible as individuals. As teams, well near impossible. Well one hospital has solved this conundrum in a very innovative way.
Barts Health has invested in a project which allowed teams from 14 older people’s ward to each take a week away. One after the other the ward teams spent a week together looking at how they could improve their care and their communication with each other. Each team returned to work with a supported action plan.
So what happened to the patients? For a six- month period the trust employed a shadow team to replace the ward team that was away. The shadow team included a matron and qualified staff – many of whom have now taken jobs on the same wards at the end of the project.
Most ward teams can only dream of spending a lunchtime meeting together. This was an amazing opportunity for these teams – let’s hope it can be replicated elsewhere.
How difficult can it be to take a glass of water, put it to a patient’s lips and get them to drink?
Most readers of Nursing Times know just how difficult it can be. It may be because the thickened fluids are unpalatable, or the water is too hot or too cold; perhaps someone forgot to put sugar in the tea or added too much but the patient can’t tell you.
Encouraging patients to drink can be a battle of wills, with the nurse desperate to record some intake on a fluid chart and avoid the need for an IV with the patient just not feeling up to it. All the while, family members are anxiously flipping through the charts and wondering why their loved one’s fluid intake is so poor.
When things get difficult it is up to nurses to rise to the challenge and think about how they can do things differently. For example, the author of an article in this week’s issue looked at types of thickener used in the care homes where she worked. She highlighted the importance of getting the right product and using it correctly to improve not only the texture and appearance of fluids but also patient safety.
Another nurse, Naomi Campbell who is hydration lead at Peninsula Community Health, has developed the “micro-straw”, a device that allows patients to independently sip fluids with minimal effort, in order to reduce reliance on nursing staff. She has received £15,000 from NHS Innovations Southwest to develop her idea.
We can’t all invent a new device but every nurse can do something to improve fluid and nutrition intake.
This is International Nutrition and Hydration Week and at Nursing Times we have organised a number of key activities throughout the week to help you to improve your practice, including free access to clinical articles, an ask-the-expert webchat, and on Wednesday you can complete our Nutrition Screening learning unit free of charge. To find out more, visit www.nursingtimes.net/nutrition
Full list of events on NT:
Monday 17 March:
We reveal this week’s free articles on the Nutrition and Hydration clinical zone.
Tuesday 18 March:
Throughout the day we will be tweeting facts and useful links, follow @NursingTimes to take part.
1pm: Ask the Expert Webchat – we’re joined by experts from the National Nurses Nutrition Group who will be answering your questions live on our webchat page. If you can’t join us at this time, you can email your questions to Eileen.firstname.lastname@example.org and we will ask them for you. A transcript will be available following the chat.
Wednesday 19 March:
Our Nutrition Screening learning unit will be FREE for 24 hours.
Thursday 20 March:
Pledge Day – tell us what you could do differently to improve nutrition and hydration in your area. Our favourite will win a nursing textbook from Sage Publishing.
Join in through twitter or on the Nutrition and Hydration page.
Friday 21 March:
Free CPD – These two learning units will be FREE to complete throughout the day:
- Dysphagia unit
- Obesity – an introduction to management in adults
Last week’s announcement that an apprenticeship route into nursing is to be developed has caused quite a stir.
Despite vociferous opposition from the “too posh to wash” brigade – who maintain nurses do little that requires the ability to think, this year nursing finally becomes an all-graduate-entry profession. And the benefits of having a highly educated nursing workforce have been confirmed by the authors of a huge Europe-wide study, who conclude that all-graduate nurses could reduce preventable deaths. It seems unfortunate timing, therefore, to announce a scheme whereby “the brightest and best” healthcare assistants can skip the requirement to go to university yet still gain a nursing degree.
Although we don’t have all the details yet, it’s difficult to see how it will be anything other than a “degree-lite” if there is no requirement to attend university. It’s also difficult to see how a 50:50 split between theory and practice can be achieved, or how NMC-approved education providers can deliver the apprenticeship – unless non-university institutions are to be approved.
I can see the logic behind a scheme supporting the brightest HCAs to become qualified nurses, but if the current system of access courses doesn’t work, surely that should be improved? We need to enable those capable of gaining a degree to do so, but this must not involve anything that devalues – or even just appears to devalue – existing nursing degree courses. Universities won’t attract the brightest and best prospective students onto nursing degree courses that are perceived to be equal to apprenticeships.
However, while the academic integrity of the nursing degree must be protected, all-graduate entry has widened the gap between HCAs and nurses. It leaves a huge group of HCAs who are capable of providing high-quality, compassionate care but who don’t have the academic capabilities to gain a degree with little opportunity to develop their careers and improve their incomes.
Some employers are addressing this issue by improving career pathways for HCAs. These HCAs are being trained to take on more responsibilities specific to their individual roles and capabilities, and employed at band 4; their role could be compared to that of the old enrolled nurse.
Surely it makes more sense to improve career opportunities for HCAs than to risk devaluing the nursing degrees the profession has spent decades fighting for?
I spent a day last week experiencing the adult student nurse programme at City University in London. The student nurses on that programme will be spending time on placement on the same wards that I trained on 35 years ago. Without a doubt I know who is getting a better deal – the patients now.
There is a myth that some hold that it was good to have trained as a nurse before Project 2000 which actually took place in 1986 not at the turn of the century. That it was better to have trained when you were based at a hospital, when after only 12 weeks of preliminary training school you went straight to work on the wards, not supernumerary but on the rota. And before long you found yourself as a second year in charge on nights.
And the often-touted belief that in those good old days you really learnt to nurse not like now when it’s all theory and no practice.Well on my visit it was very clear to me how well supported student nurses are today. And how better prepared they are to look after a patient then we ever were.
“it was very clear to me how well supported student nurses are today”
Their course includes experiencing patient care in a simulation lab where there is time to practice, reflect and think about how best to care. The lectures were interactive and stimulating and include the use of patient stories told by real patients. They will be many months into their training as a nurse before they are expected to look after a patient and their supernumerary status allows them time to grow and develop their skills.
So if I was a patient now and had to choose between being nursed by me as a student as I was 35 years ago or by one of the students prepared by the programme I witnessed last week. Well as a patient it’s an easy choice. And as a student nurse it’s the same answer.
If I could have my time again I would love to follow one of the programmes offered now.
Last week ITV aired the first of its new series looking into the lives of student nurses. The producers say ‘Student Nurses: Bedpans and Bandages’ will offer “insight into what it takes to become a nurse in the 21st century”.
What a huge responsibility for the group of student nurses featured, not to mention their tutors and the teams they’re working with. They’ve been given a unique opportunity to challenge the negative stereotypes about nursing and nurse training that have emerged in recent years, and I hope the producers allow them to do this.
When we asked student nurses on Twitter back in August what they would like to see included in a documentary about their training, the overwhelming response was that they wanted people to realise and appreciate just how much work they do and the role they play as members of the multidisciplinary team. Many voiced that they feel the general public think nursing is an easy degree, requiring little academic input.
The title “Bedpans and Bandages” does little to challenge this stereotype. Although, arguably, calling it “Coursework and Exams” would do even less for the cause as no one would watch it.
My worry was that the programme would be edited for entertainment, and feature a set of larger-than-life characters whose lives appear to alternate between embarrassing moments and heartbreaking scenarios that cause them to question themselves and grow as a person in the 10 minutes they are being filmed.
The first programme, however, felt accurate. Yes, there was motivating music, tears and spilt urine samples. But it also showed the levels of responsibility students are exposed to, it showed their need to be personable and the high levels of intelligence and initiative that are essential to becoming a nurse.
It featured an incredibly likeable student nurse sat at a desk voicing her surprise about how much work the course entailed, accompanied by close-ups of her crowded timetable. Nurses were shown leading healthcare, making quick decisions and challenging anyone who dares suggest the profession lacks compassion.
Have you been watching? What do you think?
I was shocked last week by the RCN’s decision to remove indemnity insurance from most nurses.
The RCN described this as a “small” change.
While it may seem a small change to the college I am sure many nurses will be astounded to hear that they will no longer benefit from this cover.
I joined the RCN in 1981 as a student nurse. The three main unions at the time RCN, COHSE and NUPE were eager to attract our membership and our fees. But the main attraction of the RCN was the offer of indemnity insurance. After all what would you do if someone sued you?
Even when I became aware that vicarious liability meant my employer would cover me in most circumstances I held onto my membership. In the back of my mind was an insecurity that if it indemnity insurance was offered by the RCN as a membership benefit then it must be important. Perhaps that just demonstrated my naivety, but throughout my clinical career I maintained my membership because it offered me this reassurance.
From 1 July 2014, work undertaken by RCN members who are employed – for example by the health service or an independent healthcare provider – will be excluded from the indemnity scheme’s coverage. Self-employed members will remain covered, but aesthetic practice will also be excluded from because of the high claims risk associated with this area of practice.
I appreciate the RCN needs to tidy up its policies and finances and has concerns that some employers were passing on claims relating to its members to the college, but it has failed to explain why it offered a benefit that was actually of no benefit to most members in the first place.
It seems to me that buying into union membership is a bit like choosing an energy supplier. You have to look at carefully at all the benefits before typing in your bank details.
If you want to know more about vicarious liability click here.
A year on from publication of the Francis report, The Nuffield Trust has published a report on how NHS trusts have responded to Francis’ shocking findings and wide-ranging recommendations. So how much progress has been made?
Well, it’s something of a mixed bag, but Rome wasn’t built in a day. On the plus side, four in five of trusts responding to the Nuffield study said they were taking new action in response to the report, while hospital leaders said they gave greater priority to patient safety and care, and the organisational culture that drives quality.
The report also reveals that nursing is receiving a significant degree of attention, particularly over staffing levels, the role of ward managers, and ensuring fundamental standards of care. Trusts are also working to improve staff engagement and the way they handle complaints.
Less encouragingly, trusts reported that inspections by external regulatory bodies could be better coordinated to make data collection less onerous, and that there remains a profound tension between the competing priorities of care quality and financial performance.
But perhaps the report’s most worrying finding is that many staff still don’t feel confident about raising concerns, despite trusts working hard to create open and transparent cultures, and reviewing their whistleblowing policies.
Culture change takes time to embed, particularly in large organisations. So it’s hardly surprising if staff, having seen the appalling treatment meted out to many whistleblowers in recent years, aren’t immediately won over by these efforts. That’s one of the reasons we set up our Speak Out Safely campaign – it enables trusts to make a very public commitment to protecting staff who raise concerns, and gives staff a set of principles to hold their employers to.
Signing up to NT SOS is simple, and it sends a powerful message to staff, patients and families that the organisation wants to learn from mistakes rather than cover them up. However, to date, only 76 trusts in England have signed up. What kind of message does that send to staff in the rest of the NHS who may want to raise a concern?
- If your trust hasn’t signed up to NT SOS yet, you can download a letter inviting your CEO to consider it
During the hours when most of us are asleep, in hospitals and care homes across the country, night nurses are striving to ensure the care and recovery of patients.
Nursing at night carries significant responsibilities and challenges that often go unrecognised. Nurses are caring for the same number of patients as during the day but with far fewer staff and with much less infrastructure and back up.
They are responsible for their patients when the ward is not bustling with the multidisciplinary team. In the past when hospitals hung onto less acute patients, there were some wards where working as a night nurse meant looking after a ward of sleeping patients. Times have changed and night nursing is rarely such an easy option.
As well as the challenge of the work there is the challenge on the body. A wealth of research shows the physiological toll of working when your body thinks it should be sleeping. And of course there are the social difficulties – trying to maintain a normal social and home life when your hours are so out of kilter with many others in your life.
It’s great to see that George Eliot Hospital Trust is investing £400,000 to increase the number of night nurses. It is heartening that there is currently a focus on staffing levels but I hope this will also include considering whether there are enough nurses at night. It is all too easy to pull the curtains and turn out the light on what is happening on the wards at night as most managers are not there themselves.
Part of this is to recognise the both different and difficult job that nurses do at night. And of course primarily because for the patients the experience of being in hospital is 24 hours.
When reading about the background to the upcoming NICE guideline on medication use in residential homes (due March 2014), I was surprised to find that, despite the fact that the majority are not licensed for use in people with dementia, this is a widespread practice.
Risperidone, which is commonly used to control some distressing behavioural and psychological symptoms of dementia, is licensed only in specific circumstances and only for up to six weeks.
A review in 2009 found that around 180,000 people with dementia in the UK alone are prescribed antipsychotic medication, and it is suggested that two-thirds of these are prescribed them inappropriately.
Having nursed patients taking anti-psychotic medication, I am only too aware of the serious and life-changing impact extrapyramidal side-effects can have on those taking them. These risk of these side-effects increase with age. In addition, there is an associated risk of cardiac arrest and stroke.
At times, antipsychotics may be helpful to a person with dementia in the short-term. But it appears they are often used as a first-line response to some of the more difficult to manage symptoms of dementia. This raises the question as to whether they are prescribed to help the person with dementia, or to help those caring for them.
Changes clearly need to be made. Agitation and aggression may be caused by an underlying health problem that the person is unable to communicate, or this may be how the person is expressing their fear and confusion. One-on-one time with a person who is clearly distressed can help to alleviate these symptoms, but this is only possible if staff or family members are available.
None of this is new. The National Dementia and Antipsychotic Prescribing Audit has been gathering this information since 2009. It therefore stands to reason that the NICE guideline will reflect five years of careful consideration.
What do you hope to see included?
It is nearly a year on from the Francis report and the launch of our Speak Out Safely campaign to ensure staff will be supported when they raise concerns about care. It was disappointing, therefore, to read the recent CQC inspection of Barts Health Trust.
The inspectors found that “that staff morale was low. Too many members of staff of all levels and across all sites came to us to express their concerns about being bullied, and many only agreed to speak to us in confidence”.
One of the most telling findings was the disconnect between board and ward. While the leadership team was described as well-established and cohesive, the CQC found that it needed to be far more visible across all parts of the trust.
I suspect the temptation for any trust faced with a report like this is to look for quick fix that can be rolled out quickly, but as we all know, this usually results in nothing more than cosmetic change with no lasting impact.
Last week I went to the launch of a report “Staff Care. How to engage staff in the NHS and why it matters” by the Point of Care Foundation, which aims to improve patients’ experience of care and increase support of staff who work with them.
The report is a great read. At only 16 pages – and free of jargon – it has a clear message that caring for people who work in healthcare is the key to developing a caring and compassionate health service.
It is a rare report that really gets to the point of what staff engagement means. It acknowledges that engagement should not rely solely on annual staff surveys and meetings and is more than measures of job satisfaction and commitment.
The authors of the report suggest that:
- Staff should have well-structured appraisals, ongoing training and career development;
- Line managers should have people management skills;
- Teams should be well defined and regularly review how they are doing;
- Staff should have space to reflect on patient care challenges;
- There should be coherent goals for quality and safety from board to ward;
- Staff feedback should be acted on and staff empowered to make improvements;
- Values should be articulated and how these translate into behaviour be made clear.
I’d urge you to have a look at this report. It has some important messages for managers at all levels of the NHS and it is crucial that the momentum created by the Francis report is maintained in 2014.
One year on from the Francis report I wonder what difference it has made to nurses working with patients and what its legacy will be. We are still at a turn point but for real and lasting change to happen organisations have understand that while patients matter most, staff matter too.
As Jocelyn Cornwell, director of the Point of Care Foundation says “We’d like the NHS to be notable for being not just the largest employer in the country but also the best”.
We are inviting all NHS organisations, other healthcare providers and universities offering nursing programmes to publicly commit to supporting staff who raise genuine concerns about care by signing up to Speak Out Safely, and over 60 have already done so. If your trust hasn’t already signed up, you can download a letter to your chief executive asking that it does so.