Practice team blog
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.
Only a couple of decades ago you could, in theory, qualify as a nurse and spend 40 years in the profession without undertaking any form of study or updating. And while examples of nurses who did that may be few and far between I’m long enough in the tooth to remember the introduction of PREP in the 1990s, and I know a few did exist.
“I’ve been nursing for over 30 years and never needed to do any more studying, so I don’t see why I should start now,” one nurse told me furiously when I visited her hospital to canvass opinions on what kind of support nurses might need in fulfilling their forthcoming PREP requirements. She then proceeded to give full vent to her feelings about “reflective claptrap” and “clever-clever nurses” who “went on” about this article or that new technique. That nurse was an extreme example, but at the time mandatory CPD did seem pretty radical.
It’s no secret that PREP hasn’t been fit for purpose for some time. Early promises to audit individual professional portfolios fell by the wayside, and currently there is no system of checking NMC registrants have fulfilled their CPD or practice requirements. But that’s set to change, and you have a chance to influence what comes next.
The NMC has initiated a six-month consultation on revalidation, and is inviting all interested parties to give their views via an online survey. Anyone can give their views, and whether or not nurses and midwives take part in the consultation you can bet your bottom dollar that many of your most strident critics will.
It will be impossible to come up with a revalidation system that pleases all of the people all of the time. However, we can only hope the NMC do better than the General Medical Council appears to have done, according to a survey by Doctors.net.uk and come up an effective system that takes account of the realities of day-to-day nursing and midwifery practice.
I can’t promise you that completing the survey will result in the perfect revalidation system, but if you don’t, you can’t complain if you don’t like what’s imposed.
New Year is traditionally a time when we evaluate our lives and make resolutions to change or improve things. To reflect on the past year and make a fresh start for the one coming.
One of the most common New Year resolutions is to quit smoking. And it is one of the hardest to actually achieve, particularly without any support – pharmacological or psychological. Many people will be saying on New Year’s Eve that this is the last cigarette they will smoke but sadly for their health and that of their families for many that statement will not be true.
NICE has published new smoking cessation guidance for secondary care which we are featuring in our January 22 issue. The aim is to ensure that smokers are identified and offered support during their hospital visit or stay. And crucially that there is a join up with community services so that the support they need is available so they can follow through their resolution.
Take a look at the new guidance and see how well your hospital is doing to provide the right infrastructure. It is clear that staff need to be given training so that their one contact counts and that they know where to refer to for support.
I have a few friends and colleagues in mind who I am going to encourage to make this the year that they do really quit. And to that end I will suggest support they can access. With smoking being responsible for over 460,000 hospital admissions in England each year, interventions and support to stop smoking are crucial.
How many patients do you think you can get to quit this year?
Two weeks ago, the first of hopefully many schools of nursing signed up to Speak out Safely.
As the moderator of our weekly student twitter chats, I was thrilled to see the campaign finally making waves among higher education institutions. Although the vast majority of the student nurses we speak to on a regular basis have nothing but praise for their universities and placements, there’s always one or two who share with us their frustrations of raising concerns and not being listened to.
Those who regularly join our student nurse discussions strive for perfection in everything they do, but often remark that professionals they work with tell them this “won’t last” or that “they’ll learn what it’s really like”. Granted, they are likely to come up against budget constraints and short staffing once qualified, and probably before, but this idealised view of how healthcare should be makes them ideally placed to spot when things are wrong and patients are being put at risk.
But spotting a problem is not the same as doing something about it.
Although they tell us that they like to think they would raise concerns, students have many reasons not to. Top of the list is the fear that they won’t pass the placement. Rightly or wrongly, this fear gives mentors power over student nurses who may feel that if it came to their word against their mentor’s, that they would lose.
Another powerful reason to keep quiet is the worry that nothing will change. Speaking out about poor care takes guts and if a student felt that nothing could be gained from doing so then of course they will choose to keep their head down, get through the placement and vow never to apply for a job there.
By signing up to Speak out Safely, universities are sending a strong message to students, and potential students, that not only will their concerns be investigated but that they will support and believe them. When you’re saying things you know will make you unpopular, having someone on your side is invaluable.
We are asking universities to make it their new year resolution to sign up and display the SOS logo and pledge on their publicly available school of nursing webpage. Students should be safe to raise concerns and encouraged to play an active role in improving the health service.
Thank you to Oxford Brookes - Faculty of Health and Life Sciences for being the first school of nursing to sign up.
This Christmas a close friend of mine will be dividing her time between her family and caring for her mother with dementia.
Her mother, Eve, has had dementia for several years with a slow but continuous decline. She now lives with her daughter and four grandchildren and Julia is her main carer.
Eve no longer recognised her daughter and appears to has no idea who are grandchildren are. This regularly leads to stress and upset in the family. She does remember her husband and spends most of her time trying to find him. Days in their home can be happy and sometimes they are fraught with anxiety when Eve can’t find “her young man”.
My friend struggles to cope as she wants to care for her mother but the impact on her family life is immense. The children have had to adapt and become more resourceful and independent as their mother is increasingly housebound in her caring role. She has fought and pestered for the small amount of help she receives and has learnt how to care for her mother with very little support from health and social services.
This month the G8 called for more research into finding a cure for dementia. This is a major step forward for those of us who will have dementia in 15 or 20 years but for my friend and her mother any hope of a cure will come too late.
So what do I wish for Christmas?
I want Julia to be able to care for her mother and also give her children the time she needs. I want people like her to receive accurate and clear information about how to look after their relative with dementia and to know that there is someone who they can ask for help and advice. I want her and others to be able to take an hour or two off from their caring role confident that their relative is safe.
While we strive for a cure for dementia we must not forget the people who have the condition now. Perhaps it is impossible to expect health and social services to provide comprehensive support for carers, but if they don’t do it who will?
*Names have been changed to protect confidentiality
There were some great speakers at the Chief Nursing Officer’s Summit a couple of weeks ago, and delegates left with plenty of food for thought, advice on how to tackle NHS priorities, and new networks of mutual support developed over the two days. Even in the best conferences, often the most valuable aspect for delegates is the opportunity to meet peers, share experiences and ideas and mull over the latest challenges.
One of the sessions at the summit involved a panel that included Professor Steve Field, former Chairman of the Royal College of General Practitioners and Chairman of the Department of Health’s National Inclusion Health Board. He has spent much of the last year visiting GP practices, and said one of his major concerns was professional development for practice nurses.
Prof Field said many practice nurses find it difficult to access CPD – the worst case he came across was a nurse who had received no training or education in over 20 years. Of course, like all practitioners on the NMC register, practice nurses are required to keep up to date, and we must hope that the nurse Prof Field mentioned had undertaken some independent study. But surely the GPs employing the nurse should be expected to fund some training?
The role of the practice nurse today would be unrecognisable to one practising 20 years ago. These nurses now shoulder a huge amount of responsibility, and most of the new tasks they have taken on have increased practice incomes. Aren’t they worthy of investment? And more to the point, don’t patients deserve well-trained practice nurses?
The problem for these nurses is that they are all employed by small businesses. Some of these recognise their nurses’ value and ensure they are supported in developing their careers. Unfortunately, others simply pile on the responsibilities and either expect their nurses to organise and fund their own training or don’t even bother to ensure they are undertaking any.
Working in small organisations can be isolating, with few or no peers for mutual support, while many practices have rigid hierarchies that make it difficult for nurses to assert themselves. After all, their line manager is also likely to be their employer.
As more care is moved out of the acute sector it becomes increasingly urgent to ensure that practice nurses receive appropriate training and education. Like delegates at the CNO summit, they would also find opportunities to meet their peers invaluable. Clinical commissioning groups need to take this issue seriously, and require all GP practices to offer their nurses access to professional development and peer support. These nurses have enabled their practices to transform and profitability to expand. It’s time they were given the recognition and investment they deserve.
Nurses are in the best position to observe if a patient has a reaction or a suspected reaction to a medicine they are taking. The good news is that more and more nurses are filling out Yellow Cards – more than hospital doctors but not as many as GPs.
The Yellow Card Scheme helps to protect public health by monitoring the safety profile of all medicines in the UK. Continual analysis of these reports and other adverse reaction data helps detect any previously unidentified problems with a medicine.
To help encourage even more nurses to fill in Yellow Cards, Nursing Times Learning has been working with the Medicines and Healthcare products Regulatory Agency to launch a free learning unit on the scheme.
Nurses sometimes feel that they have to be sure the patient has had an adverse drug reaction before they fill in a Yellow Card. But as our learning unit emphasises, it is enough to suspect an adverse reaction to fill in a card. Each card contributes to a body of knowledge.
The learning unit will count for two hours of continuous professional development and supports nurses to know how and when to report side effects of medications – an essential element of patient safety.
If you can’t remember the last time you filled in a Yellow Card or would like an update on how the scheme works please go to our free online learning unit.
Online learning is an accessible and convenient way for nurses to keep up to date and improve their practice. A recent survey of Nursing Times Learning found that 92% of users said it was an effective learning tool with 86% saying they would make significant changes to their practice as a result of studying a unit.
When the announcement came that the three acute mental health wards in the unit I worked were to become single-sex, there was uproar.
As is too often the case, it felt as if this change was being forced upon us with no discussion either with us, or our patients. We all debated the pros and cons but ultimately, because of the way the change was handled, the majority of staff were against it.
In hindsight, I can see strong rationale for single-sex wards. But rather than explaining this rationale to the frontline staff who were managing the change, we were simply told that it was necessary and to “pick a gender” we wanted to work with.
Reading this week’s practice article, The effect of single-sex wards in mental health, reminded me of how disruptive ward changes can be, to both staff and patients. But it also reminded me of the long-term gains of providing single-sex accommodation.
I can identify with many of the concerns raised during the ward move described in the article – particularly male staff worried about female patients making false accusations, and concerns that single-sex wards are not “reflective of real life”. Similar concerns were raised during the ward move I was involved in but, in the end, the anxiety surrounding the change was misplaced.
I stayed on the same ward, which became all-male. Patients were moved over one weekend and the ward staff who happened to be on duty were left to manage the logistics. After the initial upheaval, a calm descended over the ward, quickly followed by a feeling that very little had changed.
Perhaps the incident reports tell a different story, but while we were braced for increased levels of testosterone leading to more aggression, we found the opposite to be true. We had the same number of patients and the same variety of presentations. Gender seemed to have very little to do with the ward environment.
Speaking to my former colleagues now, there is a general consensus that the move was a good thing. But a bitterness remains over the timing and manner of its implementation. Although the change needed to be made, ward staff were not given opportunity to voice their concerns or to ask questions about the rationale. This led to frontline staff escalating concerns among themselves and worries being magnified.
Have you been involved in a change you feel was badly handled?