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Practice team blog

When did you last fill out a Yellow Card?

9 December, 2013 Posted by: -

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.

Pick a gender

2 December, 2013 Posted by: -

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?

Comments (4)

Have you defined your personal privacy settings?

25 November, 2013 Posted by: -

Student Nursing Times has been having an interesting debate on how much information about themselves nurses should share.

Not too long ago this would have been restricted to discussing face-to-face contact, but social media have changed that. They have made personal lives public and made it easy to find anyone with a presence on the internet – particularly those who aren’t acquainted with the privacy settings of Facebook and the like. While the NMC has issued advice on the use of social media, its main focus is on professional issues.

But being social media savvy isn’t just about protecting patient confidentiality and avoiding public displays of unprofessional behaviour. It’s also about self-protection.

If you know their name it is easy to find and follow people on Twitter, or friend them on Facebook. And it doesn’t take much additional information to find more about them, such as where they live or socialise.

Nurses come into contact with many people going through difficult times, and as the professionals with the most patient contact, individual nurses can come to symbolise entire care episodes in people’s minds. It is almost inevitable that some – be they patients or their relatives and friends – will form attachments or fixations with nurses.

The vast majority of these will be harmless; some may be welcome, and may even become friendships that endure after the patient is discharged. However, even if we disregard the risk posed by a tiny minority who may have malign intentions, nurses need to be able to control how much access they allow to their private lives. If they don’t, they risk being overwhelmed by patients and visitors wanting to be their best friend.

Nursing demands a huge amount of emotional labour – you need to be able to comfort a newly bereaved family one minute and joke with a cheerful patient the next. And while you’re expected to provide compassionate care, you also need to be able to switch off when you leave work or you’ll burn out.

So when it comes to giving personal information about yourself, it’s a good idea to define your own privacy settings – both for your cyber self and IRL*.

* In real life

Comments (1)

Government misses opportunity to redefine ward sister role

19 November, 2013 Posted by: -

The government’s failure to make mandatory the recommendation by Robert Francis to get ward sisters out of the office and back with patients and staff is a missed opportunity.

Instead the government response has left it open to “local flexibility” and also open to it not happening.

For many years the role of the ward sister has been undermined. Their critical role as leaders of clinical care side-lined in favour of an office-based existence revolving around ticking boxes.

Is it any wonder that so few nurses now aspire to be ward sisters and those who take up the challenge end up frustrated in their roles?

Over many years the critical role of the sister has been downgraded and their position in the hierarchy means that no one listens to their concerns.

In February in his landmark report Robert Francis highlighted what many nurses already knew; that ward sisters are pivotal to providing effective care. His recommendation for supervisory roles for ward sister which would allow them to get out of the office and lead their teams was widely welcomed.

My concern is that failing to make this recommendation mandatory and leaving this to local decision makers will perpetuate the status quo. Trusts with vision will develop supervisory roles and others will take the risk and continue to use their ward leaders as a flexible workforce.

For many years there has been a lack of investment in clinical nursing and clinical leadership. Senior nurses took their eye off the ball and as a profession we have obsessed about what nurses could become rather than the how nurses could continue to provide compassionate care in a changing health economy.

Robert Francis has shone a light on the immense pressures nurses are under and the need for clinical leadership has never been so great.

I sincerely hope trusts have at last woken up to the value of the ward sister role and will invest in it so nurses can proactively lead clinical care rather than react to it.

It is happening in some trusts. Let’s hope good practice spreads to all.  

Comments (9)

Have you defined your personal privacy settings?

18 November, 2013 Posted by: -

Student Nursing Times has been having an interesting debate on how much information about themselves nurses should share.

Not too long ago this would have been restricted to discussing face-to-face contact, but social media have changed that. They have made personal lives public and made it easy to find anyone with a presence on the internet – particularly those who aren’t acquainted with the privacy settings of Facebook and the like. While the NMC has issued advice on the use of social media, its main focus is on professional issues.

But being social media savvy isn’t just about protecting patient confidentiality and avoiding public displays of unprofessional behaviour. It’s also about self-protection.

If you know their name it is easy to find and follow people on Twitter, or friend them on Facebook. And it doesn’t take much additional information to find more about them, such as where they live or socialise.

Nurses come into contact with many people going through difficult times, and as the professionals with the most patient contact, individual nurses can come to symbolise entire care episodes in people’s minds. It is almost inevitable that some – be they patients or their relatives and friends – will form attachments or fixations with nurses.

The vast majority of these will be harmless; some may be welcome, and may even become friendships that endure after the patient is discharged. However, even if we disregard the risk posed by a tiny minority who may have malign intentions, nurses need to be able to control how much access they allow to their private lives. If they don’t, they risk being overwhelmed by patients and visitors wanting to be their best friend.

Nursing demands a huge amount of emotional labour – you need to be able to comfort a newly bereaved family one minute and joke with a cheerful patient the next. And while you’re expected to provide compassionate care, you also need to be able to switch off when you leave work or you’ll burn out.

So when it comes to giving personal information about yourself, it’s a good idea to define your own privacy settings – both for your cyber self and IRL*.

* In real life

A dog could be someone's only friend

11 November, 2013 Posted by: -

Pets are an increasingly important part of our lives and especially so for many older people. For some, their dog is the most important being in their lives with a strong attachment bond that gives them companionship and helps to get them through tough times. For those who have few friends and family they can be almost like next of kin.

I was at Discover Dogs yesterday and watched an amazing display of golden retrievers and their owners. The troupe developed when some of the owners from a dog obedience class decided to keep the group together. The relationship between the owners was great to see and I imagine being involved gives them all a lot of fun and social support.

As well as the relationship and common bond between the adults, the strength of attachment with the dogs was very apparent. It made me wonder what would happen if one of the handlers was in hospital, how they would really miss that attachment.

Recent guidance by the British Association of Critical Care Nurses included the issue of pets and visiting and how the conflicting needs of infection control and the psychological boost of a pet can be balanced.

As the report says “Critical care nurses have to consider if it is justified to let that pet visit as long as it is appropriate and that sensible infection control precautions are taken and the visit is limited to the pet’s owner only”. And adds that “the hope and joy raised by the visit” of a beloved dog “might make all the difference to the patient in terms of will to survive”. And this must be the case not just in critical care but in all inpatient situations.

When I watched the dogs with their owners at the event, it was clear to me just how much people care for their dogs. The wealth of shopping opportunities – treats, toys, grooming and even outfits (No, we do not need a dinosaur outfit for the dog) made me realise how dogs become family members. So when patients are separated from their pets they will not only miss them, but also worry about them which can impact negatively on recovery.

Have you any experience of helping patients see their pets?

Comments (11)

Prince Charles can be a powerful ally for the profession

4 November, 2013 Posted by: -

I was lucky enough to be one of the Nursing Times team who went to Clarence House last week to a reception for finalists of the Nursing Times Awards, which was hosted by HRH the Prince of Wales – who has also written of his support in Nursing Times. It was a lovely event, and great to see the reactions of the finalists – both as they waited to speak to Prince Charles and afterwards.

While delighted to have been given this opportunity, most were apprehensive before they spoke to the Prince, but all those I spoke to afterwards were elated. He had put them completely at ease, taken a genuine interest in their award entries and made clear how much he valued them and the work they do.

The Nursing Times Awards are always a wonderful celebration of the very best the profession has to offer, but it was great to see our finalists receive the additional boost of public support from such an important source. And what’s more, the event was reported by the national press – and even those who often seem determined to characterise the entire nursing profession as cold, callous and heartless were unable to put a negative spin on this story.

After such a difficult year nurses need powerful friends, who have the clout to remind the nation that the vast majority of you go the extra mile - and more - to ensure your patients are safe and well cared for. Let’s hope the message sent out by Prince Charles sticks and that you cease to be the first port of call for people looking for scapegoats every time the NHS experiences problems.

'Sometimes you have to take the clinic to the person'

28 October, 2013 Posted by: -

Driving home today from a visit to a homeless service, I was reminded of the quote, “you can judge a society by the way it treats its prisoners, its minorities, the poor and the infirm”.

I had the pleasure of spending the morning with a community matron for the homeless from Staffordshire and Stoke-on-Trent Partnership. Jane Morton set up her service in 2010 when she noticed that people with no fixed address were frequently admitted to hospital.

Intuitively we know that homeless people have chaotic lives. They may be coping with financial problems, misuse drugs and/or alcohol and often have fractured family lives. However, the way we deliver health care does not meet these complex needs and standard pathways of care do not work for these patients.

As Jane says, sometimes you have to take the clinic to the person rather than expect them to turn up and it is this flexibility that helps them engage. Jane’s model of care is truly holistic, encompassing the health, social and emotional needs of her patients. She knows and understands the community that homeless people live in. She works early mornings and at night, meeting the homeless and engaging with them. But most of all she has the experience and knowledge to know how to respond to their needs.

Jane’s service has been successful in reducing hospial admissions but its real success is improving the lives of her patients through care, empathy, humanity and kindness.

I have learnt a lot today about homelessness but I have also learnt about how we should look out for those who do not know how look after themselves. These are people who do not engage with health services and nurses have a role in ensuring they do not fall through the gaps.

The first time: Being a real-life nurse

21 October, 2013 Posted by: -

No matter how good your training is, and even if you are starting your nursing career on a ward where you’ve had a placement, everyone experiences that wave of anxiety when they feel the weight of The Keys in their hand for the first time.

I went through so many different emotions during my first week as a mental health nurse that I’m not sure I managed a full hour without getting butterflies for some reason or another.

On my first day I arrived on the ward 20 minutes early, much to the surprise of the night staff, and was directed to the kitchen where I made my first error. Never make yourself a brew without offering one to the rest of the team. Second error came shortly after: never down boiling tea in an attempt to correct your first error.

My faux pas seemed quickly forgotten and I was welcomed in to the short-staffed team who were keen to introduce me to patients and make me feel comfortable.

Day two came with its own challenges. As I was in my supernumerary period, and hadn’t been told any different, I felt the best thing I could was park myself in the day room and get to know the patients. In hindsight, this looked to the only other nurse on duty that I’d chosen to watch Jeremy Kyle rather than tick off any of the diary jobs.

“You could at least do a mental state,” she hissed at me, thankfully out of earshot of any of the patients.

I was delighted at the opportunity to do some nursing but every ward is different and I didn’t think it unreasonable to ask if the ward uses a set pro forma. They didn’t and my questioning clearly came across as stupidity when the nurse responded “You should have learnt this at university! Do they not teach you ANYTHING?”

Four hours, three completed mental states and one last ‘criticism’ from my new friend (“You type too fast”) and everything clicked in to place.

I’d proven I was willing to work hard and the nurse couldn’t apologise enough. In fact, six years later, she still brings it up whenever I see her.

This week, nurses all over the country will be taking their first tentative steps as staff nurses. To make this as stress-free as possible, we’ve rttcreated a page dedicated to newly qualified nurses. Have a look at nursingtimes.net/newlyqualified for tips and advice, blogs from other new nurses and a hand-picked selection of articles from our archive to get you off to a flying, evidence-based start.

Comments (7)

Ask yourself what you achieved today, not what you failed to do

14 October, 2013 Posted by: -

We recently published an article about the use of cognitive behavioural therapy to help depression and low self esteem in post natal mothers. The project was successful in alleviating their symptoms and helping them cope.

When I was reading it I realised that some aspects of the therapy would be helpful to everyone and especially to nurses working in busy and stressful environments. Often at the end of a shift a nurse will feel defeated and frustrated by being unable to complete all the tasks they had wanted to.   

Mothers on the CBT course were encouraged to be gentle with themselves and to soften self-critical thoughts and to regularly use the term “I’m doing the best I can”. That can be a useful message for us all. It can be better when you are looking back over your day to list all the things that you have achieved as well as all those that you have not.

Reflection on where things could have gone better is an important part of the way nurses work but needs to be balanced with things that have gone well.

Mothers in the study found that attending the course helped  them to be less critical with one saying: “Coming to the course has helped me be gentle with myself.”

During the sessions the facilitators and group members regularly use the phrase “I’m doing the best I can” to soften the self-critical thoughts of “I am a failure” or “I’m not good enough” and to address perfectionist tendencies gradually.

I find a to-do list an essential of my working day but I need to accept that not getting through it is likely to be inevitable. Focusing on the tasks that have been ticked at the end of a busy day can help to spur me on for the following day rather than focusing too much on those that were left undone.

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Why hasn't every NHS organisation embraced Speak out Safely?

7 October, 2013 Posted by: -

When we started inviting NHS organisations to declare their support for Speak out Safely, I naively thought it would be fairly easy. Send an email to all the CEOs and they’ll review their whistleblowing policies, making a public commitment to support and protect their staff if they raise concerns about patient care or safety.

To me, it seems logical for employers to embrace this opportunity.

But, at time of writing, only 26 organisations have officially signed up. Although the campaign is gathering momentum and none of the organisations we have approached have explicitly refused, it seems that many trusts are still wary of tackling this important issue.

We are simply asking organisations to make a public commitment to protect those who raise concerns and to act on these concerns, and many people not involved in the NHS might be surprised to hear this commitment has not already been made. As an outsider looking in, I have little wonder that NHS staff do not always feel they will be safe to raise concerns within their organisations, or that some feel the need to become whistleblowers by raising them externally.

Nurses at Mid Staffs were criticised for not speaking out when patient safety was clearly being compromised, but those who did were not always taken seriously. In perhaps the worst case, Helene Donnelly was left fearing for her job and personal safety, while her concerns went unaddressed and the colleagues who were the subject of concerns were protected.

I have no doubt that there are health professionals out there who want to raise concerns but have not yet felt able to. If there is no guarantee that they are safe to do so, or that their concerns will even be acted on, I can understand why they might be reluctant.

But if you knew that management have a legal obligation to do something, would you be more likely to say something?

This week is Speak out Safely week at Nursing Times. We pledge to do everything we can to make it safe for all health professionals to raise concerns over patient care if they need to.

Are you behind us?

Is your employer signed up? If not, you can download a letter here to send to your CEO encouraging them to do so.

Sign the SOS petition

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ASDA has shown us how little progress has been made

26 September, 2013 Posted by: -

This morning I heard a radio interviewer ask:

“ASDA’s “mental patient” Halloween costume was just a bit of fun wasn’t it?”

It needed to be asked because I expect many people listening to the story thought it was just that, a bit of fun.

But the question itself upset me.

I grew up with a mother who had bipolar disorder. I never told my friends because I felt it was something to be ashamed of. It was embarrassing, and as a teenager I didn’t have the vocabulary to explain what was wrong with her. I remember wishing she had something “normal” like cancer, which other people could understand.

Living with and caring for someone with a mental illness can be a very lonely place. I know people were often wary of my mother when she was ill, because they didn’t know what to do or say. The easiest thing to do in those situations was to avoid her - and the rest of the family as well.

40 years on I am happy to talk about my experiences, but while I may have moved on the ADSA costume is a reminder of how little progress has been made in removing the stigma of mental illness among the general public.

So in a perverse way ASDA has done us a favour. At least this morning the TV and radio were giving airtime to people talking about what it is like to live with a mental illness. These were articulate people who get up, have their breakfast, go to work and look after their families and happen to have a mental illness.

But there are people who cannot cope with the stigma that still surrounds mental health problems. As the former footballer Stan Collymore, who has a history of depression, tweeted: “Do you actually realise how many people are hanging themselves because of being frightened of the stigma?”

 

 

We may have made progress, but there is still a long way to go before people with mental illness – and their families – feel able to speak about their situations as openly as those who have “normal” physical illnesses.

Comments (10)

Care and compassion must begin at board level

23 September, 2013 Posted by: -

Governments around the world have been committed to ensuring their healthcare systems provide safe and high-quality care for over a decade (which begs the question, what were they committed to before?).

Yet despite a plethora of initiatives and policies, patients continue to suffer avoidable harm and substandard care.

As we know only too well in the UK, the variation in standards of NHS care is a major problem. Many organisations have made real progress in reducing harm and poor care, while others just don’t seem able to get to grips with the problem. So why is it that a single (at least for the moment) healthcare system can’t achieve universally high standards?

This question was the focus of a major article published in BMJ Quality and Safety, which gives concrete evidence to back up what most people probably suspected anyway. The authors, from eight UK universities, have synthesised a number of separate sub-studies into a large, multimethod study of culture and behaviour in the NHS that has produced an impressively detailed picture of how the service operates.

Data came from hundreds of interviews with frontline staff and senior managers, survey responses and focus group interviews from patients and carers, observations of practice, and a huge amount of performance data and minutes from trust board meetings.

Almost all the professionals interviewed were committed to the ideals of safe, high-quality care and good patient experience. Many also identified care and compassion as their most deeply felt personal-professional commitment. So why can’t they all achieve this?

Well, surprise surprise, the key influences are the actions taken and decisions made at board level. The best care is provided in organisations with clear goals, adequate staff with the right skill mix, and systems that function effectively. While most individual frontline staff may want to do the best for their patients, it is largely the people at the top who determine whether they can achieve this.

Of course health professionals are responsible for their own actions, and ward and team leaders can do much to set standards in their area. However, individual good intentions simply aren’t enough if their organisation doesn’t function in a way that enables staff to fulfil these intentions, and doesn’t value and motivate them.

As the authors conclude: “Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring and compassionate cultures by ensuring that staff feel valued, respected, engaged and supported.”

Let’s hope NHS leaders, from the Department of Health down, read and act on this important study – and create the conditions in which you can achieve your aspirations for your patients.

What one piece of advice would you give a new student nurse?

13 September, 2013 Posted by: -

If you could just say one thing to a new student starting out what would it be? If you look back and remember your student days, what advice or information would have been helpful to have known as you started? Or if you are fully immersed in your course now as a second or third year nurse, I imagine you would have some ideas about what you would say to someone starting out if you had the opportunity.

I was thinking that perhaps I would advise a new starter to be prepared to encounter things that will be distressing – make sure you get support when you need it. This is because even now 25 years later I can clearly remember some of my early encounters with patients and their struggles with their long-term and debilitating conditions. And how difficult that could be as a 19 year-old.

Or perhaps it would be something more with a more educational slant – Keep on top of the work as there is lots of it coming and once you are on placement you will be too exhausted to do much else.

But on reflection I wonder if I was only allowed to give one piece of advice it would not be earth shattering or even very profound. It would be “invest in a good and comfortable pair of shoes”.

What would your one nugget of advice be to new student nurses?

Fresher’s Season starts over on Student Nursing Times this week. Head over to http://www.nursingtimes.net/freshers to find out more.

Comments (24)

Social media blurs the boundaries of our work and private life

9 September, 2013 Posted by: -

The NMC’s decision to suspend Allison Marie Hopton for comments she posted on Facebook will make sobering reading for some nurses. As one person commented on the story “I know of several people who are sailing close to the wind with this kind of thing even though my trust recently gave out written info about behaviours expected”.

It is nice to think our work and private life are separate but social media blurs the boundaries and - as the NMC rightly points out - if you identify yourself as a nurse your behaviour has to uphold the standards of the profession.

I often see anonymous comments on our own website that make me anxious about how others will view our profession - not only in terms of the language used but the attitude nurses sometimes adopt towards each other.

Yet nurses are under pressure and need space to voice their anxieties and frustrations. Ms Hopton said at a hearing with her employer that “Facebook is where people vent. Nurses are human”, but as the NMC observed she failed to appreciate the gravity of her actions.

The immediacy of social media has so many benefits but it also enables us to post in anger. We all need to hesitate before we press send.

It is easy to avoid getting into problems. The NMC is very clear about the standards it expects from nurses who choose to identify themselves on social media, and is very clear about the penalty for failing to comply.

If we want to communicate with each other as professionals we need to ensure we do it in a measured and appropriate way. Undoubtedly nurses need forums to discuss their anxieties and our website allows you to do this anonymously. I would love to know how nurses are supported in their trusts?

We have to accept that when people know you are a nurse they expect you to behave in a certain way - and that means we are never truly off duty.

Comments (14)

Students who are committed and enthusiastic are always welcomed with open arms

2 September, 2013 Posted by: -

Last week, our online editor Nadine and I sat around a phone calling student nurse after student nurse. We had to find four new student editors for Student Nursing Times (one for each branch) and had decided to dedicate an entire day to phone interviews. That morning we each downed a strong coffee and braced ourselves for a very long day.

Six hours later we couldn’t remember what we were worried about. Every student nurse we spoke to reminded us of the incredible job they are working towards - and also reminded us why we had chosen to work on a nursing journal. To say their enthusiasm was infectious would be an understatement – their positive outlook would be a huge asset to any placement lucky enough to have one of our interviewees on board.

At a time when nursing is under fire from negative stereotypes pushed by media portrayals, it would be easy for those considering a career in the profession to be put off. In fact, applications for places on nursing courses have never been higher.

Being a student nurse is not easy. On placements you constantly feel like you’re in the way, unsure what you should be doing or whether you’re doing things right, and have to adapt to a new team every few weeks. I know I wouldn’t volunteer to go through that again.

But while they might not feel they are contributing in any way, students who are committed and enthusiastic are always welcomed with open arms. They might double workloads – and they have certainly done that for us this week – but by reminding us of why we do our jobs in the first place they make themselves invaluable.

And if you’re wondering how the interviews went, we found four great editors, although it was incredibly difficult to choose as all those we interviewed had the right qualities. We’ll be letting them loose on Student NT from 9 September.

Comments (13)

Let’s see some action on nursing numbers

26 August, 2013 Posted by: -

In the past few years we have seen a plethora of critical reports about NHS care, and in the vast majority nurses came in for a kicking. There have, of course, been examples of poor practice, some of which have led to criminal prosecutions. However, there is a general acceptance both within the profession and from independent commentators that the vast majority of poor practice can be linked to low ratios of registered nurses.

It takes time to offer compassionate, safe and dignified nursing care, and while unregistered staff such as healthcare assistants can undoubtedly do this within their levels of competency, some aspects of care require the input of registered nurses. How depressing, therefore, to read that the NHS has lost over 5,000 nurses in the past three years.

Given that some trusts have been recruiting additional nurses in the wake of the Francis Report, this drop is not spread across the entire service. It seems that some still don’t get it – qualified nurse numbers are inextricably linked with the quality and safety of care. They may cost more to employ than HCAs, but the people deciding to make short-term savings but cutting nurse numbers should look at the research. Qualified nurses make significant long-term savings by cutting patient care costs.

Six months on from the Francis report it is surely time for the government to make good on its promise to ask the National Institute for Health and Care Excellence to develop evidence-based tools for establishing minimum safe staffing levels. Without official guidance or recommendations some parts of the NHS will continue to view their qualified nurses as a first target when implementing cost savings. This blinkered attitude is bad for the profession and even worse for patients – and increases the likelihood that we’ll see more reports of localised problems that reduce confidence in the entire NHS.

Comments (11)

When is an adult an adult?

19 August, 2013 Posted by: -

I recently had an interesting chat with a young man who had just spent a week in hospital. He’s nearly 18 and was admitted to an adult medical ward. It was both a challenging and at points frightening experience for him.

He was in a four-bedded bay with three other patients, one of whom was at times, especially at night, confused and agitated. He felt lonely at night and not sure how to deal with the distress of the man opposite. During the day it was easier but some staff dealt with the issue of his age better than others.

The only people who were near his age were the student nurses, and he found his exchanges with them really helpful. The nursing staff seemed to appreciate that he would find his situation difficult and were supportive, but sometimes the doctors treated him like an adult and expected him to be able to make decisions about his care. He felt awkward having to say that he would like to consult his parents.

I asked him if he would have preferred to be on a children’s ward. After some thought he said that, if I had asked him that question before he was admitted, he would have said no. However after his experiences, he said, actually of the two choices, he would now opt for the children/adolescent ward.

The problem is, as my question revealed, that neither setting is appropriate and nor can any hard and fast rules to be set. Some young adults are very mature whereas others are still teenagers. But it sounds like the nurses got it right – appreciating the difficulties of offering transitional care and being supportive to help the patient experience.

 

What do you think?

Join us on twitter at 1pm on Wednesday 21 August where we will be discussing the transition from child to adult services.
To join the discussion, search for #NTtwitchat and use this hashtag in your tweets so they appear in the search.

Comments (12)

How can we improve patient experience of early discharge?

12 August, 2013 Posted by: -

A friend of mine recently had very major surgery and will require months of follow-up. Discharged after five days he came home feeling tired, unwell and unable to cope. He had concerns about pain, his wound, how much he should do and how quickly. After three days he was a nervous wreck and began phoning the hospital for support. His wife was equally anxious, bearing the burden of his worries and also her own concerns about his condition. For the first two weeks she felt she had taken on the role of the nurse.

Getting out of hospital quickly has clear gains for the patient and health services – reduced risk of infection, perhaps better sleep and food are all positives, but there is a trade off when things don’t go according to plan.

I felt my friend and his wife had probably been told everything before discharge but in the euphoria of knowing he was well enough to go home didn’t take it in.

When my friend’s wound started to leak they had to go back to the ward. When he felt very weak he was rushed back for blood tests and the burden fell on his wife to keep it all together. Not only did he feel worried each time he was called back in but it was also exhausting to travel to and from the hospital.

So I am left wondering if we send people home too quickly or whether support services are sufficiently developed to help those who do go home early to deal with problems as they arise.

The problems for so many patients are the simple things: When can I have a bath? What should I do if I feel unwell? How far should I walk?

They aren’t questions you take to the GP and I suspect many of us would not want to bother the ward by ringing up.

It seems to me that going home early is great if you feel you are getting better, but those who have major interventions need care to ensure their recovery is as free as possible from stress.

It would be great to hear about your experiences of discharging patients and how early discharge can be improved.

Comments (21)

No nurse wants to leave patients in need of care

5 August, 2013 Posted by: -

Nurse staffing numbers are in the news again following publication of a study suggesting that the worse patient outcomes associated with lower nurse staffing levels result from the omission of necessary nursing care. Put simply, short-staffed nursing teams don’t have the time to do everything their patients need them to do.

So no surprise there – but at last there seems to be a head of steam building to ensure decisions on nurse staffing are based on more than the fact that nurses are the biggest staff group and can therefore take a bit of trimming in hard times. The Prime Minister’s Forum on Nursing and Care Quality has called for the Care Quality Commission to monitor nurse staffing levels as an early warning of where poor care is likely to happen.

We had a lively #NTTwitchat about the issue, in which some people suggested that nurses should never allow instances of missed care. They felt it was breaching both their code of conduct and the spirit of the role.

No nurse wants to leave patients in need of care – unfortunately too many employers rely on this. But if missed care results from low staff numbers, should nurses plug the gaps by undertaking yet more free overtime – on top of what most already seem to do? That’s a perverse incentive for trusts to maintain the low-staffed status quo – or cut even further. It’s also a safety risk for patients and a health risk for overworked nurses.

One of the arguments against minimum staffing ratios is that they are blunt tools that take no account of local needs and patient acuity. That’s a fair point, but the NHS needs a method of assessing how many nursing staff it needs, and the appropriate skill mix. And nurse managers need a formula they can use to demonstrate they need more staff or cannot afford to lose existing staff.

So news that the Shelford Group of leading trusts in England have not only adopted a tool enabling them to determine their staffing needs is welcome. It’s even more welcome that the tool was developed by nurses. Here’s hoping the tool will prove what we already know – more nurses not only mean safer and better care, but also lower costs.

Comments (11)

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