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Practice team blog

Wishing I was a student nurse now

3 March, 2014 Posted by: -

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.

Comments (8)

Does ‘Bedpans and Bandages’ give nurses and student nurses the respect they deserve?

24 February, 2014 Posted by: -

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?

Comments (15)

Is removing RCN indemnity insurance really a small change?

17 February, 2014 Posted by: -

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.

Comments (9)

Why won’t trusts pledge to support staff who raise concerns?

10 February, 2014 Posted by: -

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

Comments (6)

Recognise night nursing as a specialty

3 February, 2014 Posted by: -

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.

Comments (12)

Why are antipsychotics so regularly given to people with dementia?

27 January, 2014 Posted by: -

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?     

                      

Comments (5)

Trusts must resist the temptation of a 'quick fix'

20 January, 2014 Posted by: -

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.

Comments (1)

Speak up about revalidation, or forever hold your peace

13 January, 2014 Posted by: -

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.

How many smokers can you help to quit this year?

6 January, 2014 Posted by: -

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?

Comments (1)

Will universities protect students who speak out about poor care?

30 December, 2013 Posted by: -

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.

Comments (3)

What do you wish for Christmas?

23 December, 2013 Posted by: -

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

Practice nurses deserve investment from their employers

16 December, 2013 Posted by: -

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.

Comments (3)

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.

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