Why try to understand bad nursing if you can just point the finger?

24 June, 2010 | By Mark Radcliffe

I can’t grow carrots. I don’t know why. I plant them in the right place at the right time and they are pretty much facing the right way. I water them, feed them, coax them, chivvy them. But nothing.

I tell them rabbit jokes and water them again but not one carrot has yet to emerge from my allotment. We have produced everything from sweetcorn to bananas on our allotment, but we fail to come up with the carrots.

And so I wonder about my abilities as a vegetable grower before slipping back to my default position and philosophise idly. Why am I fretting about the carrots? I have courgettes coming out of my ears (which was down to a practical joke by my daughter), I have potatoes, tomatoes, a wide range of berries, apples, artichokes.

Yet I fixate on what I can’t grow, what I can’t make happen. I am fascinated by my failures. I become full of what I have done badly, I let it define me - sometimes I even wish I had a regulatory body that could oversee me and ensure that I am punished for my inadequacies. Which is, of course, what marriage is for.

‘Sometimes I wish I had a regulatory body that could oversee me and ensure that I am punished for my inadequacies. Which is, of course, what marriage is for’

Now I am prepared to take full responsibility for my failure to grow carrots. The buck stops here. But having located who to blame is that the end of the problem? According to a report in The Times last week some nurses are about to face disciplinary proceedings over the failures of care at Staffordshire Hospital last year. It is notable that former managers who refused to address issues around staff shortages do not have a regulatory body and will therefore not face sanctions, but from a nursing point of view that does not alter the fact that we demand high standards of ourselves.

It is wholly appropriate that clinicians across the board are investigated when patients suffer. And as a profession we would expect nothing less. However, when we have figured out who is responsible, and ensured they are disciplined and that professionally the lessons are taken in, I think then we have another really important job to do - we have to try to find out what happens to nurses who stop doing what they are trained to do.

Poor nursing is not something we can automatically ascribe to bad nurses or bad people. No nurse comes into the profession in order to do a bad job. No nurse qualifies without the ability and understanding to do well, to care, to know good from bad.

Something happens to nurses who perform badly. Something disables them. It may be anything from burnout to breakdown, from mismanagement to disinvestment. A lack of professional sustenance or no supervision. But nurses do not nurse badly for no reason.

If we are serious about regulation we have to always look beyond who we can blame to understand why it happened. Not just systemically but also personally. Otherwise our investigation is, at best, incomplete and, at worst, dishonest.

And worse - we create a culture of abandonment, not only for the patients who are not cared for but also for the nurses who forget what they are doing.

Readers' comments (14)

Anonymous | 26-Jun-2010 11:11 am
"sometimes I even wish I had a regulatory body that could oversee me and ensure that I am punished for my inadequacies" - that is a big part of the problem Mark, the NMC is seen as a big scary body which will strike you off if you make a mistake - kind of like Jehovah and the Israelites.

I don't see it anywhere else in my practice, determining professional development or education needs, or as a lobbying organization for both nurses and the health of the public. After you gain a pin number your left to your own devices, no national curriculum of development through the banding system, no mandatory supervision arrangements. As a supposed professional entity we are pathetic.
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Anonymous | 26-Jun-2010 11:21 am
Just to add that NT rattles on about Mentorship as if it only applies to students and the newly qualified. Why should it end there? How else are we going to develop future experts and pass on experience and wisdom?

Such excellent role models for the student nurse that don't want to mentor, don't want to update their practice, see the pin number as a ticket to a trade and nothing more.

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Anonymous | 26-Jun-2010 12:12 pm
Was this not the job of the nurse in charge of a ward or theatre ? To train, oversee, nurture and encourage ? Where have we gone so wrong ?
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Anonymous | 26-Jun-2010 6:13 pm
What needs addressing and has not been said is the inherent culture of bullying at all levels.
It is the most surefire way of disabling a person/workforce who are not able to risk their livelihoods for pressing their concerns further, for fear of losing jobs.
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Jacqueline de Laporte | 27-Jun-2010 11:22 am
Carrot root fly is the answer! If you prevent then laying their eggs then they can't destroy the roots and prevent beautiful carrots growing. (an analogy for nursing!)
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Anonymous | 27-Jun-2010 12:06 pm
Bullying can be very subtle, and the perpetrator may not be aware of it, as they would not perceive their 'brow-beating' attitude to be detrimental to thier own, or others, practice. They behave as if their experience gives them the authority to gloss over dubious practice because "they've always done it that way". In tightly knit teams, new staff, looking for guidance and mentorship, can find themselves expected to overlook such things, because they may feel they are in no position to question their very experienced colleagues, after all, in the grand scheme of things, what do they know? Well, what they do have is the latest knowledge and the passion to train long and hard to nurse their patients in the best way they know how. One such situation has just happened to me and i have spent some sleepless nights mulling over my options. I feel my own integrity, and possibly registration, may be at risk if i do nothing, in effect, condoning the behaviour.
It is a scary place to be and what makes me sad is that I shouldn't have to be here. If the systems designed to standardise practice were consistantly implemented and audited, these problems would not arise. If mentor/preceptorships were properly run and ongoing clinical supervision were offered, nurses new and experienced would be able to talk over concerns in non-threatening environments, and these old attitudes may cease to persist. Until something changes HAI's, drug errors and the rest will continue.
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Anonymous | 27-Jun-2010 2:57 pm
during my training i worked as a HCA and support worker and applied high standards of care delivery as per the plans denoted. as a nurse i have worked in various settings. the most recent leaves a lot to desire; the manager turns a blind eye to poor infection control and moving/handling standards. The past three weeks I have taken these problems to the manager after constently challenging HCA manner to work. I have felt ignored by the manager and now left the job. Because this experience has left me completely disheartened I am looking for a job as a cleaner or shelf stacker at a local supermarket... Shame the world of nursing and care has lost another nurse.
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Anonymous | 27-Jun-2010 3:02 pm
several things result our poor performances. when i wanted to attend a pressure ulcer & wound management course my manager thought that was not important yet, she want me to attend for instance dysphagia course 1st_ the only problem is that the next one is about 3-4months away and wound care one in 2wks. i do dressings at all times yet after 3 after i am still to attend the course. so yes management dont help at times.

did i mention 3 days ago instead of 5 members of staff looking after 25 patiends in an acute respiratory ward we had 3 members of staff. how do i manage to do all dressings, tracheostomy care, NG/PEG feeds on this shift. i am not always happy with my performance in such a case cuz even if i dont make druig errors etc, how much time will i spend with my patients.
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Anonymous | 27-Jun-2010 4:05 pm
I agree nursing seems to be the only profession where they is no proper career development. Other HCPs and doctors are amazed that we have to find what to do and make up a pathway as best as is possible - for them it just doesn't happen
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Anonymous | 27-Jun-2010 4:20 pm
I want to stay with the theme of bullying
Anonymous | 27-Jun-2010 12:06 pm - thankyou for speaking, I am in a very similar position and currently in that scary place of feeling I am gambling registration and patient safety with my job and putting my head above the pulpit cos no-one else is willing to. Our team are having to endure very subtle, consistent and hidden methods of bullying in a bid to downgrade our roles, assimilate into the new company's system and tow a line which is not clinically safe. None of the managers have a defence other than do as you're told.
I am currently looking for another job!
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Anonymous | 27-Jun-2010 5:43 pm
I am glad someone bought up the theme about bullying. It is strange that in a profession of nursing you are bullied because you dare put the needs /welfare of the patient first. Dare you speak out or disagree in the way tasks are done, first you can forget about promotion you apply for the job low and behold the manager's drinking buddy gets the job yet when there is a mess you are called upon to sort it out. There are some people who belive the hospital ward are they own little project so they over look bad practice at times when it is pointed out that we are infact working for the well being of the patient on the ward some seem not to comprehend this. I wish I had an answer maybe staff and managers should be rotated at times to different wards same speciality but in a different part of said Trust this may stop some of the cliqueness that goes on at times.
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Anonymous | 27-Jun-2010 7:29 pm
I have just resigned from my position as a ward sister, without another job to go to, for the very same reason. I feel that we no longer have the resources or the time to deliver patient care to an acceptable standard. Having bought this to the attention of my managers I was told if I couldn't cope I should speak to my direct line manager, who is also snowed under. I chose to leave before I was held accountable, as the sister, for the dropping standards on the wards. Because it would be me and not the managers, who have ignored my concerns, that would be held responisble.
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Anonymous | 28-Jun-2010 7:46 am
Two points in reply to this commentary. First of all, you do seem to have insight into your lack of success in growing carrots and have decided to concentrate on what you do well. Applied to nursing (well, anything really), if a nurse does not have insight into their shortcomings then they are unlikely to move on and poor standards prevail. It is very difficult to try to improve people unless you use a competency based model of appraisal and updating or you are accused of bullying and harrassment.

Secondly, there are nurses who do not recognise good practise and are rude and arrogant. It may well mean that something has 'happened to them' and those do need understanding but some are just downright rude and do not care that patients are vulnerable and emotional. Likewise, there are a few who do not have scruples about doing bank and then going off sick for their own shifts as they know they can still get paid. Society generally is less polite and aware of others and this is reflected in all walks of life and Nursing sadly is not exempt from it either. (Mercifully, not everyone.)
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Anonymous | 28-Jun-2010 10:55 am
I find it very sad that people are leaving nursing just because they are not happy in their current job. Why not look elsewhere for a nursing job? There are decent teams/areas to work - even if it takes a bit of research/hunting. But to leave a job you like, are good at and spent 3 years training to do...........to stack shelves at a supermarket?!! You're selling yourself short.
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