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Cameron told nursing review 'must look at staffing'

  • 42 Comments

The prime minister’s new “nursing forum” must include the impact of staffing levels in its review of care standards, according to nurse leaders.

As revealed by nursingtimes.net last Thursday, David Cameron has announced the creation of a Nursing Quality Forum to suggest ways to tackle shortcomings in “dignity and respect” for patients, and to promote initiatives including routine ward rounds, the productive ward scheme and cutting red tape (see box below).

His announcement is a response to a raft of reports last year highlighting poor care involving nurses, as well as recent scandals such as that at Mid Staffordshire Foundation Trust.

Mr Cameron said the problems were due to nurses being taken away from frontline care. He said: “If we want dignity and respect, we need to focus on nurses and the care they deliver. Caring for patients is what nurses do. Everything else comes second.”

The government said the forum, which will be made up of yet-to-be chosen nurses and patients, would focus in particular on spreading good practice. Senior sources involved in setting up the review said its precise terms of reference were not yet clear.

But nursing leaders said if the group wanted to address care standards and quality it would have to look at issues including nurse numbers and the balance between qualified staff and healthcare assistants.

Royal College of Nursing head of policy Howard Catton said: “Staffing is so fundamental, so intrinsically linked to care and outcomes, that this group has to be able to consider those issues.

“We think the time has come to move to guaranteed staffing levels. Variation [in staffing] is too great. This is an even more fundamental issue in light of what the prime minister has said – the case for it has been made even more clearly.”

Unison head of nursing Gail Adams said: “All the research points to higher nurse to patient ratios delivering higher outcomes.  Yet all over the country, nursing posts are being frozen, or even lost.”

PM on improving nursing care:

  • All hospitals to implement NHS Institute Productive Ward - Releasing Time to Care programme by April 2013, with 20 trusts given “targeted support”, particularly focusing on elderly care.
  • Set up a Nursing Quality Forum to “identify good practice and advise on what is best to implement” and tackle barriers to spread.
  • The Forum to “secure greater frontline nursing leadership in the future”, “exhibit national leadership” and “stimulate local action by those delivering care to address problems and promote the improvements”.
  • The Forum to launch a “red tape challenge”, identifying “pieces of bureaucracy which get in the way of [nurses] performing their jobs properly”.
  • The Forum to encourage uptake of intentional nursing rounds by “raising its profile and demonstrating the benefits”.
  • Local HealthWatch organisations to lead patient-led inspection regime from April 2013.
  • National surveys to ask “whether patients, carers and staff would recommend their hospital to their families and friends in their hour of need”.

 

  • 42 Comments

Readers' comments (42)

  • More rhetoric. Does he not realise that the productive ward does not raise patient safety if there are not enough nurses on the ward? We are already seeing each nursing post frozen when someone leaves. No amount of shelf reorganisation will help that deficit. They want to get rid of nurse specialists who do a lot to keep standards high and prevent patient issues. I think this man should actually come and work in a hospital and not just visit them with clean corridors and selective staff to shake hands with but no real discussion.

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  • tinkerbell

    Urghh! or Arghh! Spare us the productive ward, all good in principle, releasing time to care blah,the WOW, well oranised ward, bloody blah. We spend more time filling it in, analysing the data, compiling the pie chart, taking photos, making video documentation, escorting higher management round the ward to sign the bloody thing off, before and after photos and guess what, actually less time with the patients. We gather round the board to stare at it dumbfounded, for 'gathering round the ward board meetings', whilst i make the speech to spur everyone on, which basically consists of 'well there we have it', it would be funny if it wasn't so farking time consuming. Never mind hey. Onwards and upwards in ever decresing circles. I'm ready for the next initiative, bit bored with this one now, bit like the new year, full of promise but very little return.

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  • "Mr Cameron said the problems were due to nurses being taken away from frontline care. He said: “If we want dignity and respect, we need to focus on nurses and the care they deliver. Caring for patients is what nurses do. Everything else comes second.”"

    what on earth is this man talking about? He is merely repeating what he has been told like a parrot apparently without demonstrating any knowledge or understanding of what he is saying. It would appear he is just trying to collect positive strokes and attention and brownie points from his electorate.

    Nurses are autonomous professionals who have the capacity of exercising their own clinical judgement and have been pointing out in great numbers what resources they require to do their job adequately and to the highest standards which includes having sufficient and appropriately qualified staff to carry out all the complex tasks this involves. If they have chosen this profession it is because they have chosen to care for patients and provide them with the best and most professional care they possibly can and not to be fobbed off with any less so that they are unable to do what they have been trained for and to the detriment of the health and safety of their patients as well as their own well-being. As their claims have gone totally unheeded for so long and standards of care, which they have been unable to maintain, have dropped drastically and to unsafe levels this has quite rightly caused a public outcry and attracted considerable media attention with some very damning reports about poor care.

    Mr Cameron now realising that some action on his part needed to be taken, says "...we now need to focus on nurses and the care they deliver..." but why are nurses not deemed capable of using their own highly developed clinical judgement to identify and express their own needs for the the patients in their charge and why is this not being seriously listened to and acted upon?

    Perhaps we all need to focus more sharply on Mr Cameron and his politicians and scrutinise far more closely the work they are delivering to those they are supposed to be serving.

    Furthermore, I agree, as I have posted elsewhere, Mr. Cameron needs to gain some experience if he wishes to get involved in and properly understand the work of nurses and the care they deliver, not by briefly visiting a few wards where a show has been staged for him, but roll up his sleeves and 'tuck in his tie' and work on all the different shifts for a prolonged period of a minimum of one month!

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  • tinkerbell

    Anonymous | 9-Jan-2012 12:31 pm

    Yes an absolute minimum of one month so he can really get an 'overview' as they call it and that would also include night shifts.

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  • If Mr Cameron saw the excessive paperwork that nurses fill in per patient by a staff nurse caring for 10 patients per shift including risk assessments which also includes about 4 seperate assessments to stop a patient at risk of falling actually falling he would I am sure be dumbfounded, then he might realise why nurses do not have the time to care as they would like.

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  • tinkerbell | 9-Jan-2012 12:33 pm

    Anonymous | 9-Jan-2012 12:31 pm

    Hang on - general question first of all which I have just thought of:

    why have so many nursing posts been cut and now this ?

    "Cameron told nursing review 'must look at staffing'"

    isn't he responsible for all the cuts in the first place or was he merely unaware of what was going on all around him while he was otherwise engaged with sorting out everybody else's problems overseas?

    Tinkerbell, when I said above 'all the shifts' that does of course include nights as well. there is no reason for him to get away with anything at all just because he is PM.

    Perhaps I should add that he should also be sent for complete shifts on wards in all the different specialties including A&E and theatres as well.
    How about a few shifts on your ward as well Mrs. Langstrumpf? I sure that would get him thinking about staffing levels and how nurses are in the best position to know what resources are needed to carry out their jobs effectively and safely. Only I would advise a rather stricter dress code in his presence for fear of confusing him further!

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  • At the University of Birmingham we recently convened a Think Tank to look at issues affecting the delivery of compassionate nursing care. We have produced a policy paper with the findings called "Time to care?" which can be accessed at www.hsmc.bham.ac.uk. The key issues in our paper are as follows:
    • In the 1950’s Menzies identified that nurses’ deal with situations such as death and dying, on a daily basis whilst most lay people may not experience this in a lifetime. This remains the case with nursing today. In order to avoid them being overwhelmed by anxiety they need ways of coping and these mechanisms need to include systematic support for this emotional aspect of their work. It is rare to find such a system in the day to day realities of ward nursing. In addition, the recognition of nursing as a series of tasks that are “frightening, disgusting and distatsteful” (Menzies 1960) is rarely discussed, and therefore not recognised by organisations or responded to. Coping mechanisms may have been eroded over time because they were not fully understood-for example task based nursing has been replaced by personalised care. Whilst the authors do not argue for a return to this approach, they do highlight the need to recognise the impact of this change and to take appropriate action. For example the Samaritans employ a model of emotional support for their volunteers which ensures they are able to cope in their role of providing care to others at their time of need.

    • Caring is seen as an easy task - kindly next door neighbours are described as caring for example, and therefore if it is simple why do nurses not just do it? This rationale then leads to the uni-dimensional approach of blaming the individual nurse and/ or their education - the “too posh to wash” syndrome. This approach belies the complexity of what it means to be a registered nurse in today’s complex healthcare environment, and also ignores the reality of caring which is recognised in other areas of national policy- such as the National Carer’s Strategy . It appears that this recognition of what it means to be human is forgotten once nurses are in paid employment.

    • Ward and board nurse leadership is recognised throughout the literature as crucially important in setting the right standards for practice and delivery of good, compassionate patient care. The energy required to create a culture of caring and develop, support and inspire the nursing profession does not appear to have been articulated in ways which Boards can understand or relate to. Most Ward Sisters/Charge Nurses and Nursing Directors have a myriad of other responsibilities which take their time away from nursing (Burdett 2006; RCN 2009). In addition Newchurch (1995) identified that 75 per cent of nurse directors did not have line management responsibility for nurses which creates an added dimension when trying to influence practice and standards.

    • Finally, the paper identifies a sense of dissonance between being a” good” nurse and a “good” employee. A “good nurse” might be expected to know who were the illest patients on their ward, how many needed help with eating, or the number of patients with pressure ulcers. However the mangers may want them to know how many patients are in A&E waiting for a bed, and how many beds they will have on their ward to accommodate this need. Whilst these are not mutually exclusive requirements, it serves to illustrate the tension between system pressures and priorities, and nursing care. For nurses struggling to identify how to measure the components of compassionate care in a way which are widely accepted and can be bench marked, the management culture can distort priorities and the personalisation of care can be overlooked as the needs of the organisation, in terms of achieving high profile performance measures, takes precedence. This can create internal conflict between being a “good nurse” and responding to what is important to individual patients, and being a “good employee” and responding to what is important to the organisation/their managers. The nurses’ Code of Conduct states “make the care of people your first concern, treating them as individuals and respecting their dignity” (NMC 2008), which further compounds nurses' sense of conflict.

    In summary, whilst we agree with the Prime Minsiter's view that hourly rounds can play their part, (referred to as "Intentional Rounding" in our paper), mechanistic tasks on their own do not contribute to the delivery of compassionate care - merely compliance.

    We hope our paper will contribute something new to the debate, and lead to the establishment of support mechanisms for nurses to help them to deliver compassionate care consistently. That is the reason most nurses joined the profession.

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  • Ah there are no end of forums, forms and committees spurned by this sort of initiative. David Cameron would have been far better calling NHS management to task for the chaos they have already created. Unfortunately all he has done is given them more stuff to over complicate and create forms and committees. If we are not careful we will have another restructure and that means another manager to add to the ever increasing number.

    Thanks for saying that anything that keeps nurses from patient care needs to be looked at but I wish you had just called managers to book - leave them to sort themselves and and create and fill in an endless stream of nonsensical forms and then we who nurse can get on with it.

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  • Mr Cameron et al should pay attention to these comments. Its time to stop attributing blame to those without a voice who are unable to make the changes.
    He knows only too well what impacts on care delivery..it's pointed out to him and his entourage frequently enough.
    2012 is the time to show the British public he is prepared to put his money where his mouth is and invest in the NHS before we lose even more faith in the government.
    Patient safety is paramount - all nurses know that. Give the tools to deliver high quality care. Stop depleting services, freezing posts, downgrading skilled nurses and then telling the public its all their fault.

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  • tinkerbell

    Mr Cameron just phoned in sick for the early:)

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