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‘Many nurses are blind to the importance of nursing in people’s homes'

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Listening to the individual is powerful way to show leadership says DH policy lead David Foster 

Rosemary is for remembrance. Although I can’t remember who told me that, the smell of rosemary is, for me, now associated with a specially-designed sensory garden at a care home with nursing.

And this thought reminds me that the breadth of nursing is phenomenal. Much of my clinical career has been in hospitals and I have been shamefully blind to the importance and scale of nursing in people’s homes.

David Foster

David Foster

David Foster

To rectify my understanding of nursing at home I have now visited many care homes with nursing.

Care homes might sound and look like institutional nursing but once you cross the threshold you are in an individual’s home: you are a guest, whether you are paid to be there or not. And what I have seen in those settings is nursing at its best: care focused on a person as a whole individual, based on trusting and professional relationships and with huge degrees of autonomy and responsibility. Doing this well and being contemporary takes considerable energy, commitment and leadership.

“Once you cross the threshold you are in an individual’s home: you are a guest”

The people experiencing this care have their voices heard, can make choices and have control over their own lives.

Putting your nursing brain into this gear is sometimes difficult because you might not have the professional controls and choices you once did, and your voice must become that of the advocate and enabler. But what a fantastic nursing gift to give a vulnerable individual who needs care no matter how simple or sophisticated.

Saying nursing needs strong leadership is becoming a bit ubiquitous, but it is nevertheless true. The profession needs leaders who are visionary, able to communicate that vision, are visible, actively listen and inspire others to change. It’s a tall order. And I have seen some tremendous leaders – who don’t realise they are and I have also seen some bossy people who think they are leaders and are not.

”I have also seen some bossy people who think they are leaders and are not”

So what’s the importance of leadership? For me there is a lot in the old adage about leaders doing the right thing compared with managers who do things right. This might be looking at leadership through a very simple lens, because doing things right does have a lot of merit, but those who do the right thing despite the system, despite what the rest of the herd are doing have got to be supported.

I was never more struck by this than when I met a humble yet powerful nurse in a care home for people rehabilitating from brain injuries.

She didn’t hold a position of power but her leadership was impressive. She realised that not all the residents in her care would rehabilitate and that some would sadly deteriorate and die, and some at a tragically young age.

Nevertheless, she recognised that most of them wished to die in what had become their own home, the nursing home, and not spend their last illness in an acute hospital.

To achieve this took some tough negotiating and steely leadership. Her colleagues and GPs needed persuading that the team had the right skills, could refresh their knowledge of symptom control at the end of life and help people stay in the place they knew as home to die. There was no longer a need for ambulances with flashing blue lights, for staff in scrubs with bleeps and stethoscopes.

She had heard what the individuals she cared for wanted and did the right thing.

Rosemary is for remembrance and I hope that association, in considering the people we service, stimulates me to consider it is more important to do the right thing than do things right. And I hope, whatever your field of nursing, you too will ask yourself as a leader “what is the right thing to do?”

David Foster is head of the nursing, midwifery and allied health professions policy unit at the Department of Health

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