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'Checking up on nurses won’t help them to give better care'


The chances are that when Unison, the Royal College of Nursing, the Nursing and Midwifery Council, the Department of Health, most of One Direction and everyone who has ever played Dr Who all agree something is a good idea then said idea will sweep the nation and become law very quickly.

Indeed one cannot help but notice that in the face of such universal approval, disagreeing runs the risk of appearing childish or bloody minded; arguing for arguing sake.

And so good manners suggest I acknowledge that the revalidation of nurses every three years - as a backdrop to the Francis report and to show patients that nursing is reflective and responsive - might look not just like a good idea but is obvious and inevitable. But I can’t.

In truth, I think it is misguided, misconceived, poorly premised, politically manipulative and ultimately distracting the “powers that be” from a far more important, if costly, issue. Our preoccupation with how we can check on nurses only makes sense if it is accompanied with an equally vocal “how can we help nurses to nurse well?”.

Sometimes I wonder if there is an Anti-nurse somewhere coming up with ways that nurses can be made to feel more defensive, undervalued and marginalised.

“What can we do next Anti-nurse?”

“Well, let’s make it harder for people to become nurses, make them work for a year on low pay, expose them to all sorts of unmentored, unsupported nonsense and, if they survive, offer them an education. Oh and make them hop. Hopping hurts.”

“OK Anti-nurse we’ll start with the new one. But what about those who already qualified?”

“Well,” offers Anti-nurse - who, for me, has the body of a lizard and the suit and simper of Nick Clegg, but you can make up your own - “reduce staffing levels, stop pay rises, threaten pensions, cut out increments, call them names, make them listen to Brian May, ban them from wearing shoes, make them ask patients to sign off their revalidation, especially the ones working in theatres, palliative care and dementia services… see how they like them apples”.

Anti-nurse knows every organisation charged with making sure nursing is seen in the public eye as being professional, humble and responsible has to embrace revalidation, or any other proposed sackcloth-and-ashes policy spoken of alongside Francis. They do what they want and call it action even when it isn’t.

Effectively proposals like this are indicative of an attitude whereby nursing is assumed to be bad and being bad means it must be punished or at least policed more. Now, I don’t think nursing is bad but I can be a romantic old ninny so let’s assume I am wrong. If something important is not working how can it make sense to punish it, rather than trying to mend it?

A revalidation process doesn’t repair practice, it isn’t a way of getting rid of bad nursing. It can, at best, function as a way of showing that nurses are being checked. In reality, we get rid of bad nursing by helping nurses to nurse better, by making education, group supervision or engaged practice analysis not just available, but also mandatory. If we are going to punish nurses for their failures how about we do it by demanding they learn as opposed to demanding they fill in more forms?

Revalidation is a distraction - another one, a popular one it seems - but it has little or nothing to do with the mechanics of improving practice and enabling nurses to nurse well. It’ll probably happen. It won’t help much.

Mark Radcliffe is senior lecturer, and author of Gabriel’s Angel. Follow him on twitter @markacradcliffe


Readers' comments (6)

  • Well said Mark, as always.

    However, nurses themselves continue to absorb cr*p and somehow believe that they probably are to blame for everything. That has to change.

    I read a comment (in NT online) the other day, which asserted that nurses had taken no action to report what was happening at Mid Staffs. His comment began with,
    "It doesn't surprise me that nurses dislike patient feedback...."
    This individual, who does not work in healthcare, had completely ignored the fact that thousands of incident reports were filed, nurses (with some exceptions) did openly report concerns, were bullied and often left Stafford Hospital personally and professionally damaged. The Daily Wail, the Tory Nudge Unit and Disgusted of Tunbridge Wells have a lot to answer for.

    Nurses are exposed to 'constant feedback' from any and all directions, and any patient can report any nurse at any time (whether or not it is genuine or vindictive) to the NMC.

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  • You are absolutely correct with your assessment of re-validation. Yet another way to damage an already fragile workforce who are not only jaded by the following “reduce staffing levels, stop pay rises, threaten pensions, cut out increments, call them names, make them listen to Brian May, ban them from wearing shoes", they also have managers pushing too hard with reduced staffings levels effecting overall morale. In my opinion nurses should recieve a half day study period every month or in line with other NHS professions.

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  • Here here Mark at last some common sense!

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  • michael stone

    I'm not sure that the methodology of the revalidation will make it anything all that useful, and I'm not entirely sure that this one is 'nurse bashing' (but there does seem to be some nurse bashing about).

    But I really loved this section - I'm tempted to quote that bit, in connection with almost every 'new plan/policy' I dislike, so universal is its applicability (especially if 'if costly' is struck out as necessary):

    'In truth, I think it is misguided, misconceived, poorly premised, politically manipulative and ultimately distracting the “powers that be” from a far more important, if costly, issue'

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  • I don't see anything wrong in re-validation. I am concerned as to the cost of the implementation and who will pay for the rectifying of any failings. Considering there is a Youtube video showing the NMC Facebook page openly displaying private and offensive photos does beg the question as to how do you regulate the regulators.

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  • The idea of revalidation isn't the problem and you probably won't find many nurses who have an issue with it. However, the process being suggested by NMC is ill thought out, lacks integrity and will be open to abuse. That's what nurses have a problem with.

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