Vicki Leah and Katherine Fenton explain why effective clinical leadership is vital to ensure dignified care
The Commission on Improving Dignity in Care issued a consultation report following last years’ stream of damning accounts of shocking standards of nursing received in particular by older people. These were painful to read on personal and professional levels. The accounts of appalling care described by patients and carers recounted practices and attitudes from nurses that completely contradict everything the profession stands for.
While we welcome the commission’s report and agree with its recommendations, we feel frustrated and extremely saddened that it has taken an independent commission to show us the way forward.
We cannot help but ask: “How did it come to this?” And: “Why did the nursing profession not step up to the challenge presented to us so vividly in these reports and react immediately and decisively?” We are the guardians of quality and we must uphold the traditional values of nursing in a modern and ever-changing NHS.
The obstacles to dignified care include complacency, a lack of urgency, denial, averting the gaze and arrogance. Are we waking up from a slumber to find a workforce that is disengaged, demotivated, “going through the motions” and always “too busy”?
“It is the ward sisters and charge nurses who will be the key in influencing the behaviours and values of their teams”
The commission recommended recruiting staff on their values as well as their technical skills. Values-based recruitment needs to start at entry level as part of university selection. Assessing candidates’ values, motives and attitudes to work in a patient-centred environment may be the best method to sort out the personality from the CV and lend some credence to the traits of compassion and thoughtfulness. Those good at talking about care practices need to be filtered out from those with the instinct to apply good practices. Recruitment around values rather than capabilities will identify those who do not fit with the model of nursing we all want to be proud to be associated with.
At University College London Hospitals Foundation Trust, we launched a multi-year campaign, Making a Difference Together, to support our team to consistently deliver the highest-quality patient experience, moving from “good” to “great”.
Authentic patient and family involvement is at the heart of this campaign. Four hundred employees attended workshops where five members of staff were paired with patients or carers to listen to the “story of the patient”. These powerful “in your shoes” sessions are just one example of a whole set of work streams aimed at defining and embedding a new way of working with the patient always at the centre.
Effective clinical leadership is essential in translating the outputs from Making a Difference into practice, and it is the ward sisters and charge nurses who will be the key in influencing the behaviours and values of their teams.
Organisations must give ward sisters and charge nurses the freedom to express themselves, to challenge, to innovate, to take risks and try out new ways of doing things if they are to transform services. Sisters and charge nurses must be allowed to lead their teams, not just manage them.
We are moving towards value-based recruitment at all levels and for all professional groups. We need to genuinely integrate patients’ and carers’ opinions into core business, and allow sisters and charge nurses to lead from the front, taking the responsibility, accountability and authority to drive through sustainable changes to deliver the dignified care we all expect.
Vicki Leah is consultant nurse for elderly care, London City and London South Bank Universities; and Katherine Fenton is chief nurse and professor of nursing leadership, University College London Hospitals Foundation Trust