Jill Maben on why nurses should be given therapeutic supervision to help them deliver compassionate care
Compassionate care is high on the health policy agenda. There has been much castigation in the press in recent years, of nurses in particular, for the lack of compassion in patient care. Compassion and dignity are also, quite rightly, high on any patient’s wish list for the care they receive.
I believe that most nurses come into the profession motivated to provide patients with excellent, compassionate care. Most emerge from their training having identified the nurses they do not want to be like - those who seem ‘hardened’, and unable to ‘care’ anymore. Yet many, at some point in their career will find themselves, like these colleagues, less able to give of themselves, less able to ‘care’.
I suspect most nurses at some point have felt emotionally ‘burnt out’. My first time came early. I had been qualified just a year and was working on a busy male medical ward. The sixth patient had died in as many days and I found myself unable to keep going. I headed for the treatment room to let some emotion out, and was ‘caught’ by the nursing officer who told me to ‘pull myself together’. It was the support of a junior doctor that week that got me through, though I soon left to do a degree in history, claiming I was done with nursing.
I have come back again and again, pulled by the desire to make a difference, and by the moments of satisfaction derived from nursing, but have often needed to take a break or a sidestep to ‘manage’ my emotions.
Undoubtedly the emotional work involved in giving care is very hard. Nurses meet people when they are sick, frightened, and in the most messy and fragile moments of what it means to be human. This is what makes nursing such a privilege, and what can give such powerful job satisfaction. Yet it can also make nurses feel inadequate and it saps emotional energy. It is hard to go the extra mile for every patient every day, and yet we know we should. It may one day be our relative or ourselves, and it is our professional duty and what drives us, or what drove us at some point.
‘Where is the duty of care to the carers? I believe there is a role for therapeutic supervision. The more nurses feel cared for, the more they will be able to care for patients’
Yet where is the duty of care to the carers? If it was difficult for me as a young nurse in 1984, it is much more difficult now. Patients are sicker both in hospital and on their return to the community. They stay in hospital for a shorter time and the opportunity to forge relationships is reduced. Yet today, patients rightly have even higher expectations. They want to be cared about as well as cared for.
I didn’t receive much empathy from my manager, and hope this is different today, although the pressures on managers are even greater, with ward sisters themselves more likely to burn out. My support came from other colleagues. The debrief with a drink after work is a good way to let off steam, yet this is not the case for everyone and often only applies to a ‘really stressful day’, not to the slow burn build-up.
I have long believed there is a role for therapeutic supervision, the kind that social work and mental health practitioners experience. A space to be listened to, not what sometimes passes for supervision which is much more about management.
Work that aims to transform patients’ experience of care and enable staff to deliver quality care is under way through the Point of Care programme from The King’s Fund. As part of this Schwartz Center Rounds® will be introduced to the UK. These provide a monthly, one-hour session for staff to discuss difficult issues arising from patient care and have improved the ability of staff to provide compassionate care.
Schwartz Center Rounds® were inspired by founder Kenneth B. Schwartz, who died of cancer aged 40 in Boston, US. During his illness Ken experienced care with and without compassion (‘The nurse was cool and brusque, as if I were just another faceless patient’ (then) ‘she softened, took my hand, and asked how I was doing’), both experiences from the same nurse.
As Schwartz reflects: ‘Looking back, I realize that in a high-volume setting, the high-pressure atmosphere tends to stifle a caregiver’s inherent compassion and humanity. But the briefest pause in the frenetic pace can bring out the best in a caregiver and do much for a terrified patient.’
There never seems enough time to care and those pauses in the frenetic pace of our lives are hard to find and so perhaps we need to create them, not only for patients but for ourselves, the carers. I strongly believe that the more nurses feel cared for, the more they will feel able to care for their patients.
I am currently directing a research project examining links between patients’ experiences of care and staff well-being and hope this work will provide the evidence and the business case to move this topic further up the health policy agenda.
I believe it is time for healthcare organisations to take greater care of their employees, to support staff and allow them time to recover from the challenges inherent in caring for others. Compassion, empathy and dignity have long been the hallmarks of high-quality nursing care. Let them also be the defining features of employee care and support for nurses across the UK.
Dr Jill Maben is senior research fellow and deputy director, National Nursing Research Unit, Florence NightingaleSchool of Nursing and Midwifery, King’s College, London