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Hot topic: ‘There is a lot more to nursing than just complying with legislation and policies’

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Nurses must rise above rigid processes and easy excuses to ensure patient needs are fully met, says Andrew Makin as he reflects on his parents’ care in hospital

When nursing journals carry descriptions of health and social care services as experienced by those who know how they should work, the picture is often far from pretty. Now, as my parents die, it’s my turn to find out.

When you have worked in a specialty – end-of-life care for older people – for as long as I have long, you assume that other nurses know what you know. It comes as quite a shock to realise that acute care is not on the same wavelength as primary care.

Every time my parents have been in hospital – and they have been in and out of a few in recent years, things have gone wrong; things that should not have gone wrong and about which we had to complain. No discharge planning, inappropriate medication, nurses using the wrong name, not putting my dad’s hearing aid in, for example. Worst of all was the retribution my mother received on her deathbed – complaints from one nurse that she rang the bell too much and that her son should not meddle in their affairs – I had queried some catheter care. Should I have kept quiet and not asked questions?

We did not want to turn into serial complainers, and we understood that managing co-morbidities in older people is a juggling act. Sometimes you are going to drop the ball. It happens and it’s nobody’s fault.

So were we just an unlucky family or was it because we knew good care from bad? They sure picked the wrong people to mess with. But that thought engenders another – that there are right people to
mess with – the inarticulate, the poorly educated and the grateful. And another – that most of the time nurses get away with it, so come to see it as OK.

My mother’s death was managed well enough, once we got people to understand that she knew her life was over. They were caring but puzzled staff, thinking only of treatment and cure, not of her.
The young student, whom my mother singled out for his empathy, began to see that nursing is sometimes not about cure but about compassion.

Like so many couples, my parents had propped each other up and, as so often happens, this masked the true level of dependency that my father, superficially the strong one, had developed.

His slide into disorientation has been dramatic. In August he preached his last sermon; now he is a shrunken old man. They’ve branded him ‘EMI’ – a quick fix of a label that does not begin to describe him.

Some nurses scare me because soon I’ll be old, too. Will they listen to me, or rely on processes devised by someone who has not stood at my bedside as they have? Will all I have tried to do myself be lost in their adherence to process?

The worth of a nurse is more than just complying with legislation and policies.

The malaise in our health and social care services is more than a failure to comply. It is a disinterest in quality of care for its own sake; it is the mantra that ‘good enough is good enough’.

We can blame government targets and Project 2000. We can even blame society for not appreciating us, and that is worst of all because then we become a sulky, hard-done-by profession.

We become the nurse who told me defensively: ‘If you haven’t got enough staff you can’t deliver the care plan.’ Not an excuse I was ever allowed to use.

Our goal is not process. Process is worthless if the person on the receiving end ceases to be the purpose for its existence. The goal for us is author Ralph Waldo Emerson’s definition of success – ‘to know even one life has breathed easier because you have lived. This is to have succeeded’.
Good enough is not good enough – it is mere compliance and unremarkable. We should always aim for success, which is defined by what the patient says it is.

If we are satisfied with anything less than that, we’re in the wrong job.

Andrew Makin is a nursing director at the Registered Nursing Home Association

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