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If we tolerate pressure it may lead to another Mid Staffs

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I was talking to some second year student nurses this week. I have always thought the second year of a nursing course is the hardest - what with being part university student charged with trying to construct the knowledge and understanding needed to nurse, yet also part working nurse, charged with being increasingly capable and also with fitting in.

What they are engaged in looks like some sort of cultural transition. From “idealism” to “reality”. Or as one student said: “We have to function on hectic pressurised wards and that isn’t always what we are taught it will be like.’

I think most of us understand the power of a work culture and what that can mean. Compromise sometimes, a process of socialisation perhaps. Learning to live with the “harsh realities”. Dealing with pressure and not wanting to let people down. Modern nursing can generate some powerful cultures - as we were reminded by last week’s report into care at Mid Staffordshire NHS Foundation Trust. The question is of course: what is nursing going to do about it?

‘History, managerialism, economics and emotional labour have combined to make brilliant care that bit too distant and poor care too close to possible’

Now it may be that there are some truly awful nurses out there doing really bad things. They may not care a jot about patients or their pain, they may even resent the fact that they have to nurse when really they want to be in Girls Aloud or the Bahamas. But if there are, I think they are a very small minority. Mostly I think nurses want to be good at what they do and I think they do care about the suffering of others. Which begs the question: how do we get bad care? Is it because of bad management? Did we run out of compassion? What allows us to be immune to wrongdoing?

We, as a profession, have to wonder, formally and systematically what happened in Staffordshire Hospital. We have to find a way to share responsibility for it because otherwise we cannot stop it happening again. And one of the things we need to wonder about is the culture of care that is constructed by those “harsh realities” - the trench warfare culture that can strip nursing of its brilliance and patients of their hope.

The frontline nursing reality is constructed by us all: politicians, nurses, managers and consumers. It is often considered too complex to unpack and reconstruct. However, Mid Staffs was swept along on a culture of care that failed patients and, if it can happen there, it can happen elsewhere.

So what can we do? Wait for professional bodies or government quangos to issue new guidelines? Condemn anyone who worked there as somehow different to the rest of us? Different in a way that releases us from self doubt? Or do we simply promise ourselves that we will never offer poor care, never be immune to the sound of pain?

I fear that the history, managerialism, economics and emotional labour have combined to construct a culture of struggle for too many nurses. It makes brilliant care that bit more distant and poor care too close to possible. Nursing has sought to tolerate pressure and struggle in order to protect patients. It’s time, I think, to stop tolerating it for the very same reason.

  • 5 Comments

Readers' comments (5)

  • Prehaps the problem is that we talk about nursing as something tangible that you can reach out and touch. But we have no collective voice or shared identity. We don't know what we are or what we should be but are happy to adapt to the prevailing needs of a policy makers, managers fill the gaps in a service short of cash and short of doctors. The result is that we have taken our eye off the ball and failed to act as a professional body to stop what all of us could see come- a Mid Staffs.
    We need to think quickly about who is going to be our voice and represent our interests and ultimately those of our patients. The NMC has failed us, the RCN has done nothing.
    We need to stop looking at what nurses could be if they stopped being nurses and concentrate on the real power of nursing - the power to care. Nursing is lots of things but ultimately it is about holding a patients hand when they are in pain, sitting with a patient at night and reassuring them when they are frightened, turning a pillow over or smoothing out a bottom sheet so that they feels comfortable.
    We need national leaders who really care, who believe in the power of nursing and are prepared to stand up and fight for what is best for patients. We need them to stand up and articulate what makes nursing special. They seem to be absent from this debate.



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  • Yes, Anonymous 2-March-2010 5:09 PM, our national nursing leaders are absent from this debate. They are however picking up fat salaries.

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  • I completely agree with the contents of this article - if only we could gather enought like minded nurses to speak out for our point of view, we could remind the public that we are ON THEIR SIDE, against so much of hospital management etc.

    Unfortunately, much of the political force of nursing as a profession is sapped through the continual squabbling of those who seek to blame everything on current nurse training, new nurses not caring etc, therefore refocussing the blame internally.

    This is harmful to the profession as a whole... we are all here to care for patients.

    as a member of staff in a trust where the patient:staff ratio is through the roof (1:14 on a cardiac ward with monitors) I can potentially see my hospital going that way if it follows local example and cuts posts.

    If nursing is to regain / maintain public support (much needed in the pre election phase) we need to show publicly that we are on the side of patients. The best personal and medical care is given when trained nurses are able to give it or closely supervise it - with the staffing ratios in our trust this is an impossibility.

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  • Yes if we continue to tolerate the situation we are providing no opportunity to either question or improve it. We are also effectively saying, 'its all ok' when judging by the stories posted here it absolutely isn't.
    I think it would be useful to look at all the reasons that people don't feel able to speak up as well as highlight what happens when people do or have done. There's little use or support in just throwing lots of 'shoulds' about the place as they will eventually become just more missiles to avoid.

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  • Can we get some qualified nurse staffing figures into this debate. Each trust should be made to announce on a ward by ward / speciality by speciality basis (and by shift) their nursing numbers. This should be published on 3 monthly basis. It should include both their planned and actual qualified nurse and HCA levels against the actual numbers of patients. Perhaps the government and the press will then wake up to the fact it is not lazy nurses but poor staffing ratios which are the problem.

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