Some nursing directors are still shirking responsibility for front line care, the new chief nurse at scandal-hit Mid Staffordshire Foundation Trust has warned.
Her comments come following fresh revelations of appalling standards made by the latest inquiry into the trust. The inquiry, chaired by lawyer Robert Francis, made a number of recommendations designed to improve nursing care both at the trust, which was criticised last year by the Healthcare Commission for systematic failings that led to patient deaths.
He refereed to the responsibilities of senior nurses calling on the Trust to: “review the management and leadership of the nursing staff.” (see box for further recommendations)
Mid Staffordshire Foundation Trust nursing director Julie Hendry told Nursing Times: “Too many nurse directors think the role is purely strategic. I have met those who think it is a strategic, not operational, role. I have never believed that.
“What’s happening on the ward is so inextricably linked to the role – you cannot separate them. I’m afraid that some of my [nurse director] colleagues are.”
Her comments come as over 500 nurses responding to a Nursing Times survey expressing concern that the failures seen at Stafford Hospital can also be found in their area.
The results cast doubt on the assertions made by the government and regulators, that Mid Staffordshire is an isolated case of failure.
Nursingtimes.net readers were asked how confident they were that the poor levels of care seen at Mid Staffordshire were not experienced by patients in their organisation.
They were asked to rank their confidence on a scale of one (very confident) to five (not at all confident). Just over one third of respondents gave scores of four or five. A further 28 per cent chose a score of three.
Over 400 respondents gave reasons for their concerns. Many of their comments focused on staff levels and workload.
One said: “There have been six vacancies from a team of 40 for over nine months. We have been told if we don’t like it we can leave by the general manager.”
Another commented: “Staffing levels on our renal medical ward are such that quality of care suffers routinely. This is not as a result of poor nursing – it is a direct result of a view from management that fewer nurses and support workers are required than reality dictates is necessary.”
A third respondent said: “It is not uncommon for me to be the nurse in charge, the only nurse who can administer IVs, have a patient workload of between six and eight patients, and have to provide clinical support and supervision to two newly qualified staff [with] on average eight patients each.”
The comments suggest some senior nurses are presiding over overstretched staff and poor conditions.
At the same time they are coming under greater scrutiny from the Nursing and Midwifery Council, which is carrying out investigations at both Mid Staffordshire and Basildon and Thurrock University Hospitals Foundation Trust, the subject of reports of poor care and low nurse numbers late last year.
The Mid Staffordshire inquiry was particularly critical of Jan Harry, trust nursing director from February 1998 to July 2006, who no longer works there and is thought to no longer be working in the NHS. The inquiry claimed that she “sought to distance herself from anything other than strategic concerns”.
However, current nursing director Ms Hendry believes the systematic and widespread failings at Mid Staffordshire make it a one-off.
Royal College of Nursing chief executive Peter Carter, who visited Stafford Hospital before and after last year’s damning Healthcare Commission report, told Nursing Times: “Mid Staffs had good ratings [from regulators]… so it would be foolish to say there couldn’t be another Mid Staffs out there. I would hope it wouldn’t be so extreme.”
He said there were “obviously some” poor nurse directors, but added: “Overall I think… [they] are the people stopping some of the ill-thought-through decisions.
“Every now and again we come across examples of people who don’t. If they go along with it [bad decisions] and compromise standards and put in inappropriate staffing levels they will ultimately be held accountable.”
Mr Carter said: “The RCN is not going to be a refuge for poor performing nurses but we have got to be very clear whether they were put into a situation where it was impossible to do the job.”