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'We need to be clear about our primary responsibility'

  • 8 Comments

The NMC is here to protect patients - but it also wants to build bridges with nurses. Charlotte Santry meets chief executive Dickon Weir-Hughes.

Nursing and Midwifery Council chief executive and registrar Dickon Weir-Hughes is absolutely clear about his mission.

“We don’t exist to serve nurses and midwives,” he tells Nursing Times repeatedly, at one point asking: “I’ve probably said that too much, haven’t I?”

Having spent three months in the role and 22 years in the NHS, he is more than aware of the dim opinion of the NMC held by many nurses.

But he says: “We’re here for patients and patient safety so in terms of our mission, whether nurses like us or not is more or less irrelevant.”

This unapologetic focus on patient safety means he is determined to ensure nurses retain and develop their core caring skills in addition to areas of practice perceived as more advanced.

Professor Weir-Hughes calls moves to encourage nurses to think entrepreneurially and set up social enterprises “really exciting” but has “one cautionary note which is about patient safety”.

He says: “As nurses and midwives, we have to be really clear about our primary responsibilities, and that’s about ensuring all our patients and their loved ones receive appropriate, compassionate care in every environment they’re in.

“We know that right now that’s great in some places. It’s not perfect everywhere and as the regulator that’s the thing I would push.”

Professor Weir-Hughes’ own background has seen him working in some challenging environments. Before moving to the NMC, he was executive director of nursing at Barking, Havering and Redbridge University Hospitals Trust.

Prior to that he was assistant director of nursing at Chelsea and Westminster Hospital and then chief nurse and deputy chief executive at The Royal Marsden, having started his career as a staff nurse and progressing to charge nurse at St Bartholomew’s Hospital, all in London.

Patient observations

He emphasises the importance of senior nurses’ role in patient observations. It falls on ward sisters, charge nurses and team leaders to act as role models and make clear the expectations that team members must live up to.

“The culture that they set in their clinical environment or in their team is the culture that will be all-pervasive in that environment. If the ward sister is obsessive about the quality observations then the staff will be too,” he says.

His call is timely given the findings of a Nursing Times survey last October that showed nearly one in four nurses could recall at least one situation in the previous month in which staff had failed to notice a patient’s condition was worsening (news, page 1, 13 October 2009).

The picture painted by the survey was described as “almost catastrophic” by the Royal College of Nursing.

Professor Weir-Hughes says observations must not be something nurses just “chuck towards their healthcare support workers to get on with”.

Registered nurses must take personal responsibility for observations – either carrying them out themselves or taking a very active part in overseeing them.

He says: “It’s really, really, important that nurses prioritise that care and it’s not seen as ‘not my job’ because it’s too basic. That, in my opinion, is completely wrong, it’s just not how it should be.”

Gently admonishing Nursing Times for using the term “basic care”, he says this type of nursing is anything but.

He says: “Giving fundamental care to a very complex patient is very difficult. For me, giving a bed bath to somebody who’s very ill is just as important as a highly technical skill.

“This is one of the things that sets apart a really competent, critically thinking, registered nurse or midwife from another - their ability to look at all that information and assimilate it and come up with a plan or care for that patient and, if necessary, a referral.”

Unfortunately, daily calls from patients and relatives suggest this is not happening universally, which he puts down to “slippage”.

“I don’t think a conscious decision has been taken but I do think that people need to prioritise this area of care,” he says.

Technology must free up staff time for these types of tasks rather than take nurses away from patients. This means the time saved by using machinery should be spent “talking to the patient, allying their fears or providing them with health education”.

Healthcare support workers

Much fundamental care is now carried out by healthcare assistants, and the NMC will be concentrating its efforts on looking into the options for regulating them.

As reported in Nursing Times two weeks ago (news, page 2, 19 January), Mr Weir-Hughes has sent out strong messages that the NMC would potentially be prepared to take on the task.

But pressed on whether he would like this to happen, he says: “’Like’ is probably not the word because it’s an enormous piece of work, and if I’m honest with you it frightens me because it’s so big.”

The NMC is carrying out a “scoping exercise” to see what such a scheme might involve.

He is taking a cautious approach to revalidation, undertaking research and watching how the General Medical Council carries this out for doctors.

Advanced practice

Regulating advanced nursing practice is also on the NMC agenda but is a debate that Professor Weir-Hughes says should not be rushed.

“It has to be done properly, which almost by definition means not hastily. I’d much rather do something properly that takes a little while than do something hastily and for it to be wrong,” he says.

He says that despite extensive research and previous consultation there is still no clear consensus, although there is “clear evidence” from the US that shows regulation can increase patient safety.

However he adds: “If there was ever to be regulation of advanced practice that was so tight it actually hindered innovation that would be terrible.”

 

Building bridges

Despite asserting that the NMC exists for patients, not nurses, Mr Weir-Hughes is keen to build bridges with the profession.

He wants nurses to understand, respect and support the work being carried out by their regulator but says “’if individuals choose not to then…so be it”.

While he is not going to lose any sleep over the issue, he is troubled by research showing support for the regulator is lowest among nursing directors. Over the next year, 12 day-long events are being held for nursing directors, human resources directors and heads of midwifery to find out more about the NMC’s work and observe fitness to practice hearings.

The regulator is working hard to reduce the backlog of such hearings – a frequent subject of complaints. It hopes to achieve this with an improved IT system and new purpose-built facilities. It is also appointing clinicians to help it make better judgements.

Professor Weir-Hughes says the changes should allow the NMC to reduce the number of inappropriate referrals that are unrelated to patient safety or should be dealt with by employers.

“The timeframes are better than they have been for years but we’d still like them down further,” he says.

Spending squeeze

Nurses will not be allowed to use the spending squeeze as an excuse for poor care.

Professor Weir-Hughes says he sympathises with those working in difficult circumstances in financially stretched organisations but says there will always be opportunities for “hard working, enthusiastic, competent nurses”.

He advises nurses to escalate any concerns to nursing directors, saying: “We have some really great nurse leaders…who are there to give advice and manage these sorts of situations and I have every confidence in them.”

The NMC will be issuing guidance on escalating concerns later this year, following consultation.

Preventing and acting on scandals

Legislation underpinning the NMC gives it “lots of scope” to investigate failings at scandal-hit trusts, says Mr Weir-Hughes.

The regulator wants to appoint staff able to interpret information that could indicate problems with standards of nursing in particular organisations.

This would involve looking at coroners’ letters, using intelligence gathered through educational quality assurance processes and interacting with nurses and midwives.

Professor Weir-Hughes explains: “Nurses and midwives would like their regulator to be involved in a positive way, more proactively. Not just following up after everything else has gone before and being a punitive organisation that’s striking people off, but an organisation that’s trying to prevent these things from happening in the first place and trying to help.”

  • 8 Comments

Readers' comments (8)

  • You have to feel sorry for the bloke - he has inherited a sick organisation that is not fit for purpose and run by the twin set and pearls brigade that the profession should have side lined well before now - they have forgotten how hard it is to deliver good clinical service day in day out like most of us do and accept the views of managers as opposed to front line clinicians . . He says that their job is to protect patients - well at least that is honest as for too long the regulator has wanted to run with the fox and hunt with the hounds. The fitness to practice dept is a complete joke and the NMC so called
    " guidance " trips more of us than it helps. The CHRE has said there are huge problems and there doesn't seem to be any improvement - the good professor has got his work cut out - or maybe he will just turn out to be " one of the girls " in the twin set and pearls.

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  • Then what the hell are we paying exorbitant fees for then if they obviously aren't here to serve nurses?

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  • Isn't this the crux of the whole problem? If they aren't here to serve Nurses then what the hell are they here for? For patients? Then maybe they should rename themselves a patient protection council and have the general public pay their fees, and in the meantime us Nurses can get a proper union who exist to fight for and protect US!!!!

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  • To the first anonymous, feel sorry for him? He is just displaying the sheer arrogance that already infests the NMC and is voicing it more than they usually do. Feel sorry for him? You're having a laugh!

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  • These comments have brought me to tears the same way I usually go to sleep at night. I feel sick to the stomach. I work through my breaks and work on average an hour a day over my shift to help the other nurses get back on track due to the fact we are looking after 17 acutely ill patients with two staff nurses and one healthcare a majority of the time. With these numbers prioritising means neglecting tasks which may have an equal value of importance. Thus how can he say that this does not impact on quality and SAFETY OF CARE. Nurses want the best for patients also, so give us the means to do so. In the media an emphasis was placed on poor Dimentia care and suggested we all need better training. Yes this may help but when a Dimentia patient is placed on an acute surgical ward its staff we need not training, because they need time, company and stimulation, not to be sat in a corner as everyone is tied up with poorly patients! Its common sense. I am shocked and dissolusioned by the lack of respect for nurses. Why is it assumed that we like to provide poor care? Who gets blamed for staffing issues? Nurses! We get the frustration and anger from relatives. Every day I have to self counsel because there is no support from management because their hands are tied and are too busy to worry about our welfare. The girls on the ward are so demorilised which does not breed excellence! These organisations pretend to understand with fake sympathy but we bang our heads against brick walls when fighting to highlight these issues. It worries me that the organisations in which we are governed care little in regards to staff health and stress and whether or not we are forced to work in unsafe environments. And yes most of the time it is UNSAFE and I am not gonna be afraid to say it because its the truth and I will fight to the end to PROTECT THE PUBLIC! I am sick of pretending everything is ok, it is like the world of nursing is brainwashed to be silent and subserviant. Our job is made impossible by contradictory policies. We are susposed to raise concern, but make sure you do it in a way that basically allows concerns to continue. If anyone feels my pain please say, its time we stood up for the public and for ourselves.

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  • Us nurses can talk and talk and not reach a solution, solely because the NMC is working for (the protection of Public),,,, well who pays for it? we nurses,
    There can be one solution,,, that is if Nmc really care about us frontline care providers-- that is commence, patient to nurse ratios and then expect the trained member of staff to provide care that is to the standard that is expected of them.

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  • Professor Dickson Weir seems to forget that the NMC takes fees from nurses on an annual basis so that they can practice. The NMC therefore has a duty towards nurses. It has a duty to protect the profession from those who abuse it and a duty to speak up on behalf of the nursing profession about the things that are not right i.e. Government and organisations petty focus on meeting targets and saving money rather than focusing on patients individual needs and appropriate staffing levels to provide good quality care.

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  • Why does no-one seem to understand the point of the NMC on here? You pay your fees and piss and moan about them not supporting nurses. Try reading the interesting pamphlets they send you.

    They are not an organization that's FOR nursing.

    What get's my goat about them is the slippery tentacles of DOH in everything they do. Degree nursing. Check. No involvement in syllabus up to now. Check. IVA/VBS Check. No imminent regulation of advanced practice. Check. All in the interests of the public? I wager not. Pointless impotent bureaucratic waste of your and mine cash. Very Probably. But the public must believe there is someone they can complain to.

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