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.
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.
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.
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.”
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.
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.”