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'We must stop throwing staff into an abyss of emotional burnout'


Here are words I never imagined typing but I heard an interesting comment by comedian Jim Davidson the other day.

He said, when asked how he felt about being criticised: “Being a comedian is one of the few jobs where you are criticised by people who don’t know how to do it.”

It’s interesting because it is of course complete nonsense. Football managers, taxi drivers, ballet dancers, poets, sandwich makers - all of these people and plenty more are criticised daily by people who wouldn’t know a short cut from an arabesque.

Everyone is a critic because everyone is a consumer so, if you are not funny, can’t make a decent sandwich or keep churning out dull poems about badgers and stoats, you are going to get criticised.

Much criticism, of course, lacks incision; it is an expression of taste rather than expertise. However, some criticism is incisive. It is not down to personal taste - and it does matter.

The recent report from the NHS ombudsman saying the treatment of older people is “failing to meet even the most basic standards of care” in some areas will hurt, anger and frustrate just about every nurse who reads it. Coming on the back of the Mid Staffordshire report, it degrades the name of the NHS and it denigrates nursing that sits at the heart of care.

Let’s face it - this is not a new criticism of standards. The Essence of Care sought to try to address such things formally and it was originally published 10 years ago.

Something insidious and frightening is happening in care giving and it seems to be happening too profoundly for it to be dismissed as an occasional incident or an oversight.

The ombudsman talked about a problem of culture and urged a change in attitude. While it is understandable that we may want to defend ourselves from charges of not caring or sometimes not seeing, we can surely do better than that.

I have long believed that a key problem in nursing is the mechanistic and overly administered focus on skills and knowledge ahead of qualities. It may be that these form the bedrock to the grand assumption that nursing is a profession and, because skills and knowledge are relatively easy to measure, it can be regulated and contained. But anyone who has nursed knows that skill and knowledge may underpin good task delivery but it is human qualities that underpin good nursing.

I know that 99% of all nurses who enter training are bursting with qualities such as compassion, generosity, kindness and a desire to care - to be attentive to the needs of others. The question is, however, what are we doing to help those nurses sustain those qualities?

We expect nurses to do their jobs and to retain the ability to care endlessly, tirelessly and attentively, without any focused support on these qualities. It is absurd; it is like treating care as an add-on when it should be the core of the relationship.

Nurse education, professional bodies and organisational managers need to turn their attention away from meeting targets and budgets and look seriously at how to help nurses sustain themselves as deliverers of thoughtful attention.

It means a radical change in what we regulate, what we measure and what we think about when we educate nurses. Without this, we are abandoning our patients and, without even noticing, throwing our nurses into an abyss of emotional burnout.


Readers' comments (10)

  • SO true! And this all too evident lack of basic care & compassion for ones fellow human being arises from just simply being squeezed to do far more with increasingly less. Time is the most valuable resource we can share with our patients and we have less and less of it to give these days despite using technology to help. Whilst completing the paperwork and meeting targets outweighs hands on care as a priority this balance will never be redressed

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  • What we can do to' help those nurses sustain those qualities' is provide them with ward sisters as leaders who work with them, support them and motivate them to maintain the high standard of care our patients deserve.
    Give ward sisters / managers the time and autonomy to run their wards and ward staff and the public will reap the rewards.

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  • May be it's time nurses stood up and publicise the facts... Over many years now we have dwindled in numbers, our patients have increasingly more complex needs which we have no time to address as resources force us to inappropriately prioritise - community is as bad as hospital in this regard, don't you find that patients who complain get the best treatments because it affects outcomes, targets and resources.

    I am compassionate, I am caring, I dont have the time to put it into practice which is why I have so much time owing and am too burnt out to care for my family at the end of my shift.

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  • I honestly think that nurses should go through a screening process to see if they are intrested in caring for the elderly. There is anegative stigma attached to caring for the elderly, it is not very high teck. It is so sad that we are in the caring profession and some nurses thinks caring for the elderly is not important enough. I always think that if someone can show compassion and respect,in return someone will do the same for my parents. We are all going to get old one day, regardlees of your poistion in the NHS. The elderly needs time to do everything, we have to work at there pace.I hope I will get the care I need if I am old in hospital or a nursing home. Thank you, Olga.

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  • I agree with the conclusions of the above article.

    Regarding the statement

    olga nash | 5-Mar-2011 11:49 am

    " is not very high teck."

    The gerontologists would disagree with this. the trouble is that care of the elderly had, and may still have, a reputation of employing people who have been unable to get jobs elsewhere such as older nurses or those returning to employment from abroad. These people may not necessarily wish for a job caring for the elderly and their skills, experience and interests may lie elsewhere but they may need a job and take whatever is going, and where there are staffing shortages, as a last resort.This may only be considered as a stepping stone but nurses often find themselves stuck unwillingly in these jobs. The best response to this is to take an interest in the care provided and seek further training in the broad and fascinating academic and practical field of gerontology (and why should this be any less interesting than any other specialty and which also has areas of specialisation) which will increase understanding of the needs of the elderly, improve skills and turn it into a highly rewarding job where these skills can then be passed on to others and used for successful management of this group of patients and the general organisation of the environment where this care is provided. Rewarding opportunities are everywhere if only nurses would look beyond the ends of their noses. It is up to each individual to seek out these opportunities and to use them to the best advantage to provide the highest standards of care.

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    I myself think that nursing is instinctual and there are many many wonderful nurses on our wards. the problem is that they have ,no support from the higher management It is becoming a dog eat dog world. . Lets start supporting our nurses properly .Give praise when it is due and if we need to criticise make it a constructive criticism,So that the nurse come away from it feeling that the criticism was of value to her ongoing care of her patients and he /his self esteem.

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  • So much publicity is focused on the NHS.There is just as much anxst within the private sector. Targets to be met and another body in another bed= more money to go into the coffers. x amount of staff to x amount of residents with increasing complexity of care which is /cannot always be addressed and never enough time to complete all the paperwork we are supposed to ultimately whether it is the NHS or the private sector who suffers ? its the patient isnt it?
    Encouragement and praise for a job well done means more motivated staff and this in turn improves an outcome for a client surely ?? Self esteem for the profession is at an all time low and I am sure unless you have a very thick skin it is difficult to be an efficient and caring nurse at this time

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  • why is it that when you have had a difficult shift and failed to carry out one of the procedures on your list of tasks, for whatever reason, which you have successfully carried out many times before, an emotionally intelligent and enlightened colleague (increasingly rare) may ask if you would like them to carry it out on your behalf and may offer some useful advice afterwards, whereas others will adopt a bolshie attitude or make some snide remark and go off and do it in a very self-important way, and the patient may report their dissatisfaction afterwards as the nurse may have been brusque, forceful or inconsiderate. They then return saying nothing or with a critical or unfriendly remark leaving you with the impression that they consider you incompetent or an idiot. This then may be further transmitted over the 'Corridor Radio' to other colleagues and the bosses out of context and for misinterpretation!

    How many times have been confronted with this situation? I always prefer to help my colleagues and would never dream of questioning their professional competence without good reason to protect a patient, or offer advice unless I esteem they need it or have asked me for guidance. Working relations are far more successful and agreeable if nurses are helpful and supportive to one another than if they are hostile and antagonistic. Ultimately poor attitude always affects care delivered and the well-being of the patient.

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  • I have been a nurse for many years and still feel passionate about nursing and compassionate towards patients. It saddens me reading this and other similar reports but also leaves a sense of dejavu. Why are nurses scapegoated for wider failings in the health service? Why are we such an easy target? Because we are caring, committed and bound by our code many won`t fight back for fear of bringing our professional reputation into disrepute. Because we don`t want to be seen as `difficult` and then become a target ourselves? Because we are always so busy and rushed we don`t have the time? I know many caring and committed nurses as well as some who are not, sometimes personality comes into it, undeniably there are those in the wrong job or suffering burnout. The vast majority of nurses do care and show that often by working above and beyond the call of duty but they are often not supported by their management and leaders in this. These are management issues. Too much is expected with too little resource, patient care takes time and resources especially when people are sick or at the extremes of life. Cultural change may be needed but it needs to start at the top, I have seen in some organisations the difference good managers and leaders bring to the culture of that organisation. I have also seen nurses deliver good care despite poor management but if an organisation is worn down and under poor management nurses can only firefight the situation but over time they will become victims too and ultimately patients suffer. Nurses are so often at the bottom of the health hierarchical pile particularly where money is concerned, posts cut or not filled to save money, basic equipment lacking, meetings and support networks for nurses shelved due to poor staffing, education and training budgets plundered. How can any workforce feel valued and able to keep continuously delivering and giving under this sort of climate? Please care for nurses so they can continue to care for patients.

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  • Very interesting debate this subject has begun. We all knew that basic nursing care and aseptic technique would go out the window when 'Project 2000' came in. Student nurses made up alot of the workforce and learned the importance of the therapeutic relationship.
    In every department we are short of staff, equipment, and time. We must spend more time inputting data than giving care to our patients.
    I can only see the situation becoming worse as the various 'Trusts' join up to become large and more and more data input will be expected. Managers who at one time lead the team with clinical skills now must lead with office skills.
    I am counting down to my retirement date, and hopefully will not end up on any of these wards as a patient.

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