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9 ways the Francis report could change your nursing practice


How will the Francis report affect your nursing day? Here’s how …

  1. Allocation of key workers on every shift. Patients should be allocated a key nurse for each shift responsible for coordinating their care needs
  2. Improving of the nurse/doctor relationship.The patient’s key nurse should be present, wherever possible, at every interaction between a doctor and their patient. Nurses can advocate for the patient and coordination of care will be improved.
  3. Ward managers to come out of the office. Ward nurse managers should ensure and develop a clinical aspect to their role, working alongside staff as a role model and mentor
  4. Complexity of older people’s care recognised. The report suggests the development of the creation of a status of registered older person’s nurse.
  5. Regular rounding. Contact and interaction between nurses and patients to be systemised by regular ward rounds to improve engagement with patients.
  6. Who’s who to be clearer. Name badges and uniforms to make it clear to patients and relatives the difference between HCAs and registered nurses
  7. Testing applicants for nursing. Potential student nurses should be tested by at least three months of work experience of hands-on care, including time with the elderly and possible aptitude testing to assess caring and compassion and other professional values
  8. Keeping up to date. Nurses need to ensure they keep up to date through continuing professional development. The report recommends that nurses have an annual learning portfolio, signed by them and countersigned by their manager.
  9. Standardised training for HCAs. As well as regulation of HCAs, the report calls for a common set of national standards for the education and training of healthcare support workers. Robert Francis points out that the minicab driver who takes a patient to hospital is subject to regulation under which they can be disqualified if not a fit and proper person, but the HCA who washes the patient and accompanies him or her to the toilet is not.

Readers' comments (21)

  • I don't disagree with anything....but when do nurses have the time for all this? It would be lovely to always be there for patients. We are just too short staffed for it!! The other issue is lack of bed spaces for patients. We continue to operate on patients with no room in the hospital for them, purely so the hospital can make money. These patients are then nursed in inappropriate settings with few staff or resources to look after them!

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  • Gary Musgrove

    Fully agree with anonymous above. We have had "lean working" "skill mix" re-organisation etc which will only work if the staffing ratio per patient is increased and improvements will only take effect if resources are made available and used "appropriately". I hope when I read the Francis report it has recommendations of this nature too.

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  • I would just like to say all these things were once in place and 'the suits' took it away. Why oh why do non medical staff get employed to run the NHS into the ground. I would love to be there for everyone but unfortunately most of my time is spent on people using the NHS as a hotel as they are the ones who shout loudest because of their addictions!!! They need to be weeded out and a new firmer admission system for 'boomerang' patients needs to be implemented. Its funny how they seem to come in when they know the new junior doctors will be 'on call' so therefore will feed their habit leaving poor Doris with her fractured femer to suffer in silence THE ROT HAS TO STOP!!!

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  • Nursing will take the recommendations on board and will really try to improve things. How about the Managers involved? Will they face any sanctions at all? Well that's a big fat NO! They just get promoted out of the way with a nice big salary. Will they face charges of corporate manslaughter - NO! What about the medical staff?? Where's the justice for the victims and relatives??

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  • So, Francis wants the Ward Managers out of the office then. Well, l have news for him and it's all bad! I am a ward manager and l spend 4 days a week clinically and one day for management. I have to give that 1 day up if the ward needs me, so when do l get to do my 'management stuff' Oh, yes - l stay on after my shift to make sure my audits, sickness and absence, budgets etc etc etc are completed on time and l don't claim this as over time. So come on Francis' live in the real world and walk a mile in my shoes!!!

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  • PS As a nurse of complex older people, I also have to do CHC checklists and DST's which take up inordinate amounts of my time and l have to type them up, attend & present at panel, appeals, talk to patients & relatives whilst juggling my ward and providing hourly rounding for 17 patients of which at least 50% are demented. But l love my job!

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  • Reading through these recommendations, I recognise six of them as having been in place when I was a student in the 1990s.

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  • Anybody who has followed the debate and all of the recommendations, what has been said about adequate and appropriate staffing levels? What has been said about medical practice and what has been said about the different levels of management, what has been said about the roles of other staff working in the hospital who also contribute directly or indirectly to patient care, or was the report focussed on how nurses should practice?

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  • it's always just about the nurses, how bad we are, how we have to do this and that all the time.

    1. the named nurse system has been in place for years, it doesn't happen where I work because we all just work wherever we are needed, there is no consistency.

    2. don't really know how 2 nurses can go around with every doctor - would be nice but we have other stuff to do as well.

    3. hourly rounding - not always achieveable as we often spend at least an hour with one patient.

    4. ward manager to come out of the office, that would be nice but every day seems to be a 'management' day.

    This govt will just fluff around, they don't care. If the Francis Report recommends changes then things should change, why should it be up to the PM, he is not the one looking after people.

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  • Maybe ALL managers should come out of the office? Perhaps seeing for themselves the reality of cost cutting on the wards, ticking stupid boxes which prove nothing re care and standards just add to our ever increasing work load might actually improve patient care. But no, that won't happen ,just keep promoting numpties and blaming the nurses as usual while families demand more and more! But above all, what nurse would raise their concerns about poor care knowing that they will be bullied by senior staff and ignored. The NHS is a busted flush.

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