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Scottish CNO defends blog criticising poor nursing care


Scotland’s chief nursing officer has told Nursing Times she stands by a controversial blog post in which she highlighted instances of unprofessional behaviour by nurses.

In the New Year blog, Fiona McQueen set out her wishes for 2016, including calling on the profession to “put patients first at all times”.

“I absolutely stand by it. But I am genuinely sorry for the upset I’ve caused to decent, hard-working nurses”

Fiona McQueen

The article entitled “No more Mrs Pishy Pants” featured some examples of poor care witnessed by Ms McQueen in the past year. Among them was an incident where a registered nurse threatened a patient with the words: “If you wet the bed, we’ll call you pishy pants”. She said she never wanted to hear comments like that again.

“At all times I want nurses and midwives to put their patients first,” she wrote. “No skipping off for a break when relatives need to speak to you or worse when patients should be having their meals served.”

The article prompted outrage among some nurses, who complained it painted a poor picture of the profession as a whole.

One nurse said she was “disappointed” by the blog post, which left her feeling “quite disheartened”.

“I, along with many of my friends and colleagues, felt that nurses were being ‘tarred with the same brush’, in particular with reference to nurses skipping off for a break,” she wrote in response.

“On some shifts nurses often struggle even to have a toilet break never mind a tea break. There are lots of good nurses and we need to place more emphasis on the excellent care, compassion and dedication nurses display daily especially under current nursing workforce pressures,” she said.

“It has surprised me that we feel unable to talk about the professional behaviour you would expect in interactions between nurses and patients”

Fiona McQueen

Another described the article as “yet another slap in the face to the vast majority of staff who are professional, hard-working, caring individuals”.

In addition, the blog prompted a letter from the union Unison, which described it as “demoralising” and “unfair”.

Ms McQueen has publicly apologised to nurses genuinely upset by what she wrote, but she told Nursing Times in an interview that she stood by the piece.

“I absolutely stand by it. But I am genuinely sorry for the upset I’ve caused to decent, hard-working nurses who maybe don’t get their breaks, are under severe pressure and thought I meant all nurses,” she said.

“However, I have had overwhelming support from the public and from a lot of nurses and others who’ve contacted me to say ‘quite right – this needs to be said’, and I really want to build on that momentum.”

CNO for Scotland

Professor Fiona McQueen appointed CNO for Scotland

Fiona McQueen

The blog post – which also mentioned examples of care “so good it’s breath-taking” – featured other instances of rude and dismissive behaviour, including midwives being surly and unwelcoming and removing a newborn baby from a mother’s bedside “without a word of explanation”.

Ms McQueen said she had been “quite shocked” by the number of people who had contacted her to applaud her stance and highlight other incidents of poor care. She said it was clear her article had “hit a nerve”.

“We seem comfortable talking about physical harm to patients and the profession is rightly proud of the impact a lot of nurses have had on improving outcomes for patients,” she said.

“But it has surprised me that we feel unable to talk about the professional behaviour you would expect in interactions between nurses and patients,” she said.

“It is so important and for me is the absolute essence of excellent care. Yet what relatives – and nurses – are saying is that it is actually quite difficult to speak out,” she added.

“As chief nurse, I think it is my job to challenge”

Fiona McQueen

She said as CNO for Scotland it was her role to be a cheerleader for the profession but also to challenge it.

“Some people have asked ‘whose side are you on’? I am on nurses’ side but if we’re going to truly meet patients’ needs we’re going to have to face up to the fact we don’t always get it right,” she said.

“As chief nurse, I think it is my job to challenge and my call to arms is: we can eradicate complaints about attitude and communication,” she said. “Within Scotland, 50% of complaints are about attitude and I think that’s something we need to talk about.

“I also challenged leaders to get enough resources so nurses can get their breaks, have time for reflection and continuous professional development and the environment to flourish so that we’re nourishing our staff as well,” she noted.

While adequate resourcing and ensuring a supportive culture were key, Ms McQueen said there was also an issue of “complacency” in nursing and that professionalism tended to be “more consistent” among allied health professionals.

“I think there is something about complacency,” she said. “I think a lot of the time nurses think it is okay to say to patient ‘Yes – I’ll get you that but I do have 30 other patients to deal with’. That’s different from saying ‘Of course I’ll get that for you, I have one or two other things to do but I’ll be back with you in 10 minutes’.

“If I look at the behaviour of allied health professions my sense is their level of professionalism is more consistent than in nursing,” she said. “This may be something to do with the one-to-one relationship AHPs have on the whole with people, whereas nurses have a caseload and there’s more pressure.”

“My sense is allied health professionals’ level of professionalism is more consistent than in nursing”

Fiona McQueen

Ms McQueen said she had been talking to universities about the need to cover the concept of professionalism in nurse education and was optimistic the introduction of revalidation would help by encouraging “feedback and reflection”.

“In Scotland we are looking at having a quality assurance system across the country which now, for sure, is going to include something about attitudes and behaviour,” she said.

“There is outstanding care delivered nearly all of the time but I am keen to take everyone to that level. My resolve has been stiffened by the amount of support I’ve had publicly and privately that this is what we need to do across the board,” she told Nursing Times.

Ms McQueen has been backed by the Scottish government. A spokeswoman said: “The chief nurse is immensely proud of all the work done by nurses across NHS Scotland. The care they provide every day is second to none.

“But the chief nurse is also passionate about getting it right for every patient, every time,” she said. “Of course, these examples were reflective of exceptional cases where treatment fell below what we demand, rather than generalisations. It is regrettable if anyone has interpreted them differently.

“However, this reflects what we all want – treatment with dignity and the upmost professionalism for every single patient, every single time,” she added.

The Royal College of Nursing said poor practice was not the norm but it was important to challenge it.

“We know there are instances of poor practice, which can undermine all the good work that is done by nursing staff across Scotland every day. This can be down to a number of reasons,” said RCN Scotland in a statement.

“It is crucial nursing staff are able to raise their concerns in an open and transparent way, whether this is about a negative working culture, low morale because of nurses being under immense pressure at work or, in a very, very few instances, poor individual conduct,” it added.


Readers' comments (7)

  • Em when did she last care for a patient. Typical, lets just knock nurses, everyones doing it the CNO, Nurse Managers, patients, the public. No wonder complaints are about and attitudes, who does she think she is. Nurses are exposed to dreadful attitudes on a daily basis, so are we supposed to become a breed of " Stepford Nurses" and just smile sweetly and accept everyone disrespecting us - I dont't think so. "Unison, which described it as “demoralising” and “unfair”. Totally agree with this comment. Fiona McQueen should listen to the nurses point of view instead we get the usual sanctimonious guff quoted by someone only out for themself, and pretendingit's in the interst of patients

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  • Generally speaking its the nurses that can't hack it on the shop floor and those that don't really enjoy looking after patients that climb the job ladder!

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  • It's the lack of qualified nurses that make it so difficult to give the standard of good care that the majority of nurses want to give. The nurse patient ratio needs to be seriously looked at, 1:14 patients make it impossible to provide quality care, lots of nurses are wanting to leave because of this.

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  • To be clear Fiona McQueen's comments were to do with the attitude of SOME nurses and not the fact that 'care' was not provided. We may get all of our shopping scanned through correctly and even packed for us in a supermarket, but if the checkout operator is rude and miserable the overall experience will be poor and we possibly complain to management. If not we certainly do to our friends and relatives. That for me is what Ms McQueen's point is. A poor attitude is just as damaging for the profession as is providing a poor care package

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  • Guy Holt - that is very poor comparison, and it's not just 'some nurses who have a poor attitude' but as i have highlighted we are the easy targets and can't even rely on the CNO to back us up. No wonder nurses are leaving the profession.

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  • 'No skipping off for a break when relatives need to speak to you'.
    This CNO should work on my ward. There is a constant barrage of phone calls from relatives so much so, that nurses can hardly get time enough to look after the patients, they call all day long and on visiting time they sometimes get annoyed when the nurses are taking too long with a patient to talk to them.
    One even reported me for keeping her waiting so long when I was with poorly patients because she would have to pay more for her parking.
    In fact this point on relatives taking up so much of the nurses time is becoming a massive problem.
    When I worked in another hospital the Ward Sister dealth with this problem by spending the evenings talking with relatives who had to have an appointment slot, so her nurses can just get on with their nursing of the patients and get the much needed jobs done.

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  • As a practising nurse for more than 30 yrs I find the level of comment about this disappointing. The Chief Nurse is highlighting examples of poor attitudes - arguing that we are worn down and understaffed does not excuse these. To counter what she says with 'when did she last look after a pt' is breathtakingly naive - poor attitudes are identifable by people who haven't even trained as a nurse let alone require being in current bedside practice.

    Atrocious RN to pt ratios of 1:14 need to be challenged - contact the CNO if you are getting nowhere locally. Part of her remit is to address factors which are interfering with quality care. Challenge poor ward organisation which doesn't set boundaries of acceptable behaviour for relatives, demand better admin support to free up nursing time for nursing.

    If you are a RN and upset by the CNO wanting to improve professional attitudes so that no one who wets the bed ever gets called 'pishy pants' you need to seriously question your professionalism. Things have never been perfect in nursing but they are always worse when poor practice is tolerated, when nurses don't identify where care isn't as it should be and why and push to change that - whether it be more staff, better skill mix, better ward organisation. We are too tolerant of the status quo, partly because we are worn down, and find it hard - or lack the skills - to take a step back to analyse what needs changing and to articulate that as a team in our respective workplaces. But my experience is that if we do that things can change.

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