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”
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”
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.”
Professor Fiona McQueen appointed CNO for Scotland
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”
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”
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.