Sisters and charge nurses must have clearly defined roles as clinical leaders, urge Alistair Hewison and Yvonne Sawbridge
Last month prime minister David Cameron said: “If we want dignity and respect, we need to focus on nurses and the care they deliver. The whole approach to caring in this country needs to be reset. And it needs to start with this simple fact. Caring for patients is what nurses do. Everything else comes second.”
However, events over the past few years, - and indeed those dating back to the 1960s such as the Ely hospital inquiry - suggest that caring often does come a poor second. The disturbing accounts of failures in nursing care revealed by the Francis Inquiry into Mid Staffordshire, the Health Service Ombudsman’s report into care of older people and Care Quality Commission inspections show that in some settings the approach to caring does need to change.
The recent announcement that the prime minister is launching the Nursing and Care Quality Forum shows that care has become a high-profile political concern and, while the measures outlined are welcome, if caring in hospitals is to be “reset”, then more fundamental action is needed.
“Leading care needs to be seen as a full-time role and nurse leaders must be freed from the competing demands placed upon their time so that they can reclaim this responsibility”
Late last year, in response to concerns about care standards, a nursing think tank was convened by the Health Services Management Centre at the University of Birmingham. Its members were executive nurses from acute trusts in the West Midlands and other local and national nursing figures. Its report, Time to care? Responding to Concerns About Poor Nursing Care, can be downloaded from tinyurl.com/bham-pp12.
The think tank’s purpose was to examine the factors that prevent nurses from being able to deliver high-quality care. Its findings support much of what is contained in the government announcement as well as other long-standing concerns that need to be addressed.
For example, ward sisters/charge nurses must have a clearly defined role as the clinical leader of the ward. They should be developed and supported as leaders, recognised throughout the organisation as the linchpin of good patient care, and be the main role model for developing the next generation of compassionate nurses.
The lack of appreciation of the complexity and demands of caring on the part of boards and policy makers has resulted in nursing leadership at ward and board level being diluted and devalued. Leading care needs to be seen as a full-time role and nurse leaders must be freed from the competing demands placed upon their time so that they can reclaim this responsibility.
Where ward design limits how well nurses and patients can see each other, intentional rounding should be introduced - and in a manner that encourages compassion rather than tick-box compliance. A mechanism should enable nurses to prioritise this activity over other demands. Clinical dashboards that capture and measure nursing care indicators and are regularly reported to the board should be introduced into every hospital.
If lasting change is to be achieved, boards must recognise the emotional labour of nursing and establish a systematic approach to supporting nurses. It was noted by Isabel Menzies in the 1960s that nursing work involves carrying out tasks that, by ordinary standards, are distasteful, disgusting and frightening. The increased acuity of hospital patients adds another dimension to the emotional demands care make on nurses.
The Samaritans has effective procedures for supporting its volunteers in their vital and stressful work, yet such a service is not routinely available to hospital staff.
As Mr Cameron, said, caring is what nurses do and, with the organisational and emotional support in place, they can do it more effectively.
Alistair Hewison is senior lecturer; Yvonne Sawbridge is senior fellow; both at the University of Birmingham