Concerns about staffing and organisational culture were the biggest issues raised by nurses in response to the consultation on the chief nursing officers’ strategy for the profession, one of the authors of the document has told Nursing Times.
Compassion in practice was published by England’s two top nurses, Jane Cummings and Viv Bennett Hospital, last week following an eight week consultation with nurses around the country.
Professor Juliet Beal, who works alongside chief nursing officer Ms Cummings at the NHS Commissioning Board, told Nursing Times staffing levels and the “absolute, fundamental importance” of culture were highlighted most frequently by the 9,000 respondents.
“There are clearly areas [around the country] where there are not appropriate staffing levels on particular wards… Nurses and midwives absolutely recognise their own accountability… but they said one of the most important levers was to have a culture that enabled them to deliver that care,” she said.
Based around the “6Cs” that Ms Cummings and Ms Bennett believe should underpin nursing - care, compassion, courage, communication, commitment and competence – the strategy also proposes a number of actions.
It recommends boards publish staffing levels “at least every six months” and that all ward managers and team leaders be made supervisory to “give them time to lead”.
Professor Beal said she wanted to “steer clear of ratios”, such as registered nurse to occupied bed, which can mask understaffing at ward level.
Instead boards will be asked to declare publicly they have reviewed staffing levels across the organisation and assured themselves they can be confident of delivering care that will give good outcomes and patient experience.
Professor Beal, who is director of nursing for quality improvement and care at the commissioning board, has ten years experience as a director of nursing in an acute hospital.
She said the evidence around supervisory status for nursing mangers was clear but this meant a “senior leader out on the wards” not “sitting in an office”.
Although the strategy has been largely welcomed by senior nursing figures some have questioned what power they have to implement it.
Professor Beal told nursing times while the power of professional backing for the strategy “should not be underestimated” there were “hard levers” as well.
Commissioners will be encouraged to insist on supervisory nursing managers in contracts with hospitals and other providers of NHS care. In future the requirement to publish staffing levels could be written into the national contract for all NHS organisations.
A detailed implementation plan will be drawn up over the next few months and Ms Cummings and Ms Bennett have promised to report on what progress has been made by the end of February.
Speaking at the conference last week, Ms Cummings said: “We thought it would be a really good opportunity to do a stocktake on where we are at the end of February, in terms of how we move this on. That’s setting a challenge for me and the rest of the team around actually being able to report back on what we’ve done.”
Em Wilkinson-Brice, director of nursing at the Royal Devon and Exeter Foundation Trust, described the strategy as a “call to arms for us to start emotionally investing in some of our nurses”.
“How do you ensure you refresh and regularly lift people to be able to give compassionate care. That’s a really big challenge for us,” she told delegates during a panel debate.
Suzie Loader, director of nursing at Northampton General NHS Trust, added: “We need to recruit people for their values and behaviours as well as their clinical skills.”