Having worked in several NHS and private healthcare settings, I have found that the stronger the focus on the medical model of care, the less autonomy nurses and therapists have – which can lead to considerable pressures, not to mention a ‘them and us’ mentality.
With this model, nursing staff are under pressure from consultants to discharge patients as soon as they are medically fit. This can lead to conflict as therapists need more time for rehabilitation and to provide equipment – particularly for older people – which can be construed as ‘delaying discharge’ or the derogatory ‘bed-blocking’.
Where I work now, in a 40-bed community hospital in Derbyshire, this is not the case. Generally the multidisciplinary team has a great deal of autonomy and flexibility. We organise nursing care, therapy and other non-medical interventions to fit with patients’, carers’ and our own schedules.
We have a weekly ward meeting involving all health and social care staff, where patients’ care and discharge is agreed and planned. We arrange case conferences involving the patient and significant others to ensure we are all working towards an agreed and realistic goal.
While we have very clearly defined roles, we recognise where these overlap and actively aim to work as a team. If the nursing staff are busy, the therapists will increase the number of patients for washing and dressing practice, or rearrange home visits to fit around outpatient appointments, nursing interventions or carers’ schedules.
Likewise, if therapists need to take patients off the ward early for home visits, breakfast club or gym practice, the nursing staff will assist by ensuring patients have received medication, been washed, dressed and fed and are ready to go on time.
This works extremely well for staff, patients and carers. In my opinion, this is only possible because the hospital takes a positive, holistic approach to care and works very hard to ensure communication is maintained between all involved. Furthermore, all team members are valued and respected for their contribution.
Far too often in the target-driven NHS, therapists and nurses are forced to become adversaries to the detriment of cooperative working and, ultimately, the patient. Trusts that insist on a strictly medical model of care are missing the point. Simply by encouraging and nurturing a positive skill-mix and a more client-centred approach, they will improve the patient experience and reduce the risk of readmission, as well as creating a more harmonious and productive working environment.
Jane Richards is an occupational therapist at Whitworth Hospital, Matlock