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'It’s time to change the culture of the NHS'


Equipping nurses with the skills to become leaders has been a long-standing issue for the profession.

Equipping nurses with the skills to become leaders has been a long-standing issue for the profession.

How many times have we heard about the lack of adequate support given to sisters and charge nurses to lead improvements at ward level?

Equally, the profession has had to fi ght hard - too hard - for positions of infl uence in the new clinical commissioning groups, which will lead the design of NHS services at a local level.

Last week there were suggestions that someone may have finally listened and taken notice. The government announced more than £40m was to be invested in leadership training for nurses and other NHS staff over the next three years.

The plan is to provide leadership training to 10,000 NHS staff, including 5,000 nurses and midwives, in what has been billed as the biggest ever project of its kind.

According to the NHS Leadership Academy, which will lead the project, the aim is to create a new generation of leaders that will usher in a new culture within the NHS. Ambitious aims indeed.

Of course, being taught about good leadership is not the whole story of creating good leaders. Natural aptitude, experience and the culture of the organisation in which staff work are all vital factors.

Last week it also emerged the past culture in the NHS - hopefully now long gone - may have allowed young patients to be abused by Jimmy Savile while in the care of the health service.

We heard allegations that nurses knew the risk he posed to their patients but felt unable to speak out or prevent the abuse. When one nurse did share her concerns with a policeman, he said they were dismissed by his superiors.

It is hard to imagine something as bad as this being allowed to happen today but, even though progress has been made, recent cases like Winterbourne View and others suggest work still needs to be done. The present culture in healthcare still seems slightly reluctant to view the raising of concerns as a good thing that can improve care, rather than something to be hushed up and hidden away.

Therefore, it is also welcome to learn that a range of key organisations, from employers to unions, had signed a whistleblowing charter to support the raising of concerns by nurses.

Nurses should be in the vanguard of changing the culture of the NHS. But they cannot do it alone. The charter must be worth the paper it is written on and the academy’s drive must deliver genuine access to leadership training for nurses.


Readers' comments (10)

  • tinkerbell

    well let's hope the change is positive and fast tracked because how many years has this madness been going on with corrupt management? Bad practice, bad culture, where the good nurses have to leave as the scapegoats to save the bad guys?

    Bring it on, far too long overdue, at least the whole of my career as a nurse waiting for change, but part of me wonders is it all another whitewash in the whitehouse.

    As usual i hope i am wrong and it be will be the dawn of new, honest era and not just more lip service.

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  • Anonymous

    tinkerbell | 17-Oct-2012 9:44 am

    You are probably right, because the issue isn't how to improve good existing cultures, but how to deal with cultures that are bad: it isn't entirely clear, that this has been adequately addressed yet.

    You've got to work out how to protect the people who raise concerns, as the first step.

    Much easier, as is often the case, to describe the problem, than to propose suitable solutions.

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  • I'm a newly qualified nurse and got a ticking off from my ward sister for speaking to doctors and daring to make suggestions, I wrote a report detailing a recommendation that has been filed away and ignored, and been told as a junior nurse I am bottom of the heirachy and have no place in offering advice/talking to doctors.
    I have toned down and curbed my enthusiasm and now tow the line. I honestly thought now I was staff nurse, I could contribute to nursing care, how i have quickly learnt as told.
    Ward culture gossip and undrmining.

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  • Ward culture has detoriated considerably since the matron was in control.
    Most time there is not enought staff however, there are times when there are sufficient but there is still no help coming from the lot who are working on the 'easier' side. I have spoken about this on various wards I've been on, but the sisters just did nothing about it.
    I've noticed now the sisters are beginining to wear their own clothes instead of uniform so they do get away from being clinical.
    The sisters also only work on the early shifts and try to get away by 16:00 hrs.
    The late shifts especially are very difficult as the Multi Disciplinary team gone the sisters gone the ward clerk gone. I do not understand why there is also less staff on the late shift as this is when it gets dangerous for falls, the relatives are around as visiting time and they want to talk to he nurse taking care of their love ones.
    There should be a strong lead on all the shifts and when sisters and senior managers take responsibility for the people in their care and lead by example then the culture will start to change.
    I am sorry that the newly qualified above has been made to feel that she has to join the rest of the crowd and stay quiet and carry on.

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  • Juggling Dog

    Anonymous | 20-Oct-2012 11:36 am

    The medics have now started to accept that consultants need to be around the place all 24 hours to deal with emergencies - fits with your:

    I do not understand why there is also less staff on the late shift as this is when it gets dangerous for falls, the relatives are around as visiting time and they want to talk to he nurse taking care of their love ones.

    Anonymous | 20-Oct-2012 10:55 am

    'how i have quickly learnt as told.'

    Irrespective of 'nurses are no longer handmaidens for doctors', there are tensions between the concepts of nurses being autonomous professionals, something such as a hospital needing to have 'joined-up behaviour', and patients needing to know who is at fault if they receive poor care or flawed treatment.

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  • I agree with all of the above , nursing is rife with bulling , staff shortages and exhausted nurses, everyone so stressed out with having to watch their backs all the time , Ive been nursing for 34 years and yes we no longer have to practically curtsy to a matron these days, but we know not to speak up or become to mouthy or work is made even more difficult. Its been along time since I have encouraged youngsters to go into nursing as I think of it now as a thankless job spent literately running around like a headless chicken, I'm 54 now and can retire next year but my pension will not pay the energy bills and roof tax so its not a realistic possibility . This latest endeavor smacks of assertive training that was all the rage 15 years ago , that caused chaos as the bullies became more adept at what they did best, no one could actually get on with their own jobs, It wasn't long before managers gave it up as a bad idea.

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  • I agree with a lot of the negative comments above......its been my experience too and I've lost jobs because I spoke out! And there's no loyalty either...first whiff of trouble and your "mates" vanish!
    I think its down to insecurity on the part of the seniors...think some people were definitely promoted too far and too fast!

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  • NO, NO, NO, NO. We do not need more leaders. Has no-one learnt anything in the last 30 years. Leaders = bullying. We need to make EACH PERSON a leader of themselves. For 30 years I worked as a secretary without any supervision and I was fine working that way, very productive, very happy. Now I have a superviser who makes me less productive and less happy. We need to get rid of the majority of them with just a few to encourage and manage the department.

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  • I agree, some people has been promoted too far and too fast. ( 10:20 )
    I have met many of them.
    This is a big problem on the wards as people in management unable to run the ward effectively, don't know a thing about dynamic organisation of work load.
    Try to stay away from the patients as much as possible. Spent hours and hours doing off duty, unable to deal with lazy staff, not training any one, even those Health care Assistant who don't even know how to put away dirty lining. Not taking the student nurses under their wings and working with them. When the ward gets hectic runs off to do office work. Unable to detect bullying and deal with it. Some even has poor communication skills.
    A big reason the wards is such a stressful place is the inability of ward managers to manage. This need urgent attention.

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  • I am not changing anymore. I shall remain totally rigid and inflexibly rooted to the floor and refuse to budge one way or another.

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