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'Nursing needs to get comfortable with being challenged and challenging itself'

  • 14 Comments

Nursing has not gone bad. That was the view of Peter Carter, chief executive and general secretary of the Royal College of Nursing, when he spoke at last week’s Student Nursing Times Awards ceremony in London.

He is most certainly right. No one who sat in that room and listened to the stories of nurses and students delivering extraordinarily compassionate care on a daily basis – sometimes in the most difficult of circumstances – could contend that the NHS is bereft of good nursing. It simply isn’t true.

Story after story of excellent care crosses my desk. I hear from patients who are overwhelmed at the good care they have received, from staff who want to praise their colleagues and from managers who are delighted with the way their nursing teams look after their service users.

Coming a week after the RCN congress, where nurses stood up and admitted to often putting their patients before their own families and themselves by going in on days off and working unpaid overtime, it is clear there are plenty of nurses who provide compassionate care that is exemplary.

But the chief nursing officer of England Jane Cummings says it is not consistent across all parts of the NHS. And she is right.

So why is this?

It could be there are pockets of bad practice that are not challenged. It could be trusts under pressure to meet tough financial or performance targets. It could be poor leadership. In many cases it’s all three.

Nursing needs to get comfortable with being challenged and challenging itself and others. Professor June Andrews, our lifetime achievement award winner at the Nursing Times Awards 2012, verbalised this beautifully at last week’s Student Awards. She said that you should always ask “Why?” when someone tells you not to do something or to do something.

But how comfortable are nurses and student nurses with asking why? How receptive are nurses to being asked why? And are they just too busy and too over-stretched to even think about whether they are doing things the best way?

The profession needs to find a way of creating a culture of expressing opinions that doesn’t create disharmony but fosters good practice and service improvement.

All leaders – not just some - need to get better at this open style of managing, and trusts need to think about always listening to their staff when they challenge and raise concerns.

Change must come from everyone – the leaders and their teams.  Everyone has a duty to speak out – but must feel safe to do so.

This is why our Speak Out Safely campaign is so important. Everyone should feel comfortable challenging practice and raising concerns, and we won’t rest until they do.

Find out more about our campaign at nursingtimes.net/sos.

  • 14 Comments

Readers' comments (14)

  • As a new B.S.N. R.N. I am appalled at the actual working culture I have found myself in. Expression of ideas and opinions has been met with outright hostility. Lateral violence is alive and well for too many practicing nurses. Speak Out Safely is an excellent place to start. As a new nurse, I am committed to being a patient advocate and will not compromise my integrity by cutting corners or providing inferior patient care. Let's all stand together to ensure that Nursing remains a honorable profession!

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  • Anonymous | 7-May-2013 6:04 pm

    I agree with you. Having trained a long time ago and spent most of my working life outside the UK in an excellent working environment until the latter years when reorganisation, general management, staff cutbacks, IT and increasing volumes of paperwork took over too many direct nursing care hours, I just wonder how widespread this really is? Our flagship hospital caught the USA general management model bug just like the UK which all but destroyed patient centred care and processed them all instead along on a conveyor belt system similar to goods handled by staff on factory floor! We lost much of our professional autonomy and had many of our decisions even at clinical level made for us by the coffee drinkers/biscuit munchers/chain smokers on the top floor whom we had never met and who had never had any contact with any of the patients.

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  • "But the chief nursing officer of England Jane Cummings says it is not consistent across all parts of the NHS. And she is right."
    I am so fed up with this government puppet mouthing off but saying nothing useful. She had steadfastly refused to speak out about nursing staff shortages which has been highlighted by the RCN as a major cause of poor care. If it were not for nurses subsidising the NHS by working over their contracted hours for free, things would be a lot worse. But managers are quite happy to rely on their good will and continue to cut nursing posts and not replace nurses who have left. How does Ms Cummings know anything about nursing now that she is entrenched in her ivory tower at the Department of Health and do doubt at Mr Hunts beck and call.

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  • It appears that "good nursing" not being consistent means nurses need to conistently prop up shortage of staff by going in when on leave and working over contracted hours. Is this the new dedication we are moving towards?

    I trained the the 70's and recently have willingly gone in when on leave (to no thanks, just abuse from some patients expecting to be seen even earlier), and also worked outside contracted hours (to be complained about by patients who choose to not keep appointments but insist on their prescriptions stat when I am only trying to reduce their risk of complications).

    The whole system is skewed towards (in many cases) unrealistic expectation of the receivers of care on an increasingly diminishing provsion of care, and we are to put the patient first?

    Yes, when my own daughter was in hospital after a suicide attempt, I still turned up for work the next morning, then when my last patient arrived 15 minutes late (when I was due at the hospital myself) guess what?

    Yes the patient complained I was in too much of a hurry to care!

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  • Jenni Middleton
    I don't know which ' school' of journalism you went to, but surely they told you not to begin a sentence, least of all a paragraph, with the word ' But'.

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  • michael stone

    redpaddys12 | 10-May-2013 4:41 am

    Why should sentences not begin with 'but' ?

    Practice should be evidence-based. But all too often, it isn't.

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  • DH Agent - as if ! | 10-May-2013 12:38 pm

    "redpaddys12 | 10-May-2013 4:41 am

    Why should sentences not begin with 'but' ?"

    it was never allowed when i was at school, nor was starting sentences with and. Why? Dunno! I wasn't very attentive at school.




    "Practice should be evidence-based. But all too often, it isn't."

    Who first said this, it is a fairly recent concept? before it was based on sound clinical judgement, observation and exchange of information with the experts and seemed to work very well and arguably even better than now where stereoptyped guidelines seem to have overridden basic common sense and professional autonomy and good judgement.

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  • Mike Stone
    Because it makes for poor sentence structure, and whilst not per-se against the rules of grammar, has been bad form in this country for at least the last hundred years!

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  • redpaddys12 | 10-May-2013 6:18 pm

    seems the rules of English are changing and becoming far more lax if the press is anything to go by.

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  • Anonymous | 8-May-2013 4:49 pm

    "If it were not for nurses subsidising the NHS by working over their contracted hours for free, things would be a lot worse. But managers are quite happy to rely on their good will and continue to cut nursing posts and not replace nurses who have left."

    Anonymous | 9-May-2013 2:03 pm

    "It appears that "good nursing" not being consistent means nurses need to conistently prop up shortage of staff by going in when on leave and working over contracted hours. Is this the new dedication we are moving towards?"

    Here's a challenge to nurses, and it is one that they really don't like. Stop propping up a failing system! It causes more harm to patients. Stop working extra hours for free, take your breaks and go home on time. Management will have absolutely no reason to staff your ward/unit adequately, as long as they have staff who are willing to plug the gaps for free and take the abuse for it. As you have both demonstrated in your comments, what you are doing at present doesn't benefit patients or yourselves. Ironically, it is actually making things worse.

    Anon 9 May 2.03pm......I really do hope that things are better for your daughter. You need to look after yourself too.

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