It’s another day and there is a new initiative for you to implement. In a bid to improve patient safety and make lines of accountability clear, the health secretary Jeremy Hunt has come up with the idea of putting the name of an accountable nurse above every patient’s bed.
I know – it seems like we have been here before. Anyone around in the early 1990s will remember the named nurse and may be quick to dismiss this idea. And there are certainly lessons to be learnt before we rush into a repeat.
The named nurse initiative of 1990s had its origins in a grassroots movement that aimed to develop the philosophy of primary nursing in the UK. This movement championed the nurse-patient relationship and the vital role that continuity of care played in ensuring patient-centred care. This involved a fundamental change in the way care was organised and delivered.
The success of this approach in a small number of enthusiastic wards and units led to a government policy to implement a blanket named nurse system across the NHS irrespective of whether they had adopted a primary nursing approach to care.
Hours were spent discussing who could be a named nurse - was it just for a shift or length of stay; what happened when staff were on days off etc etc etc.
The failure of this policy lay in rushed implementation, managers and nurses failing to understand why they should do it and inappropriate staffing levels. Fundamentally there was a failure to appreciate that for the nurse-patient relationship to be successful there needed to be a fundamental shift in the way nurses thought about, organised and approached care.
The net result was a cosmetic implementation of the policy, with whiteboards and name badges, which fizzled out as people tired of the “not my patient” reply to every question.
I don’t think this is what Jeremy Hunt is trying to resurrect. But sadly I think it may suffer the same fate with a new generation of nurses.
What worries me is this idea is born out of a need to be seen to do something rather than any real understanding of the problems ward nurses face day to day. We have fundamental problems with staffing and skill mix on many wards and the prospect of major staff shortages in the next few years. There has been a systematic failure to invest in our ward sisters over many years and as the Francis report identified there is a crisis of clinical leadership in nursing.
So by all means put the names above the beds, but it will not make an already overstretched workforce work any differently or any harder. All it will do is make many nurses feel they are being “done to” yet again. Another change with another audit to ensure it is carried out.
So please Mr Hunt, invest in nurses first. Only then will you have a chance of meaningful change with a long-lasting impact on patient safety.
Last week I visited a ward that was actually well staffed; it had a proactive approach to staff education and an experienced and very effective ward sister. The ward was calm, tidy and every patient I spoke to knew their nurse. They didn’t need a name above the bed.
What more can I say?