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Please Mr Hunt, invest in nurses first

  • Comments (9)

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?

  • Comments (9)

Readers' comments (9)

  • Anonymous

    '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 'named clinician' approach logically has to be about that person (nurse and/or doctor) 'investing more time and effort' in becoming deeply familiar with the patient. This is fundamentally 'at odds with' a culture of 'write everything necessary down and then refer to the records'.

    This is like so many things: you get 'pilots' when everyone understands the point, and is given enough resources, then wider roll-outs, when the point of the thing is corrupted or not properly understood, or when lack of resources stop it from being applied properly.

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  • tinkerbell

    yesterday i visited another nursing home, 25 patients on one floor, mostly all total needs. Very pleasant young RN nurse spent time with me and i highlighted a couple of things, insulin not signed for, has it been given? Yes. Good. No access to fluids by a ladys bed who can drink independently and is recovering from a UTI. Sorted. In the end i said as i can't seem to stop myself anymore from asking this question 'Do you have enough staff - Yes. How many staff do you have? 5. Does that include you - yes. How many qualified, just me. How many patients do you have - 25. Do you have 5 staff on an early and 5 a late? We work long days.(quick calculation that these 5 staff will need at least a 40 min break throughout the whole day).

    At the end of it all i said 'you must be rushed off your feet'. She answers 'No, not really'. Hmmm!

    So if this RN works regular long days, and her counterpart works long days and they obviously have to have days off which are longer in duration to account for them working long days how will named nurse work, obviously they can share named nurse with named nurse and associate nurse but then, study days, annual leave, sickness, oh never mind.

    I can only say what i see.

    A good hearted, keen young nurse, working flat out, still young enough to be fresh and enthusiastic, doing the best she can, not knowing possibly any different and thinking she's not really rushed of her feet, soon to be seriously 'burnt out'. How do i know cos' i've been that nurse as most of us have.

    We the willing, led by the unknowing, have done so much with so little for so long we are now qualified to do anything with nothing.

    The manchurian candidate.

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  • Tinkerbell I really respect nurses and I know they are wonderful. I think nurses work flat out giving, giving and giving as much as possible for their patients.

    If I ever need a hospital bed I shall be very careful when I press the call button - I don't want to get a nurse into trouble - they work too hard and care too much and I don't want to waste their time.

    I think the keen young nurse needs a medal and lots and lots of love and support just like you and all the other nurses here.

    Thank you nurses
    I really appreciate you


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  • Anonymous

    PDave Angel | 26-Jun-2013 8:02 pm

    why would you get a nurse into trouble for pressing a call button?

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  • You see I always respect nurses and I should only press call if I am getting worse, not just for silly things as I might take her time away from dealing with seriously ill patients. I would push it away at night so I don't press it by mistake.

    I always tell them how much I appreciate their care and thank them. They are basically looking after me.
    If I had to go to the loo and I had to stay in bed, I would feel totally embarrassed asking a Nurse to help me as they and the HCAs have more important things to do then serving me all the time.


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  • Spot on Eileen. Well said, the sooner we get to the core issues and away from gimmicks the better

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  • I dont know about anyone else but I am tired, very tired of hearing about what nurses don't do, should do, how we dont want to nurse just sit on the computer, how we get pay rises when we shouldn't, treat patients badly etc etc.
    Every day, on the news, in the papers.

    I am also tired of hearing myself moan when something doesn't get done well, gets forgotten etc & most times, I & my colleagues feel that we would have done things differently & better.

    We never used to be like this. Is that because we dont have any control or have lost the faith or enthusiasm in nursing, I dont know because there are some very good young nurses out there as I have seen thme & have been impressed.

    On these threads there appears to be folk who like me get upset & imply they want to make changes but thats all, nothing seems to happens.

    Just what can we do, how do we go about making change when we are powerless in the face of senior managers & politicians who are faceless & if they ever do hit the shop floor, the situaions are always contrived or controlled & if the nurses did say what they truly felt , they will be in trouble for not towing the party line, & problable told it is them not the organisation that is at fault.

    I have always been proud to say I am a nurse, I am proud to be a nurse but I will be leaving soon & I dont want to go feeling like I do most days.

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  • Anonymous

    Hmm invest in Nurses; very good plan - except our salary is now under threat when the increments are removed. I'm struggling on my salary now to support my family. When that reduces as it sure will based on what has been said there is no way I'll manage

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  • I am proud of you Ann and all the other nurses here.
    Thank you very, very much for looking after everybody
    I value you lots


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