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A supportive culture would enable better care


Nurses are stressed. You’re not looking too shocked at that news… don’t blame you.

The results of our survey this week hardly surprised us either. Extensive studies carried out over the past few decades have shown time and time again how stressful a job nursing can be. Being surrounded by illness, dependency and death is mentally draining, and add that to the physically demanding aspects of some nursing roles and you have a recipe for an exhausted and stressed-out workforce. Nurses at last month’s Unison conference told us they are often penalised for being ill, and disciplined when it all gets too much for them. Or make themselves more ill, because in today’s environment, nurses often don’t want to admit that they can’t cope with the pressure.

The culture that exists in many trusts makes nurses feel disempowered and disengaged. Targets and measurable outcomes are vital for an accountable health service, but they can create tension between multidisciplinary teams as they try not to be the one to blame for a breach. And nurses have told us that targets can create a top-down environment of relentless bullying, with staff who care more about the numbers than the patients.

Little wonder that when nursing comes into the spotlight in yet another television documentary we see some nurses failing to care. The very skills they were employed for have been driven out of them. Believing that the targets are more important than how patients feel, they find themselves unable to take control, to make decisions that benefit the patient, and so they survive by ignoring the details and just going through the motions.

Of course there are masses of excellent staff doing a phenomenal job. But employers should ensure those that are still putting their patients’ meal trays out of reach or failing to ensure a patient takes their medication are motivated and supported to improve the care they give. Not by targets but by praise, good examples of practice and great occupational health services.


Readers' comments (7)

  • Are you related to Kate?

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  • "A supportive culture would enable better care"


    speaking from bitter personal experience.

    A supportive culture should be common sense and go without saying, especially since the time when 'General Management' from the USA was introduced to the NHS. One of its key concepts is to value, motivate support and reward the most important, valuable and costly resource of any organisation, which is its personnel. The NHS seems to have conveniently forgotton this small detail whilst adopting all the rest of the management process!

    Perhaps they should try 'Macdonaldisation' for their next trick! i.e. from the personnel management point of view and with free hamburgers, bagels and chips for all the patients!

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  • I just visited the BMA website and to my surprise this is the first thing I read!

    "British Medical Association

    Standing up for doctors"

    My first thoughts were that their professional body now need to protect doctors from the public, whereas the NMC see the need to protect the public from their nurses although one would hope and imagine that the role is protect the interests of both groups from unfair treatment!

    Would it not be a good idea if NMC,
    as well as the RCN and other unions representing the profession, adopt
    a similar title such as:

    Nursing and Midwifery Council

    Standing up for Nurses?

    Although, with their current attitudes towards nurses, I cannot imagine such wishful thinking being transformed into reality it should be considered that this could act as a very helpful reminder to these organisations, employers and the public of the need for respect for the individuals who are members of this profession!

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  • Yes - it used to be more supportive years ago. When I returned after 18 years out I was shocked at the change. Of course those who are negligent ,unprofessional or dangerous need to be removed
    But I have seen at close hand the ruined the careers of excellent health professionals partly due to complete management failure,but also because of the way the NMC operates. I feel deeply anxious for the rest of us , trying hard to do a good job despite management and the NMC
    - No, certainly not there to support or enable.Only there it seems to let us know many they have struck off the register in any one year Driving up standards ? Its not happening!

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  • I have a set of first year student nurses, and I'm trying to encourage a community of learning using Twitter, this is my MA research... Slow start, I'm presenting the progress of this twice this year... slow going...This should lead to a supportive culture.
    It seems that they rarely refer to themselves as doing their nurse training more an emphasis on STUDENT, what does that say? Is student a devisive word? Leading to classroom devides, I think so...does this culture begin early in a nurses career?

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  • I would say one of the places the division starts is the encouragement at college level to evaluate colleagues practice and then report it rather than have discussions about it. There is a stance taught that you should be accountable and liable for everything which although good also results in defensive posturing and then fragmentation of teams, particularly where there is poor leadership and communication. British culture then picks up this ball and runs for the hills, and I say that as a native of the UK. Suddenly everyone is back in the school playground.

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  • bill whitehead

    I agree with the idea that the culture at work should be supportive rather than authoritarian and confrontational. There are straightforward and well evidenced organisational adjustments that can be made to engender this change. My recent research identified a set of criteria and a tool to implement this in nursing. See this week’s news item for more information.

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