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OPINION

'It’s good old-fashioned nursing values that have really transformed the culture of the ward'

  • 6 Comments

One of the joys of my job is being invited to see the great work being achieved by nurses.

It’s not because I get itchy feet in the office or that a long train journey enables me to catch up on some of my writing (although I do and it does) – it is genuinely one of the most rewarding aspects of being the editor of Nursing Times to meet readers and see the difference they have made – and how they proud they are of it.

Steve Hams, deputy chief nurse of the triple-sited East Kent Hospitals, invited me to Kent and Canterbury Hospital last week. He gave me a whistlestop tour giving me access to all areas, while Julie Pearce chief nurse and director of Quality and Operations and Sue Roberts, deputy director of Infection Prevention and Control and Head of Nursing, annotated the tour with their perspectives.

Originally, Steve’s invitation came after the trust found itself at the centre of the maelstrom surrounding red tabards, but we decided to evolve the tour into more than just that. I met the sister on Kent ward, who had introduced them. “I am genuinely baffled by the media’s reaction,” she told me. “They write we should be able to multi-task, and of course we should. But occasionally we will make mistakes. Isn’t it better to focus on the patient that you’re with?”

Steve agreed. “Some of these patients have complex co-morbidities, that you need to be able to manage and that requires focus when dispensing a large number of medicines.”

Lynne Wilkinson, deputy ward manager of Kent ward, says that the tabards were introduced to protect the patients, to prevent another member of staff interrupting a nurse in a drug round “We would never ignore a patient’s request if they were in pain or needed the toilet,” she said. “In fact, we make sure that patients have been sat up, are comfortable and have been helped to the toilet before we start. It’s upsetting to think that the media and the public would think we’d do this for our own benefit.”

I am glad to say that the tabards are still being used – with one subtle difference to the ones pictured in the media. The “do not disturb” wording is on the back, so it’s more visible to other staff than to the patients who may see a nurse approach them face on. In fact, not only are the tabards still being used, they are being rolled out for use by other members of the MDT. Thank goodness – a triumph of sense and judgement over media panic.

Up in theatre, nurse Julieann Pain also has a single focus – the patient on the operating table, She works as a patient side assistant with surgeons using the £1.2m Da Vinci robot. This enables the surgeon to operate on a patient remotely using the four robotic arms that have the rotational movement of human arms. At the moment, it’s just being used at Kent and Canterbury for prostate surgery, where the benefits are a speedier recovery because there is no open surgery and a reduced risk of HAIs. However, in America, its use is widespread for other surgeries, and the trust thinks they could follow suit. What’s fascinating about the surgery is that the nurse is the only one to have contact with the patient. In the handful of places where the robot is used elsewhere in the UK, it is the registrar who acts as the patient-side assistant. But at East Kent, the surgeon trusts the nurse to tell him what is going on and offer advice while he monitors everything on a 3D screen that has membrane by membrane definition.

“You’ve got to be vocal,” says Ms Pain. “I have to be his eyes and ears and tell him if I think he needs to know information.”

Speaking out has definitely not been a problem for Anita Hodgson, the matron in charge of the endoscopy unit. She’s revolutionised the unit so that it is open seven days a week for the benefit of patients, and has increased nurse staffing on the unit so that endoscopy now offers a full and comprehensive career path for nurses. No longer a Cinderella service, she has created a career structure that is attracting nurses to the unit in their droves. And that’s benefitting the patients too, who have less waiting time and a seamless care pathway.

An open all hours mentality is also part of the renal unit. Here the nurses run home dialysis training sessions to give patients back their independence, but if they have to come in for their dialysis the 30-bedded unit affords them the opportunity to get on with life while they are there. “One guy comes in and runs his business from the unit,” says senior matron of Renal Services Mark Nicholls.

Technology is high on the agenda, with the renal unit offering patients internet access so they can check their symptoms and information about their condition. “Don’t make assumptions about the patients,” he says. “I see 80-year-olds wanting their passwords for RenalView, a system that gives them information about their condition.”

Feeding patients as much information as they can is a key theme running throughout East Kent.

In the chemotherapy unit, it is nurses who manage important information about the patient. “We found that patients weren’t being honest with the consultants about the side effects of their chemotherapy drugs,” says Wendy Hills, head of nursing. “So we put the nurse in charge of doing their blood tests and managing their route through the process. This has speeded up the process for the patient and enables us to judge the right time for carrying out chemo for the patient in our 14-seat ambulatory unit.”

The final leg of my visit was in Kingston ward, a ward I was shown because it “hadn’t been perfect”. In receipt of a number of customer complaints and the subject of a responsive review by the CQC, which it passed with flying colours, the nurses decided to reinvent the stroke ward, led by ward manager Nicola Collins.

The 27-bed unit has, like other areas of the hospital, adopted new technology to help it speed up patient diagnosis and treatment, knowing that this will have the greatest effect on patient outcomes. When a patient with a suspected stroke presents, nurses can use a high definition camera to film the patient whilst undertaking the initial assessment and link it to a consultant on call, who can see and talk to the patient and the nurse over the screen, from their own home or wherever they are.

But while new technology has increased patient safety, it’s good old-fashioned nursing values that have really transformed the culture of the ward. But Ms Collins has instilled core values, introduced intentional rounding with a chart that all HCAs and nurses have to fill in every two hours and nutritional strategies. And complaints have all but ceased.

Now why doesn’t the media ever write about that side of nursing?

  • 6 Comments

Readers' comments (6)

  • michael stone

    Two comments, having scanned this.

    Firstly, I think it supports (the' red tabards' bit) the suggestion that media reports are often very misleading.

    Secondly, 'The “do not disturb” wording is on the back, so it’s more visible to other staff than to the patients who may see a nurse approach them face on.'. That is an improvement, which suggest a lack of initial thought - as soon as you think about it, putting 'do not disturb' on the back, makes sense. I read a draft of my area's CPR/VoD policy, which stressed that community DNACPR Orders must be notified to the local AS database, and detailed what then happened - as I pointed out, the draft did not explain who was responsible for doing the notifying. It basically explained who would catch the ball, and that the ball had to be thrown, but it did not clearly define whose responsibility it was to actually throw the ball !

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  • Am I alone in my dislike of the wording of this article? The word "old fashioned" in relation to nursing evokes images of Hattie Jaques matron, not the nurse of today. Why should GOOD nursing practice be referred to as "old fashioned"?"

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  • Anonymous | 2-Nov-2011 7:37 pm
    Hattie Jaques was in comedy films, and was never meant to represent the nursing profession in reality. Just as 'Angels', Holby City, Casualty, etc., don't represent todays profession, although they aren't comedies. I trained in 1973, have kept up to date, more than most in some instances, but proudly maintain the nursing values that the profession once held. 'Old-fashioned' values may not be the right term to use, but it certainly does not refer to 'Carry on Nurse'.

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  • michael stone

    Anonymous | 2-Nov-2011 7:37 pm

    Feel free to slap me down, but I think most people use 'old fashioned' in pieces such as this, to mean those nursing values and attitudes, which were present when nurses were less academically qualified: what a nurse in another discussion, has described as something like 'a holistic human-touch approach to treatment' (compared to a doctors paradigm being less 'human-touch' and more 'illness centred').

    But whenever people emntion those 'old-fashioned values' they get attacked along the line sof 'You are saying we don't need to be qualified !' which isn't true - the people are suggesting that expertise and 'a caring attitude' would both be present, in most people's idea of 'the perfect nurse'.

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  • And just what is wrong with 'old fashioned values' if it means the return to good nursing care and focussing on the patients? It seems a shame to divert the discussion of good nursing practice - and the good work of one NHS Trust - into a discussion of the semantics of the words we use. Why can't we just remember what we're there for - to provide caring and supportive care for patients and address their needs and recognise - and praise - good work when we see it.

    Why do readers of NT seem to feel it necessary to criticise 'everything' from good practice to bad - or to be pedantic about the words used? If we can't agree amongst ourselves what hope is there for the profession or, more importantly, the patients in our care?

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  • michael stone

    Anonymous | 9-Nov-2011 8:44 pm

    I agree with you ! Although without being 'pedantic', you do need to check that everyone is using the same words, to mean the same things !

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