We live in an environment of “deficit journalism” - the focus is rarely on what is going right in the world.
So, in relation to nursing, who wants to write about the many, many times care has been exemplary? Who would be interested in all the times that, despite insufficient resourcing, it is outstanding?
Emotionally brilliant nursing care, which occurs when situations are at their worst and nurses are most under stress, is rarely celebrated - but I hear about it all the time. I hear it from experienced nurses who are taking the time and making the effort to do a demanding course to become community specialist practitioners or community public health nurses. They never think they are emotionally brilliant or doing anything above and beyond what is “normal” practice. But they are. And their patients, clients and families would tell people that if anyone took the time to ask.
I have never met a nurse who wants to treat patients in a dehumanising manner. So who are they? What has gone wrong to change them from wanting to be caring and therapeutic practitioners to accepting less than the best for their patients?
Resourcing is clearly a key area of concern but it would be simplistic to say it is the only reason for poor care. When Elaine Ryder and I wrote our first book in 2009 we tried to identify what compassionate care actually was, how it was exemplified and what it looked and felt like for people. Were there common denominators for compassionate care in every practice environment, be it learning disability, mental health nursing, acute, community or public health settings? We concluded there were commonalities but there were also challenges to address. As such, in our next book published this year, we focused on these challenges - resourcing, the culture of the environment and individual nurse attitude.
Insufficient resourcing is key so we focused on how nurses can best challenge unsafe resourcing, maximise time - their most valuable resource - and capitalise on every patient interaction and working day.
Nurses become used to the accepted norms and values of their practice area. How else can adjacent areas that have the same resources create such varying environments for patients and clients? What could contribute to this difference, and how can nurses challenge inappropriate norms, values and assumptions?
The final challenge is individual nurse attitude. Edmund Burke, the 18th-century English parliamentarian, said: “All that is necessary for evil to prevail is for good men to do nothing.” Nurses can accept that substandard care is a necessity or take an active part in challenging it.
We often fail to recognise what it is that feels special to people in our care. If we dismiss it as “normal”, we cannot make it the norm in our practice area. Times of great change and challenge need great leadership; we are those leaders, and we must not underestimate our role in taking a lead in excellent, compassionate care.
- Claire Chambers is leader of the Specialist Community Public Health Nursing and Community Specialist Practice programmes at Oxford Brookes University