Sisters and charge nurses should be responsible for making sure their staff have time to “reflect” on the care they are providing, a major new report on caring for older people has recommended.
Delivering Dignity, a report from the Commission on Dignity in Care for Older People, says time for reflection is “essential” and could be a “few minutes” at the end of a shift or a more formal session.
NHS London chief nurse Trish Morris-Thompson, who sat on the commission, told Nursing Times that time spent having ward or team meetings provided an ideal opportunity and should include patient stories.
She said: “We do have opportunities. If a patient and their family had a bad experience they can bring that to a team meeting and we can reflect on how that happened.”
The report also recommended that students applying to nursing and medical courses should be assessed for their values and compassion alongside their academic ability, while the values of existing staff should be considered during appraisal.
Professor Morris-Thompson said assessing for values using a range of hypothetical scenarios had reduced attrition rates and improved the quality of graduates when the method was trialled for entry onto an undergraduate children’s nursing course at London’s Southbank University. It will now be rolled out across London.
Asked about the potential impact on working relationships of the recommendation that staff challenge each other more over poor practice, she said the success of the programme to reduce MRSA rates was a “fantastic example” of where nurses had refused to accept poor standards.
“We challenged each other, medical staff and senior management to maintain what was agreed as a group of policies and procedures.
“If you see somebody pass a bed where a patient’s water has fallen over and they don’t do anything about it I don’t care if they’re a consultant or the chief executive, if somebody doesn’t do it somebody should challenge them,” she said.
The commission was set up by the NHS Confederation, Age UK and the Local Government Association in the wake of a highly critical report from the Health and Social Care Ombudsman last year.
It spent eight months gathering and reviewing evidence from more than 40 organisations and held three days of public hearings last year.
The report calls for management to respect the judgement of staff as the people working closest to older people and their families and describes the role of the ward sister or charge nurse as “crucial”.
Speaking at the launch of the report, University College London Hospital chief nurse Katherine Fenton said a ward sister should be able to “click her fingers” if she’s not happy about something and know it will get dealt with.
At UCLH, she said, all ward managers were supernumerary and were supported by a consultant nurse for elderly people working across the whole organisation “setting standards and challenging practice”.
She denied providing good care was necessarily a matter of resources.
“We need to start working much harder on values based recruitment and strengths based recruitment,” she added.
The report also deals with care of older people in care homes and ageist attitudes in society.
Professor Heather Tierney-Moore, chief executive of Lancashire Care Foundation Trust and a nurse, said staff needed to be careful about the language they used.
Referring to “the old dear in bed three” could be offensive she said, as was referring to patients by their conditions for example as “the stroke”.
The commission is inviting views on the report by 27 March and plans to publish a final version later this year.
Royal College of Nursing chief executive and general secretary Peter Carter said: “There is much to welcome in this report, particularly the recognition that many older people have complex needs that require dedicated nursing care.
“We also welcome the focus on the vital leadership role of the ward sister or charge nurse, and the need to empower them so that hospitals can provide the highest possible standards of patient care.”
But he added: “We need to see proper planning systems, based on sound clinical evidence, in order to ensure safe nurse staffing levels for patients of all ages. We would once again urge the government to take on board the need for guaranteed safe staffing levels as a matter of urgency.”
Unison general secretary Dave Prentis said: “Everyone deserves to be treated with dignity and respect - regardless of their age. And the overwhelming majority of NHS, home care and care home staff work hard day in day out to do the best for the people in their care.
“At the heart of the crisis in elderly care is the chronic lack of funding.”