“What’s the matter with nursing?” cried a BMJ editorial a few weeks ago. Just about everyone seems to have a view, with many commentators looking for a scapegoat or a quick fix. Many of my friends know exactly what’s wrong. They don’t make nurses like they used to. In our day…
Well, it’s easy to hark back to a golden age, but I would challenge anyone who does to think carefully about the workload, staffing and challenges of modern healthcare. Most wards have significant numbers of chronically sick, frail and vulnerable patients. Many nurses work on wards that are not fit for purpose, with staffing levels that have not changed in years. Many of you describe your working life as a war zone. And this week we learnt that ward sisters in some hospitals spent 40% of their time on bureaucracy.
Most of the criticism levelled at nurses relates the essential care given to dependent older people.
So let’s be honest about how we care for older people. Although there are many individual examples of excellent care, there has never been a golden age. I remember the warehouse-like Nightingale geriatric wards during my training in the early 1980s. In the 1990s, I took over management of a rehabilitation hospital where communal toileting, communal clothing and milk and sugar in the tea pot were standard practices. When I asked staff why they did this they were happy to explain. The toilets were difficult to access with a wheelchair; patients’ clothes got lost so it was better to use the hospital ones; and it was quicker to put everything in one pot than ask patients’ preferences since most had dementia.
Scary stuff for a newly appointed senior nurse.
I learnt how easily staff lose sight of what they were doing and why. If we put nurses in silos, give them little education, no feedback, and an inappropriate skill mix they will cut corners. Deidre Wild, a nurse researcher with a passion for care of older people describes it as caring for, rather than about, patients. Getting the job done, rather than thinking about how best to do it, becomes the priority.
My staff worked in a vacuum. What was missing was a crucial element - strong clinical leadership provided by empowered, skilled and enthusiastic ward sisters.
The ward sisters who inspired me to be the best nurse I could be weren’t in the office doing the paperwork but equally they weren’t mucking in. They worked as role models alongside staff, facilitating, challenging, managing and developing every member of the team. This role is for nurses at the top of their game, who can teach, inspire and develop our next generation.
Everyone knows ward sisters hold the key, but is there a will to make the organisational change and investment to ensure we keep our best nurses close to the bedside? If we don’t do this what is the alternative?