No patient’s care should ever be reduced to a job list. Yet nurses have resorted to task-based care in NHS organisations that have failed to put patients first.
As we all know patients can have their physical needs met efficiently, have all the tasks ticked off but may have received no care.
There is so much talk about putting patients at the centre of the NHS and this is laudable. BUT to make this happen nurses must have the resources, training and support to make patients matter most.
Every patient needs a nurse who will guide them, inform them, advocate on their behalf: someone who is knowledgeable, an expert in their specialty who they can look to for help.
So I welcome the Francis recommendation for key nurses but I am worried about how it will be implemented.
I have been, and remain, a firm advocate of the principles of primary nursing. The “my patient-my nurse” relationship is a fundamental tenet of care.
But I remember my anger when those principles were translated into a national named-nurse policy in the 1990s. A target date for implementation put the focus on the “how to” of providing personalised care rather than the “why”. As a result the system failed and the legacy was a fragmented team nursing approach to care epitomised by the catch phrase “Sorry, not my patient”.
So how can we learn from those mistakes?
The key nurse role must not be imposed on nursing teams. The mechanics of how to make it work are much less important than the philosophy that underpins the nurse-patient relationship.
Nurses need support, development, supervision and time to reflect on how they can put patients at the centre of care.
But responsibility does not rest with nurses alone. There needs to be a shift in organisational culture, that puts the nurse-patient relationship at the heart of its business and before any attempt to implement the staffing implications have to be considered.
Key nurses are not an answer to the problems facing the NHS but the recommendation offers a glimmer of hope that the value and importance of nursing care has at last been recognised.
We have an opportunity to use this and many of the other recommendations to challenge a culture that cares little about patients and even less about front-line staff.
Remember to make this work it is not “how” we do this but “why”.