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Opinion

‘Target-chasing turned nurse against nurse’

  • 5 Comments

The second article in this six-part series on the Mid Staffordshire Foundation Trust Public Inquiry looks at why nurses were in turmoil

Several nurses in various positions gave a range of insights into the NHS and the profession at the Mid Staffordshire Foundation Trust Public Inquiry.

Royal College of Nursing chief executive and general secretary Peter Carter expressed grave concern about the selection and training of student nurses and, in particular, the lack of good-quality mentoring in clinical placements. He felt that some university departments had distanced themselves too far from clinical reality and were running textbook-based courses.

Chief nursing officer for England Dame Christine Beasley told the inquiry that nursing “lost its way” as not enough attention was paid to the “values” of new entrants to the profession during the recruitment drive at the turn of the century.

Staffordshire University’s dean of the Faculty of Health Hilary Jones described how nursing departments were suffering from reduced resources, fewer students and increasing bureaucracy.

Qualified nurses were unable to attend training days owing to staff shortages in clinical areas. Some senior trust managers appeared happy to replace skilled caregivers with a largely untrained workforce, believing that this would have no effect on care.

“Codes of practice, professional values and ethical standards were all sacrificed”

All the nurses who spoke at the inquiry agreed that nurses needed compassion and the skills to deliver high-quality care.
The danger in opting for untrained workers is that nursing becomes a set of tasks undertaken by rule-following operatives, creating a culture of mediocrity.

Patients and relatives may tolerate drab surroundings, poor food and staff shortages - but not unkind, discourteous and uncommitted nursing staff.

The most heartfelt and penetrating insights were delivered on the final day of the inquiry (day 133), when the last of the 161 witnesses gave oral evidence.

Helene Donnelly spoke with dignity and courage and her message should reverberate throughout the profession. In a controlled and courteous manner, she told the inquiry that she had worked as a staff nurse in accident and emergency at Mid Staffs hospital between 2004 and 2008. The atmosphere was one of fear; there was a lack of professional leadership, and a chronic shortage of staff and basic equipment. Two senior sisters ruled with a heavy hand, regularly using physical threats and verbal abuse to intimidate staff.

Helene was appalled at the standards of treatment and care, especially where older people were concerned, and at the number of patients who died needlessly in undignified circumstances. Patients endured “unimaginable” suffering and were left “sobbing and humiliated” by staff. Fabricating waiting times was common practice and, when Ms Donnelly refused to falsify records, she was threatened by her managers. Her workload increased and she was expected to stay long after her shift was finished. She became so frightened as a result of threats of physical harm that her husband or her father would collect her after work.

Codes of practice, professional values and ethical standards were all sacrificed, as long as the trust did not incur financial penalties for missing targets. Making a formal complaint to managers or supervisors was futile - it was they who were the problem.

Target-chasing attacked the professionalism of nurses and turned nurse against nurse. Ms Donnelly concluded by making a recommendation that nurses should have access to independent supervisors and confidants who were not part of the organisation.

Ms Donnelly left her post at Mid Staffs fully aware that a culture of neglect may exist in other hospitals and that nurses are frightened to speak out.

After her evidence, people rose to their feet, some in tears, others in stunned silence. The audience at the inquiry, mostly relatives of deceased loved ones, applauded her. They did not applaud what she had to say - they knew that already. What they applauded was her honesty and courage in saying it.

Peter Nolan is professor of mental health nursing (emeritus)

Look out for part 3, which will explore the dangers of gaming and false accounting

  • 5 Comments

Readers' comments (5)

  • michael stone

    'Helene Donnelly spoke with dignity and courage and her message should reverberate throughout the profession. In a controlled and courteous manner, she told the inquiry that she had worked as a staff nurse in accident and emergency at Mid Staffs hospital between 2004 and 2008. The atmosphere was one of fear; there was a lack of professional leadership, and a chronic shortage of staff and basic equipment. Two senior sisters ruled with a heavy hand, regularly using physical threats and verbal abuse to intimidate staff.

    Helene was appalled at the standards of treatment and care, especially where older people were concerned, and at the number of patients who died needlessly in undignified circumstances. Patients endured “unimaginable” suffering and were left “sobbing and humiliated” by staff. Fabricating waiting times was common practice and, when Ms Donnelly refused to falsify records, she was threatened by her managers. Her workload increased and she was expected to stay long after her shift was finished. She became so frightened as a result of threats of physical harm that her husband or her father would collect her after work.

    Codes of practice, professional values and ethical standards were all sacrificed, as long as the trust did not incur financial penalties for missing targets. Making a formal complaint to managers or supervisors was futile - it was they who were the problem.'

    In answer to the many NHS staff who ask 'why do the public seem to hold us in low esteem' the answer is the sort of thing above - even if most care is decent, you cannot expect examples like that, to not 'drag down the rest of you' in a 'perceptional sense'.

    That sort of thing, must be prevented from happening !

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  • I take my hat off to Helene Donnelly. What a dreadful position to have found herself in. It could of been any of us.

    To the 2 "senior sisters" not only shame on you for bringing the profession into disrepute but employing cheap gutter bullyboy tactics. I hope you are called before our governing body and I also hope that the NMC have the GUTS to strike them off the register.

    One question reverberating around my head, is where was the Rcn regional officer in all of this, or Unison etc etc. The behaviour leading to such appauling standards of care is indefensible.

    Furthermore, it is an offence to threaten people, So why, I ask myself, did no one involve the police. They do take threatening behaviour seriously. I can only assume that the fear created by these two "senior sisters" was tantamount and comparable to the SS during the last world war....Surely we have moved on from such darstardly behaviour...sadly not.

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  • So so sad that a once lovely hospital was reduced to this. I trained at Stafford in the late 80's and worked with a lot of inspiring knowledgable nurses that helped me to become the kind of nurse that I wanted to be.
    The people who ruined that Hospital should never work in healthcare again.

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  • michael stone

    Sarah Stanley | 4-Nov-2011 6:44 pm

    'The people who ruined that Hospital should never work in healthcare again.'

    Definitely ! But I think I read that both of the people at the very top of the Mid Staffs hierarchy, avoided attending the enquiry 'because of mental health issues' - this adds insult, to injury, for the relatives of the bereaved.

    judith willis | 4-Nov-2011 4:29 pm

    ' I can only assume that the fear created by these two "senior sisters" was tantamount and comparable to the SS during the last world war'

    They have something in common with the Police, who appear to believe that Gestapo-like behaviour for home EoLC deaths is acceptable (I don't, and I have issues with both the Police and the wider NHS over that).

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  • I admire Helene Donnelly for telling her story and being brave in doing so. I have worked in wards where there are some bullying nurses. They intimidate both patients and staff, it is terrible how they seem to get away with this. I spoke up and the bullying nurse did not change, though she understood that I would not put up with her bullying and left me alone. I have never understood how she could ever have managed to qualify and become a nurse. Yes she should have had checks for compassion and values, before being accepted for training.

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