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