Sunday, 25 September 2011

Name and shame or name and praise – badges must be worn by hospital staff.

The UK Newspapers seem to be concentrating on Nursing standards this week. Camilla Cavendish in the Times bravely states that she ‘lay on a ward where most of the nurses regarded it as an imposition to ask them for help’ and she goes on to say ‘dedicated nurses look exasperated at having to work alongside ones whose ability to care extends only to caring about when their shift ends.’

Minette Marrin is equally blunt in the Sunday Times today reporting ‘there have been enough scandals to prove the point that disgracefully bad nursing is widespread’

Both articles agree that varying standards of care are a major concern and lay the blame at two doors. One – the type of training for nurses, introduced nearly two decades ago, ‘intellectualising’ the content and focus. And two – the increasing use of healthcare assistants who are usually unqualified, poorly trained and unregulated.

I wouldn’t argue with either of these points and refer to my blog of 15th February entitled ‘Can you teach someone to care?’ I have sympathy with the dilemma currently facing the nursing profession. Increasing sophistication of technology and treatment regimes mean that nurses need a wide range of specialist knowledge. But this is no excuse not to care.

Peter Carter, General Secretary of the Royal College of Nursing has said that patients’ relatives should take more responsibility for patient’s care. Patients tend to be split into two camps. Those with healthy, compos mentis relatives who do take responsibility for their care, often in spite of, rather than in association with, the nurses. The other group of patients are the elderly and vulnerable who may have no relatives nearby.

I do agree with the sentiments behind Peter Carter’s comments – joint personal care plans between relatives and nursing staff is a good idea but it’s not always going to be possible or appropriate.

When I was an inpatient recently I was in a four bedded unit with one 90 year old lady who had broken her hip, another elderly lady who had broken both arms and one who was completely away with the fairies. None of these ladies had relatives who lived nearby. Luckily as I was the walking wounded I happily took responsibility to ensure that their day to day needs were catered for – fetching things – holding cups and finding a nurse when needed.

And this brings me to my plea. ‘Finding a nurse’ was tricky – not because there weren’t any around but because I couldn’t tell who was a nurse, who was a ward clerk, who was a healthcare assistant, porter, cleaner or whatever. There was no standard uniform and NO BADGES.

In my role as a change leader, I know that it is so often the smallest changes that can make a huge difference.

Yes we need to get back to basics and look at nurses’ and healthcare assistants’ training, caring attitude, roles and responsibilities. Yes we must support the great nurses who do a fantastic job and censure the lazy or mean (as in any profession) In the meantime, every person employed in a hospital should wear a badge stating simply their name and their job title. And this must include doctors.

There are so many good reasons for this. I have no doubt that it is far easier to do a sloppy job if you are anonymous, but the flip side is that good work can be recognised in named individuals. I wonder how much time is wasted every day in hospitals as patients and visitors struggle to find the right person to ask for advice, guidance or help?

The NHS is a service industry. It’s success or failure rests with the individuals who are tasked with providing technical, medical, practical, personal or emotional care.

If anyone is dealing with mine or my loved ones’ needs in the healthcare environment – I want to know who the hell they are.


Chairman Chegwin said...

I think the problems in nursing are multi-faceted. Yes, there is a real problem with the "caring" element - as I know from personal experience with my grandmother, who was treated appallingly in the couple of years before she died. But the issues go much wider. First, for me there appears to be a lack of common ground on the educational standards required to enter nursing. Most professions have a common entry-level standard that defines them as a profession - for example, in order to be a dietitan, you must possess a minimum of a degree, the same as for a lawyer, teacher, etc. As far as I'm aware, for nursing, there is no real common entry-level and this must cause a degree of confusion to young people looking at nursing as a professional career path. A common entry level would also provide transparency to patients that they and their families are being treated by a person that has attained a certain standard.

Secondly, and this may be related to the qualifications aspect, nurses lack of respect as a professional group. Many will claim that they receive little in the way of regard from consultants, administrators and in many cases even more senior nurses. As a result, nurses I think view their voice as limited in the NHS - and really, bodies like the RCN have preferred to criticise and moan about their lot rather than doing something to address the issues of respect and standing. Nurses are poorly represented in my view.

Many will say that pay and staffing numbers are issues too. Plus, as a country we becoming more litigous and nurses are increasingly in the firing line. Litgation takes money out of the system and makes people risk-averse and I think all of this contributes to a lack of nurses willing to work at the patient's bedside, hence the reliance on "healthcare assistants". I don't actually believe there is a nursing shortage - rather, there is a lack of willingness for registered nurses to work in these increasingly compromising situations. With a rapidly ageing population and the management of long terms and chronic conditions challenges that this brings, I think we may have trouble on the horizon. A doctor who parachutes in for five-minute visits once or twice a day is no good for ongoing care - we need appropriately qualified nurses at the bedside.

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