What do nurses really need?

As usual, there have been several stories in the British press about nursing standards in our NHS hospitals. David Cameron announced that nurses will be told to do regular ward rounds, suggesting that they should check on their patients hourly to ensure high quality care.
In another report, the NHS future forum stated that nursing training has become ‘too academic’ while at the same time reporting that some nurses lacked basic skills, have a poor grasp of maths and do not understand the values of the health service. The report goes on to say that ‘selection in nursing …. has moved away from selecting students on their ability, capacity for compassion and caring and desire to work in nursing’

None of this will come as a shock to anyone associated with the NHS. But what is strange is how government, watchdogs and ‘health leaders’ seem to be going about addressing the issue.

I find it a little odd that the Prime Minister should get bogged down in such detail as a ward round. In fact – I suspect he isn’t even clear on what a ward round is.

I have written before about the farce that is a ward round in many facilities - a hotchpotch of ‘health workers’ with neither badge nor recognisable status, standing at the end of a poor patient’s bed, discussing them as though they don’t exist and even getting their name wrong.

Likewise the NHS Future Forum suggesting that nurses should be assessed for their capacity for compassion. How do you measure that?

Nursing is a profession. It is a profession that requires intelligence, physical ability, emotional strength and a genuine interest in the health and wellbeing of the people in their care. Nurses’ pay in the NHS really isn’t that bad. Truly. It’s not. But it’s not an easy job, particularly in the current NHS environment of limited resources, proposed cuts and most of all, uncertainty. It's a job that can be physically and emotionally draining and I can completely sympathise with nurses who bemoan their lot. It must be very tough right now.

So what do nurses need? I had a very interesting conversation with a senior nursing leader who has worked in the public, private and community care sector and I absolutely agree with her. She reckons that what nurses need most of all is support and leadership.

It’s not for the PM to decide how often a nurse should check a patient. It should be down to a ward sister, matron or whatever you wish to call the leader of the unit. That leader should nurture a culture of care and compassion, of good customer service and excellent medical practice. That leader should discipline the work shy, weed out the bullies and encourage those who need and want to improve. But most of all, the leader in charge of the ward should take personal responsibility to nurture the nurses and carers. Like a good parent, they should be firm but fair, lead by example with resilience and treat everyone with kindness and professionalism.

Come to think of it – that’s what patients need too….

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 15^th 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.