I want to use my position a Chief Nurse for England to make a positive difference: for patients and for our profession. We have an opportunity to shape the way nurses and midwives work in the future so that we can care for our patients with compassion and dignity, while confidently working with the latest technology to help us do our work better. At the same time, we need to build the profession so that we win respect for carrying out complex jobs and the hard work we do. This is why I have started work on a new vision for nursing, something I hope will support nurses and midwives everywhere to improve the care we give our patients as well as building strength into our profession.
My starting point for this work is the five areas I think define good nursing. I call these the five Cs. We show care and compassion in how we look after patients; we find the courage to do the right thing, even if that means standing up to senior people to act for the patient’s best interests in a complex and pressured environment; we demonstrate commitment to our patients and profession and finally we make sure we communicate at all times.
I believe these five areas define nursing as a profession and by focusing on these values, we can achieve our aims of improving care for our patients and strengthening the profession. For instance, I think a good nurse will show care and compassion to his or her patients, but also demonstrate care for a colleague who is having a difficult day. Supporting colleagues is important because nursing is a hard job, and we do have tough days. But, we cannot let our patients down because we are distracted so we need to look after each other as colleagues, so that we can give the best care to our patients So good patient care and experience is also dependent on good staff care and a positive workplace experience.
To help me develop the vision and most importantly how we are going to involve as many nurses as possible in this, I asked a group of nurse leaders to spend time thinking through some of the issues around nursing and midwifery. Among these issues are getting staffing right and staff experience. I’ll be able to give you more details about how we will go about building this vision soon. My ambition is to involve as many nurses, midwives and health care assistants so that we can build on their experience and use their ideas. I know from the enthusiasm and energy of this landmark meeting that there is a commitment to improve from nurses and midwives everywhere.
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Ah yes, five Cs to define nursing — Care, Compassion, Courage, Commitment, Communication. The trouble is, exactly the same five words could apply to almost any other job from bank manager to zoo keeper. Maybe you should have found out what “define” means first.
Thanks for that Rod. How can we professionalise ourselves, if we do not embrace some notion of what defines us. You should perhaps suggest a definition in place of the 5 C’s ? It would be helpful, in place of your substitution of a ‘knowledgeable doer in whose hands one is born and dies’ with a zoo keeper.
Steve.
Agree with the 5Cs, but need to give nurses the time and capacity to be professionals they are. So many occaisions I here the “there just is not the time or staff” Patients need and have the right to be given the nurses time to communicate with them, and nurses need to be allowd the voice to show their courage in demanding the time and capacity needed to care and communicate. As for compassion towards staff that dissapeared when staff became a “Human Resource” a WTE, some staff dont even get a staff room to take there break, so how about standard by which management treat staff, I know there must be good examples of treatment out there so lets hear them and share. show that the profession is valued and not by a Disney like song and dance routine at an opening ceremony !
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I trained in an era when nursing was only just beginning to emerge from the concept that the profession was a ‘vocation’ with the expectation that nurses were expected to give up everything to succeed. Matrons ruled the roost and ward sisters lived in the ‘Sister’s Block’ in the nurses homes.
Fortunately today the profession looks very different but sadly so too does the care. I am sure that the reasons for this are many and complex but I do remember the feeling that at least for the 3 years of my training I was entering a different world where every minute of my life was nursing. These 5 C’s were the cornerstone of everything we did from prelimary training school to our ongoing careers.
My question is how do we assess for these 5 points of the star which will create our future nurses? I have read so many sad cases recently were it is clear that nurses don’t seem to have these 5 c’s – it may be that they never had them but surely it is partly down to us, the nurses who have been clinicians for many years to instill these? The role of clinical nurse tutor is so important equal to that of the nurse tutor or academic but so too is the role of each registered nurse to ensure that our profession remains strongly built on these foundation stones.
I welcome and support the 5C’s approach and equally feel saddened that there is a need to remind the nursing profession what they are and why they are the cornerstone of practice. I like Lynne’s analogy above that they are the points of the star!
Nursing has advanced in so many ways during my career and whilst new technologies and practices should be embraced we must remember that they are there to support nursing care not to replace it. Registered nurses have a duty and responsibility to support student nurses and doctors in developing their communication skills to ensure patients are fully informed and involved in their own treatment and care and that where there are concerns they are able to be voiced. Demonstrating compassion is not a sign of weakness but a sign of a nurse that approaches her role showing empathy and support to patients, carers and colleagues. We can only do this by being confident our own nursing abilities which comes through being up to date ourselves and role modelling best practice to our colleagues and those in our care. Engaging in initiatives such as E4E and the Productive series reminds us of what is important, what we can influence, how to work efficiently so that we can spend time adding value and how we can share best practice. We need to be proud of our profession and we can only do this by being committed to constantly improving what we do, being in the media because we are doing a great job and buliding on our fantastic history and taking it into the future. in the environmentin which I am employed we have quality reviews in place that consider the communication style of staff interactions with patients, the ability to build rapport and demonstrate empathy so I am confident that this can be built into assessment processes not only for pre registration nurses but those in registered nurse positions.
I would like to add my support for the five cs as a nurse of over 20 years the change in the service has reached a fever pitch of cost over care It is our duty to the patient to remain focused and to remind the work force that high quailty care has a cost
I am concerned that the levels of management post and change experts appear to be increasing and the levels of nursing staff decreasing
I do wholly agree with the comments that Lynne and the previous person state around the 5c’s being vitally important in the redevelopment of our nursing role. Never before thoughout my nursing career have I experienced so much change and unrest, I do feel that we would be very short sighted to not grasp this opportunity to be involved in shaping the future role of nursing with both hands. For to many years nurses have buried their heads under the excuse that they haven’t got time for all this new stuff or to attend events. In this current financial climate with huge strains on social care it is quite often left to nurses to be the patients voice in what can be quite difficult arenas. We are also in an ideal positiion as community nurses to help our GP commissioning colleagues reform the future of our services.
I agree that it is admirable to address the problems nursing has particularly the public perception – however – some things are beyond the control of nurses at grass roots. This government and previous recent governements have been partly responsible for the changes. Financial constraints, cost cutting exercises and targets, targets, targets are not conducive to increasing nursing time at the bedside.
I started nursing in 1982 and will probably be retiring in 2019 and have seen so many changes I am sick of them. A lot of change is for changes sake – to be seen to be doing something- to pacify the electorate and a lot of public money has been wasted implementing these changes.
I am proud to call myself a nurse yet am ambarrassed at some of the stories I read about lack of care of patients in hospital. I am still convinced after speaking to colleagues who wook in secondary care that the problems should not be placed squarely on the shoulders of the nurses.
Money seems to be the prime focus of health orgnaisations these days – because that is the focus of the governement – dont forget the NHS is still run form Whitehall – no matter what the publicity people say about giving the control to clinicians. Whilst I appreciate that the NHS is not funded from a bottomless pit of money the focus of patient care seems to have been left to those on the frontline being expected to do the same excellent work with less time, less nurses/doctors/ AHP’s etc whilst the government propganda rolls on blaming those same caring professionals for the problems. The buck quite clearly should stop with the minsiters who change things with no idea what is going on beyond their safe cosy offices.
These are certainly laudable aims for nurses. Just first let’s check that we as managers are doing our jobs right first. A friend of mine is a committed nurse who has constructively stood up to others over poor care of patients, His typical experiences include:
- frequently (at least once a week) being called while he is on holiday or on a rest day (including when asleep from a night shift) to come in an fill a vacant rota slot.
- given 24hrs notice of a new rota start. This has now moved to 4 weeks notice, however, if you have childcare commitments it is very difficult to arrange childcare at such short notice. People on shifts in other industries get a least 6 months notice.
- Being asked to work both christmas day and new years day for two successive years.
Let’s get our staff management right first, then we’ll have the right foundation to get patient care right.
Thank you for all the helpful comments and reflections on this article, all of which have been passed to the team who are collating feedback for CNO and DH DoN.
Dear Jane, Nobody will argue with the sentiments of the 5C’s. We have had so many similar initiatives to improve care and compassion, but the latest evidence would appear to suggest that it is just not working. If you really want to know how to “make a difference” ask the hard working frontline nurses, not the usual select group of leaders who will tell you what they think you want to hear. I have spoken to many such nurses over recent times and unlike your 5C’s these hardworking committed nurses describe the 5 B’s of their daily reality, namely Bewildered, Bullied, Bruised, Bemused and Burnt Out. To make the change you dream of will require a major cultural shift in the NHS and real leadership at all levels. Harking back to the “good old days” is pointless. The NHS of today is significantly different to the one of yesteryear. I do seriously wish you every success in your role and the challenge(s) you face. Good luck!
Well said on the disconnect between nurse managers/leaders and workers. Most nurses go to work and want to do a good job – it is the circumstance they meet when they get through the door that makes for the outcome of the day.
Siobhan
Jane, your most recent piece, as reported on the Nursing Times website, now has 6 Cs. It also has a lot of comments, most of them not very positive about you ‘personally’ (there is a lot of that on NT).
My comment was this:
‘She believes that the recent high-profile cases of poor care that have been exposed in the media would be helped by nurses feeling able to speak out.’
Yes – unless people do speak out, they cannot be heard: if they are not heard, their potential audience remains uninformed.
I like the piece, but it looks very much a challenge if all nurses are over-worked ?’
Judging from the NT site, most nurses seem to believe that higher management routinely ignores their input: as a layman, I think nurses are the clinicians who are closest to the patients, so the insights of nurses are valuable – in an earlier piece on NT, you said something like ‘I agree that in theory managers should listen to nurses’ and I pointed out, the ‘in theory’ is where the problem rests !
My comment, is to Jane – so I hope she checks back on these.
As part of my one-man-campaign to improve end-of-life care for patients who are at home, I read the Nursing Times website, and the typical response on that site was along the lines of ‘Jane and people like her ‘have sold out’ and don’t improve things for us on the front line, and don’t help us in our battle against cost-cutting managers who don’t care about patients like we do !’.
I’ve just posted a comment on NT (so I’m awaiting the abuse) to the effect that perhaps Jane is on the side of front line nurses, but she also feels rather ‘isolated’ in pushing their case to the DH etc.
My suggestion, was for a bit of unity between those front line nurses who are not happy about managers discounting their views, and Jane (provided the objectives are similar).
So my question for Jane, is do you a mechanism to ‘harvest’ support from front line nurses, to use in your discussions/negotiations ?
I agree with the comment about moving into the present day and not keep referring to the last 20 years as if they were perfect! I trained nearly 20 years ago when bullying was endemic and ‘patient care’ was based on how well you could make the corners on the beds! So lets move on.
I just do not want this to become another exercise and ‘consultation process’ that fizzles out and no one is made aware of the outcomes. Recommendations are meaningless unless you have the ability to enforce them. These 5cs are embedded in the NMC Rules and Standards – please do not reinvent the wheel. Go back to basics and make sure that the students of today are fit to practice in the working environments of tomorrow. We need to be planning ahead and looking at how we are expected to provide patient focused care, underpinned by our Rules and Standards, in the 21st century. Maybe we should be redefining the role and responsibilities of a nurse or midwife and stop defending and protecting a role that is now undertaken by nursing assistants!!
In many clinical areas, particularly the ward setting, bullying remains endemic within the nursing profession. Often it is subversive in nature & therefore difficult to identify & deal with. This may be a result of poor staffing resource and/or poor organisational culture. Until staff shortages & bullying are dealt with in a more proactive manner I see no point in “the 5 c’s”, it will be quite simply a band aid on a large festering wound within current nursing culture in the UK.
I support the 5Cs model, they are words used everyday. Its for all nurses to consistantly lead to influence the behaviours that support to display the 5Cs. My ask is for nurse leaders to value their staff, allow them to take control of the improvements they know need to be made. My ask for nurses is to choose the right attitute and continue to be resiliant, note what you enjoy about the caring profession and build on it.
I have been a registered nurse for 32 years and a user of services for three years where I have experienced both general and specialist care. Each time that I have been in hospital I have sat twiddling my thumbs wishing I was elsewhere and forced into an almost time and motion study of process’ and nursing care. There are so many instances where I have noted continued inflexibility leading to what I would consider to be huge wasting of resource and money which makes my heart despair when we are strapped for cash. There is kindness and compassion, but how it varies. The specialist centre appears to value it’s nursing staff. They are well trained,they all are able to do a variety of procedures and as a result seem to have more confidence in their own abilities. In the general hospital they are not given the same responsibilities and of course they are less well resourced. I feel that we really must invest in our nursing staff to give them good effective training and continued professsional development, it makes such a huge difference. The variation in care has been noticeable on my own personal journey and I feel that there is a great deal to be learned in terms of challenging ineffective procedures and rules and regulations that lead to endless paperwork. Nurses have and always will be major innovators, let’s really start to listen to their ideas and what it is like for them on the frontline, only then will they feel that they are leaders in the field of excellent clinical care and are making a difference.
it really does take COURAGE to commit to doing something and its much easier to COMPLAIN than do. Maybe the 7th C should be Complacency which is what the NMC suffer with…. Doctors are constantly loved up and nurses are ignored and sidelined.
Nurses need action and the support of a ‘do-er’
So much to say not really sure where to start! I trained in 1972 when yes nursing was a vocation,we were seen as some form of angels by most patients and slaves by most doctors,we spent most of our training in a practical setting and the expectations of us were very high in every aspect. At 18 years of age I was on nights for 7 nights every month, at 18 I laid out a baby that died in my arms and was made to carry it to the mortuary,at 18 I was petrified of the sisters in charge, at 18 I was always late home. The world has most certainly changed since those days; but when someone is ill and in hospital or being nursed in the community, their needs are pretty much just the same as they always were. They want to be looked after,comforted if they are afraid and they want to get better and go home. For me the problems of providing these things in many enviroments has changed because of the training given to nurses today. In some aspects I believe it has improved and there is far more emphasis on the patient as a whole and far more depth of knowledge and also more involvement of the patient in their own care, which has to be good. However, I am most certainly not convinced that nursing should be under the umbrella of universities. Nursing remains a practical job and I would like to think also retaining a degree of vocation, perhaps therein lies the problem. My daughter has just qualified as a nurse and found the whole training incredibly frustrating. There appears to be a high drop out rate generally and that is in my opinion because we have made nursing degree only attracting a different kind of student. Students spend more time in the classroom than they do learning how to be a nurse, to have to teach students how to care says it all. Students used to nurse because they wanted to care, not nurse to get a degree! We need to re-balance their training or maybe have two levels of nurse, having just got rid of the diploma nurses perhaps bring them back! I now work as a Health Visitor and the same pressure is exerted on us to do endless mandatory training, tick boxes, don’t do this, don’t do that; but the families what do they want, they want people who care, who listen,who understand and who will do their best to help them. I do my upmost to give them that and I do so because I chose a caring profession in the first place because that is what I wanted to do! Please lets choose the right people to nurse in the and then get the academic,practical balance in perspective.
Some interesting comments.
For your information the NHS Leadership Academy is in the process of designing a nurse and midwifery leadership development programme. We are seeking as many views as possible to help shape a programme that really meets the needs of nursing and midwifery today. If you would like to contribute, here is the link to more information and a place to post your comments.
http://www.leadershipacademy.nhs.uk/grow/nurse-leadership-development-programmes/