Creating a new vision and strategy for Nurses, Midwives and Care-Givers
This feedback exercise is now closed. It ran from 21 September 2012 to 16 November 2012. Thank you for your valuable input. We are now considering all of the responses and feedback received. Any comments left on this page after 16 November 2012 will not be added to the feedback exercise.
To be a nurse, midwife or care-giver is an amazing role. There is hardly an intervention, treatment or care programme in which we do not play a significant part. They provide care, health promotion advice as well as treatment for ill health. They support the people in our care and their families when they are at their most vulnerable and when clinical expertise, care and compassion matter most. In the video below Jane Cummings, Chief Nursing Officer for England, explains the vision in more detail.
As our NHS helps people to live longer, care needs are changing, and our health and care services are evolving to meet these needs. What hasn’t changed is the fundamental human need to be looked after with care and compassion, by a professional who is competent and communicates well, by someone with the courage to make changes that improve people’s care and deliver the best and the commitment to deliver this all day, every day.
Over recent months, Jane Cummings, Chief Nursing Officer for England, and Viv Bennett, Director of Nursing for the Department of Health, have been talking to care givers up and down the country to start to understand what the new vision and strategy for Nurses, Midwives and Care-Givers should look like, and what values unite the profession.
They have now published their draft vision for the first time.
We want to hear your views on the issues contained in the document to inform the strategy for the development of the nursing, midwifery and care-giving professions.
This is a fantastic opportunity. You will influence the next steps we will collectively take to set a course for the nursing, midwifery and care-giving contribution to developing the culture of compassionate care and meeting health needs for the coming years.
Please read the visual summary or Nursing Vision.
Webinar sessions: Developing the culture of compassionate care
The NHS Commissioning Board is running a series of interactive online webinars to discuss the new vision and strategy for Nurses, Midwives and Care-Givers, and its six key areas of focus, the 6Cs.
- Thursday 11 October
- Friday 19th October
- Thursday 25 October 2012
- Wednesday 31 October
- Thursday 1 November 2012
- Thursday 8 November 2012
- Friday 9 November
- Wednesday 14 November 2012
Join the twitter chat #6Cs
Comments on this page are now closed.
Comittment, Competance, Communication,Courage, Compassion and Care are all a daily part of the profession with Care being the most important – having worked for the NHS for 35yrs and now working part-time for an affilliated private company – the one thing I have noticed that is essential for all the above to be effective is good communication – quickly followed by no shortage of equipment.
Poor staffing levels and lack of equipment have a lot to answer for regarding poor care within the Health Service, which ultimately causes nurses to become disillutioned and undervalued.
As for Communication, my current company have issued all their nurses with Blackberry phones and Ipads – all data is downloaded on a daily basis by the nurses going directly onto the patient’s notes, enabling all the Medical Staff to refer to this.
Care is what a good nurse does but unless we have the back up of committment to supply good communication and staffing then it is almost inevitably going to fail in some way.
Completely agree that modern nurses need the equipment and technology that is used by all other professsional workers to function effectively and efficiently in today’s world. This will allow nurses to communicate with their patients and clients in the most appropriate and time ly manner. Equally the ‘old fashioned’ values of care, compassion and pride in one’s profession need to be valued and promoted. Not everyone can be a nurse and it requires a set of skills, knowledge and attributes that we should be proud of. The need for these often only comes with maturity or personal experience but a national innovative marketing strategy that demonstrates what nurses ( of all kinds) do and raises the profile of the profession will do much to ensure that we attract the best and most suitable people to the profession. the vision is very comprehensive but would benefit from this aspect which we as nurses are often reluctant to do – that is ‘blow our own trumpets!’
Couldn’t agree more that the experience and role of nurses needs to be better understood and appreciated. There’s an important body of research by nursing professor Christine Jonas-Simpson based on her personal experience that can make a meaningful difference.
“I was deeply moved and comforted by my caregivers’ expressions of grief. While I was living my worst nightmare I could not help but wonder what it was like for my healthcare colleagues to grieve and bear witness to our devastating loss. As a nurse I experienced grief of my own patients as well as identified with their families’ losses – these moments transformed me.”
For her full description and to see her documentaries on the subject of what grief is for nurses who care for bereaved families with perinatal loss go to http://patientcommando.com/patient-commando-blog/2012/09/when-nurses-grieve/
Nurses trained at university seem to think that basic care of patients is beneath them. I would like to see Nurses training schools attached to training hospitals with continuel assessment of student’s like it used to be. A final exam at university does not test the students attitude to their Job.
Amanda Jayne Maclachlan
I strongly disagree with your opinion, and this type of out-dated stereotypical rhetoric does a diservice to our pre-registered and registered profession. At our University there is a stringent competency system to assess and develop student nurses’ practical skills throughout their academic training, and we work in partnership with our hospital colleagues who provide excellent mentorship throughout the students training. Moreover the “final exam” as you mention has not been part of nurse training for years…….
I’ve just finished working in the NHS for three years as a physio placed on a nursing team in the Northeast of England. What I have observed is some very wonderful and compassionate care provided by senior staff. The new graduates, however, are not capable of providing compassionate care (although they have been taught about it, over and over again) because they don’t have the basic competencies of care mastered upon graduation. It is impossible to provide compassionate care when one is struggling to provide clinically appropriate care. This sentiment was echoed by the new graduates themselves who voiced frustration at being taught the one element that propelled them into nursing to begin with, but not being taught the essentials of clinical skills.
A good example of this would be that the trust I worked for contracted with a local university to provide a clinical skills course for new graduates. On the first day they are handed a simple diagram of organs within the body and asked to identify them. Nobody could get all 10 correct, and these are people who have graduated from a nursing programme!
This education fails the new graduates, the patients they care for, and puts additional strain on senior staff who have to teach basic skills that should have been mastered by the time they have reached this point in their development.
Compassion can flow when clinical skills are mastered, staffing levels are sufficient, and there is genuine support from management for those on the front lines of care.
I think University Lecturer should be able to point to a number of students who have left the course because of a lack of compassion or communication skills – if not, one wonders why?
Are there perverse incentives in the system which allow nurses to complete their training and go on to employment lacking these skils?
I could think of a couple:
Firstly the payment and outcomes measures in HEIs – how much income and so forth is tied up in pass rates and recruitment to courses – if significant then HEIs will strive to maximise their outcomes by “supporting” students long past the point where the correct decision would have been to discontinue them.
Secondly – lack of ownership. How many students are actuallyidentified at placement level of not showing the qualities of compassion and communication. I am sure there are many dedicated mentors out there, but how many are willing to identify these factors honestly leading to the student failing their course? When the student moves on it becomes a problem for the HEI and the next placement – could it be easier just to breathe a sigh of relief and, given all the other pressures, settle for the quiet life?
I don’t know the answers to these points. Perhap someone does. Maybe they aren’t relevant. It might be worth remembering that the system works to achieve the outcomes that it has been set – if these are measured in number of nurses completing training then the system will react to maximise this outcome.
Amanda and Chris are so right in what they say. The idea of a “Degree Qualified Nurse” has all but destroyed the good name of the Nursing Profession. The problem now faced by the RCN and the DoH is how to get around the problem of their own making.
I am a member of the public whose wife died with Vascular Dementia 2 years ago. The reason that I am here is that her treatment whilst in hospital was so bad that I have been crusading ever since. The points that I raise will therefore be from that angle.
Sitting on the outside looking in, the only “Positive” in the new Basic Training that I have come across is that Canterbury Uni are seconding students for 2 weeks to an Elderly Care Home which caters for those suffering from Dementia, thus giving them an insight to one of the major nursing problems of the present and the future.
Another of the problems I see looking in, is the lack of proper training for those being promoted to Supervisory and Management roles. DoH provide Courses but as they cost money! Senior Management therefore tend to promote with no training which leads to all kinds of problems, including bullying which then has a knock-on effect on standards of care.
There have been improvements with Dementia Care training being provided for staff and if the Dementia Challenge funding is spent wisely on things like the Butterfly Scheme and Dementia Buddies the overall improvement in patients will soon become evident.
I should also like to add that there is a lot that could be learned from the Armed Forces Nursing Professions or what is now left of them.
Maurice,
Firstly and most importantly, let me express my condolences. No patient should die with less than compassionate care delivered by people who genuinely care and want to deliver the very best everyday. We as professionals need to remember that when we have gone home and put our feet up, the families of our patients that day will still be carrying the results of our action or inaction and will do forever.
Picking up on your point about leadership and management, I couldn’t agree more. As an Armed Forces nurse who has worked with NHS colleagues I was astounded that perfectly capable nurses were elevated to leadership positions without any leadership training.
Leadership and management are not ‘added extras’ they are essential elements. We wouldn’t expect a nurse to start prescribing without undertaking prescribing training. Why then should nurses lead or manage without appropriate training? The art and science of leadership is as difficult as the art and science of nursing.
It is sad to read this misinformed view. Student nurses spend 50% of their time learning in a ‘training’ hospital, and are continuously assessed, this is a Nursing & Midwifery Council requirement. The practice assessment document developed at our University does assess attitude on an ongoing basis. All of our students are interviewed individually, face to face, by a lecturer and a practitioner before being allowed onto the course. This interview takes into account their attitude and commitment to the profession and doesn’t just look at their academic qualifications.
There will always be good and bad in every profession. It is easy to make nurses a target for a problem which is so much bigger than them. Increased strain on the NHS, poor staffing, lack of resources and the ‘tick box’ culture does nothing for morale, and leaves nurses unhappy that they cant do their job in the way they wanted to.
It’s nice to see a one tracked mind that tarnishes all student nurses with the same brush. As a first year student we have already spent a lot of time in practice, and will continue to do practical placements for 3 years. In which we have to prove that our caring, communication etc skills are as good as our written. I strongly disagree with your view, as I believe that being able to critically analyse a situation and back yourself up with evidence is just as important for your patient. It is not down to one exam it is 3 years of working hard to learn and experience how to help your patient in the best way possible. I can only assume that you are jealous and uneducated on what we do, and feel saddens that you have this opinion. I would be very grateful for you to have and open mind and perhaps do a little research into the good education we receive to be able to help save people’s lives and comfort them in the process.
I think it is important to remember that historically nurses were percieved as less important than the medics. Should it not be celebrated that the nursing profile has been raised thanks to a strong academic base. Without academia and the ongoing efforts of research, nursing is in a far stronger position to challenge the stereotype that Drs know all and nurses are there to carry out instructions.
I came from the heavily critisized P2K training and throughout that period comments from traditionally trained staff reigned in. Character building if nothing else! Perhaps what is needed by sceptics of the current training is a reinvestment of energy, i.e. if there are any deficits in the individual student nurses’ practice support and encourage some positive changes instead of attacking a system that seems to be working. Students, and practiting nurses are at different levels, have differing personalities and attitudes to practice. What is needed is a positive supportive role not critism.
I strongly disagree with this outdated view. I’m not sure it was ever true, it was often said in the late 70′s when I was one of the first nurses to do a university nursing course. Why should the study of nursing principles in an academic setting, with opportunities to learn with other disciplines, preclude a nurse from delivering care in an empathic, compassionate way? I have found that a medical degree produces both very caring, compassionate doctors and ones who are brusque and poor communicators but we would hardly dispense with their rigorous preparation for their profession. I applaud the work of the report on developing a compassionate culture, although it seems sad that we have to ‘instruct’ on this subject. I think that the disappointments with the nursing profession and the perceived lack of compassion are a reflection of the way society in general now places little value on integrity, unselfishness, ethics, altruism and kindness.
Your last statement says it all. Society no longer values the integrity and good ethics that the nursing profession stands for, nor is prepared to pay for them, BUT if things go wrong they are ready there to sue you for the same things they do not value or want to pay for. Are patients taught how to behave as well?
As a mature student nurse, going into the profession at 37 and studying whilst looking after a young family, I feel very hurt by your comments that University degree nurses don’t ‘care’! I have committed myself to the nursing profession for that very reason! I can only comment from the teaching on my degree course in Swansea but communication is taught, by experienced nurses, as part of the fundamental aspects of nursing care and its importance can not be stressed enough. However, what I have found from my experience working on the wards, is that its some of the older nurses who have ‘forgotten’ how to care and seem to just ‘go through the motions’, its like they don’t ‘see’ the person anymore. Additionally, evidence based care is also lost on some older experienced nurses. I was being shown as procedure on a ward once by an ‘experienced’ nurse and she told me that she was supposed to do it a different way but ‘ I’ve always done it this way and I don’t see why it should change!’…….. Probably because the new way is evidence based??? Since starting my degree in March, all my training has focussed on is the patient. Communication, respect, privacy and dignity, care and compassion are key and I for one am committed to delivery first class care to all patient I come into contact with. I know not all nursing student will have a patient centered approach but then again, neither do all nurses. What chance do the ‘new’ nurses have with people like you championing us?? I know I will be a good nurse regardless pog what people like yourself think because I genuinely care.
An interesting document, but whilst the NHS tolerates poor leadership in the way it does, with models of nursing leadership lost in the 1980’s, development will continue to be a challenge. I believe this document has its heart in the right place and I think the content is spot on, deliverable in the current climate of cost-saving and poor leadership? Interestingly, for a document that purports progress has no male caregivers on the cover, only female! Not very representative I fear and perhaps even deeper meanings than that!
Chris.
A good document and support Carol Scott’s comments.
I have been in the NHS forover 40 years and I don’t believe any nurse goes to work with the intention of not showing comittment, being competant, communicating to the best of their ability, showing courage & compassion and caring. However with the ever increasing pressures in the workplace and on the healthcare economy there is no doubt that the care delivered is not always optimum.
With the development of a graduate workforce and the ‘strained’ healthcare economy, I believe the non registered workforce will increase in numbers. To ensure the increasing numbers of the non registered workforce have the appropriate skills and competencies a central registration with a distinct career pathmust be developed. For those of you old enough it feels like the old SEN & SRN equivalent is on the way back!
Teresa,
Nursing has already gone around this circle with the NVQ.
I feel the whole process keeps reinventing the wheel, like a model of small car, ever increasing in size on the new model so people perceive it is bigger and better, only to reintroduce a new smaller model.
In nursing it always seem to be a them and us situation. If you are not one of us (our way of thinking and our view), then you must therefore be one of them (and not fit into this clique). I found this when I returned as an SEN in 1995, but with a degree that involved some insight into how computers would help documentation and patient care. I failed one assigment because my ‘critical incident’ included evidence on how the NHS was becoming more like a ‘business’ and was too far fetched!
My managers, colleagues and tutors often commented that a nurse belonged at the bedside and that to like or understand how computers could help was somehow heretic. The frustating thing was, within an often insular view, there seemed at the time, a lot of nurses who were unable to comprehend how patients’ actually felt cared for by me as well. I could fluff up the pillows as well as understand how documenting and communication all contributed to the well being of the patient.
I hadn’t the ability or knowledge to examine the patient rectally but my gut feeling told me that the ongoing presribed enemas was nothing to do with constipation but obstruction. The patient was dead the next day as I didn’t at this point beleive what I was feeling at the hierachical level and only a couple of weeks on a ward after 14 years away.
My gut feeling told me a drug was going at 5 times the rate so someone with the maths ability beleived me and acted on it.
I ‘felt’ that the chest drain was filling too fast. My team surgeon did not respond (nurses so often overreact)so I grabbed another team and the patient thanked me for saving his life next morning.
I have worked with a few excellent untrained assistants who had more common sense and empathy than many of the doctors. I know not all doctors are uncaring, but I do think the level of academia attracts people more interested in success, money, even technical challenges to the medical profession and management. Where I work in primary care, we are governed by GPs whose focus is making money and managers who do not recognise nursing input.
I have come to the conclusion that ability in nursing (or anything else for that matter) is not due to excellent grades at University, but a spectrum of other qualities that involves reasonable academic ability combined with emotional intelligence and that certain ‘gut’ feeling of ‘knowing’ when something is wrong, along with technical and spatial ability as well as some vision of how things might come together beyond the getting through the present moment. Has anyone seen the B&Q online psychological assessment???
I have been a nurse for ** years and have worked in general nursing, mental health nursing, provider management and commissioning. For a number of years I worked as a manager for CQC and its ancestor organisations, regulating health care in the NHS and nursing care in the independent sector. During this I have seen the best care delivered by day to day heroes, and the worst ‘care’ delivered by callous and malevolent individuals – I have been part of investigations in partnership with safeguarding practitioners and the police. I have just read the Francis Report and have to say that it would provoke feelings of greater intensity were the North Staffs issue not yet another failure in a long line of the same; in part due to the failure of nurses to assert themselves as professionals and step forward as advocates for vulnerable people.
The truth is that there are always going to be; champions (remember Graham Pink), ordinary practitioners who are just doing their best, and bad people in this job. That is why as nurses we have to maintain vigilance, courage to blow the whistle, and determination to be advocates for the people who pay our salaries in everything that we do.
The word ‘profession’ carries a number of meanings and connotations, but nursing has undoubtedly been attempting to define itself in reference to this word for all the time that I have been associated with care. I don’t think that it is any nearer now then it was when I was training. The regulation of the profession doesn’t seem that much different for a start. Perhaps one of the issues is that we are too conscious of status?
Although many of the debates about recruitment and training seem to be recurrent if not circular I would like to make a couple of observations. It is clear, and it is starting to be acknowledged, that too often contemporary arrangements place responsibility for meeting ‘basic’, though critical, care needs in the hands of people who haven’t had the benefit of professional training. NVQs do not substitute for nurse training when it comes to making sure that someone’s hydration and nutrition needs, their need to eliminate, and their need to be perceived as human and individual. Responsibillity for ensuring that these needs are met is a nurses job, whether by direct intervention or by taking responsibility for the standard of care delivered by others.One discernible trend over the past three decades has been that toward care provided by progressively ‘cheaper’ people. It just doesn’t work.
This failure has been compounded by the distancing of nursing from the point of care by the end of practical but technically knowledgeable nurses, known as enrolled nurses. When they existed they were abused, their position in the hierarchy was invidious; but they often provided the spine of a care venue; they were the purveyors of the ‘culture’ of care being coordinators of and examples to student nurses such as myself.
I might be accused of nostalgia but the reality is that successions of reform have not reduced the flow of scandal. Reviews and reports do not result in a reduction of scandals. Despite clinical governance boards do not always show greater awareness of what is happening in organisations.
Heretical though this might be it might be time to exercise a bit of retrospection to see what has worked in the past!
How about the addressing the culture of ticking boxes? Senior management/operational management (not all…don’t want to generalise!) talk of targets CQC..Essence of care and the like, that it sounds so far removed from how they transfer into patient care. The pressure to conform to the right paperwork, collecting data etc removes the fundamental purpose of realising that actually there is a person/people at the centre of this! There is no doubt that the intention behind these standards is meaningful and purposeful however has the perspective been lost?
How do you get quality interventions/quality care for people from practitioners with already busy regimes and day to day running without the additional pressures of making sure the boxes have been ticked (from whatever that entails). It is not my intention to suggest that all managers have this perspective however anecdotely it would appear that box ticking is a high priority….commissioning, funding etc.
Is there something to be done about how to address embedding the culture of government/trust/managerial directives into the clinical arena without the pressure, fear and need to continue to deliver high quality care in a less beaurocratic forum. How can this become part of day to day running and not feel like yet another add-on to a list which is already not exhaustive?
Jane i completely agree with your comments, nursing staff in my own area often feel demoralised at the amount of tick box excercises they have to carry out. Often resulting in less time for direct patient contact, minimal staffing levels add increasing frustration to this.
We are not seeing a bottom up led NHS as promised.
The standards proposed are precisely why I became a nurse, what i would like to see is the support from employees and governmant in realistically achieving these. Work with adequate staffing levels and skill mix, stop focusing on ticky box excercises, stop dupilicating work and i am sure we can achieve the proposed standards.
Ticking of boxes works when you want a moment of pause before you endeavor work that may harm patient if you leave everything to memory or assumption like in theatre before starting surgery. The WHO (World Health Organisation) checklist is now adopted nationwide or maybe worldwide. These is like checking your cockpit before you fly a plane.
I hope this opportunity is siezed to enable the nursing profession to promote its caring compassionate side.
Communication is also about infoming/asking the patient when they are having a basic proceedure performed in an appropriate manner and ensuring that it is understood.
There is not enough connection in the document regarding the patients and carers and what they want/need. Please don’t make the mistake of going to over the top with technical training levels again – lets remember nursing is a hands on touching/caring profession.
Which begs the question, why do you have to be educated to degree standard (with the level of education required to get onto a degree course) to be a caring, compassionate and competent nurse?
I have worked with many nurses over the years whom I have the greatest of respect for, who would not have been considered for a degree course with the qualifications they obtained at school if they were wishing to start their nursing in todays current climate. You cannot teach compassion to a level required of for nursing.
Many of these nurses have excelled in their chosen field through continuing education backed with the practical experience and knowledge that enables them to nurse with continued passion in their expert role.
Maybe all prospective degree students should spend 3 months working shifts on a ward (at a minimum wage) to see the realities of hands on care in a short staffed, high pressured work place with patients requiring patience and assistence with personal basic needs.
Feeding a patient, oral care, dealing with incontinence, confused frightened patients etc in a caring and compasionate way has to come from within, the ‘tricks of the trade’ can be taught but doing this day in day out with compassion when tired and stressed can’t.
Christina Patterson, Ann Gallagher, Ray Tallis and Alka Sehgal-Cuthbert will discuss this important issue at the Battle of Ideas Saturday 20 October 2012 and explore the following :
How can we tackle the compassion deficit?
Can we really train people to be compassionate?
Do we as a society care less about each other?
Is there even an institutional fix?
Does the crisis in compassion for the elderly reflect a deeper lack of respect for wisdom and experience? What are the causes behind our seeming inability to care?
Full details are available here
http://www.battleofideas.org.uk/index.php/2012/session_detail/6776
Like many attempts to improve care, if it is achievable, the summary diagram is a good step forward, even if it is, perhaps inevitably, dominated by processes and procedures. The person on the receiving end seems to sit around the diagram, not at its heart. (And it is all very well having a mission statement, but those responsible for delivering the outcomes need to buy into it and sign up to it.) The crux is this:
If we don’t care ABOUT those we are caring for, we cannot care FOR them well. That is the only compassionate care there is.
All nurses should be given experiential dementia awareness skills training/coaching of the kind that I and other dementia communication specialists facilitate. This includes understanding the importance of the reminiscence bump, empathic engagement/communication skills, active listening and life story enquiry techniques.
These basic skills should be underpinned by discussion and reflection to provide those learning with a comprehensive understanding of the endless and growing loss of control and quality of life for the person with a dementia and how this affects their confidence, their ability to speak for themselves, their freedom to make their own choices or to control what is done to them; and their escalating difficulties in relating to and interpreting the world around them.
I agree with Maurice Bernard, that The Butterfly scheme and dementia buddies should be adopted by all hospitals as standard practice. Through my work with carers and people with dementia in day centres and care homes, with AgeUK’s My Home Life and through CQC inspections as an Expert-by-Experience, I do see good practice, but also much that must be improved.
Almost all improvements in compassionate care of people with dementia could be achieved if people were better informed about how dementia feels to the person living with it and were therefore more able to put themselves in the person’s shoes. Interestingly, this ability is often something older staff members seem to be more able to do naturally. Whether this is because they have received different training, or because they are older themselves is probably a moot point.
The Lancet Commission report (http://healthprofessionals21.org/) was released in December 2010 and is fast becoming the new Abraham Flexner report (1910),’which paved the way for medical/healthcare delivery across the globe in the 20th century.’ The Lancet Commissioners (p/also see* below) advocate a new model for training healthcare professionals, including
(1) the development of health and social care programmes that actually meet today’s and tomorrow’s population needs, especially keeping in mind an ageing population that requires urgent re-balancing of community and hospital care;
(2) ensuring that ‘the quality and safety of patient care are the primary focus of all training programmes’*; (3) ‘incorporating within all health/social care curricula -and at all levels- practical ‘interprofessional/teamworking learning approaches that nurture the self-worth, mutual respect and dignity of patients and colleagues’* ; and
(4) providing a much better curriculum balance in terms of emphasis on ‘curative and preventive’ measures, thereby preparing health/social care professionals who take a holistic approach to practice. This ‘person-centred’ view of care is becoming crucial across the globe as poor lifestyle choices are creating unhealthy and unsustainable life environments in most western and now many eastern nations. Indeed, a recent study in the US confirmed that ‘life expectancy among poor white Americans ( a drop of about 5 years) is falling sharply’ caused, in the main, by ‘a combination of unhealthy lifestyles, obesity, and prescription drug overdoses.’
Dr Robert Horton, a UK physician and editor-in-chief of US-based ‘The Lancet’ calls for a ‘re-moralising’ of the healthcare system, one which builds ‘a new kind of professionalism -patient-centred, interprofessional and team-based,’ and one that rises above the ‘rigid and damaging tribalism that afflicts the professions today.’* Dr Ruth Collins-Nakai, former chair of the Canadian Medical Foundation, echoes Dr Horton’s observations, envisaging a type of leadership that ‘would be courageous enough to act in the best interests of the populations they serve rather than the best interests of business or economics.’ *
In short, providing more compassionate and competent patient/social care in this decade and beyond necessitates structural changes in the way we prepare our health/social care professionals. It also requires broader and more ‘joined-up’ thinking and commitment -social, political, economic- on what needs to be done, by whom, how and by when – in terms of health and social care. Given the state of finances in the UK and across many nations, deliberations along these lines cannot start soon enough.
*-< http://www.rcgp.org.uk/bookshop/info_1_9781846199691.html>)
As a person with a learning disability and i also work with the mental health Nurses in my role and the new plan looks like a great start.Well done
Further to my previous reply, I do agree with the 6 Cs but would add *Collaboration* as another fundamental attribute as emphasised by the Lancet Commission (and also highlighted in several chapters in
http://www.radcliffehealth.com/shop/transforming-medical-education-21st-century-megatrends-priorities-and-change)
From a curriculum development perspective, planners reviewing and re-shaping UG/PG curricula (e.g. Nursing, Medicine, Social Work) may need to ask how each of the domains/attributes can be optimised across the health and social care professions in terms of learning approaches and training capacity and who needs to be involved in making these types of decisions ideally, in my view, involving representatives from the specific professions, the other health/social care professions, patients and service users, employers, regulatory bodies, trainees, etc. The best way to develop inter-trans-professional curricula is by involving key stakeholders from the start, in particular reaching out from one’s profession and talking things through collaboratively.
I would like to see more examples of excellence where nurses and students give high standards of care to service users and carers. I think we tend to showcase negative examples and expect students to learn lessons from poor care. Surly we need to be able to articulate best practice so that students have something to aspire to. I have experience of students and nurses delivering excellent standards of care to members of my family and would like to celebrate nursing sucess stories. I believe that whatever you give attention to will expand, so a focus on excellence rather than poor care would make sense to me.
Well said.
Returning to a clinical setting, to actually deliver care, for the first time in years ,very recently, with all I know now about management and the architecture of the NHS , I am in awe of the job done my nurses , midwives , doctors and all the allied professions caring for patients. Their dedication and commitment knows no limits at times and yes, we need to celebrate this alot, lot more
I have been in healthcare since 1977 and have continuous and significant experience in care , management and leadership both in provision of care and commisisoning of care and across many settings. I have recently been fortunate enough ( as a senior manager in the NHS ) to undertake a full return to practice in health with a clinical placement of almost 300 hours .
The great thing about this was finding out that my approach to all the roles I have held in my career came from my original role as a nurse and caring for people in a safe and kind way.
Sure, There are huge differences in care at the front line now from when I trained and when I was last in charge of a ward as a ward sister . But , so there are huge differences in life everywhere as one might expect over any period of time.
There is little change in the needs of people who are ill or dependent in some way.
.
I do not think that continuing the debate about nurse training at this stage is useful to the profession as it just feeds alienation internally “amongst ourselves” and damages respect for one another . All the newly qualified ( post graduate ) staff I met were amazing in terms of their enthusiasm for their work and the level of knowledge they brought to the care arena . Nursing is a practical skill inextricably woven into care and compassion. This skill is developed over time and sometimes through life itself.
Give people a chance and make sure we ( the older models) are good role models that support and guide younger nurses through their career journey.
Theres always room for improvement-at every level in the system .
Lets use the opportunities of this vision to move forward positively with what is an already highly valued profession -Look at the key questions asked and iget people together to answer them honestly and try to inform a better future for evreyone.
Be proud.
Can we please stop blaming degree level nursing for poor care. Doctors and other AHPs have been educated to degree level and it hasn’t interferred with their ability to care. It is nonsense and we need to move the debate on.
I qualified in 1988. One of the striking statements that I heard at the time is that ‘The whole is more than the sum of the parts’. I think that looking at the whole way we provide healthcare and promote health is key to success. Nurses cannot be taken in isolation. They are a part of a whole system. Any discussions that includes nurses and the 6 Cs needs to include every person that works in health including accountants; doctors; cleaners; caterers; radiographers; physiotherapists; OTs; laundry staff; psychologists; commissioners. The list is endless. Everyone one of those people need to be signed up to these 6 Cs. And, if for one tiny moment, we could consider all staff as a value to the organisation and not a cost in accounting terms, I think this would really help.
I agree fully with your point of view. You also provide an excellent rationale for why we need to re-think how we conceptualise and enact training in these professions in order to ensure safe and effective quality care and support for both patients and service users. As mentioned earlier, I suggest that another ‘C’, ‘Collaboration,’ be added to the 6. Planners may then need to reflect on how the UG/PG learning environments can best reflect the clinical/social work environments maintaining the quality of the patient or service user experience as the main focal point in terms of all educational decisions made.
Working together effectively or harmoniously -across and within professions- does not automatically occur by chance but must be designed into the learning experiences (hospital, community, individual) of the students/trainees right from the start of their education/training and weave spirally/seamlessly through the curricula. We can no longer afford – morally and financially- to continue to train in silos and inter/trans-professional teamworking needs to become a top priority for all health and social care training in the next few years.
Developing the culture of compassionate care: Creating a new vision and strategy for Nurses, Midwives and Care-Givers
It is unfortunate that my hackles start to rise as soon as I begin to read the new strategy as the title begins with denigration.‘Developing’ the culture of compassionate care suggests that the provision is a new concept. Surely compassion must be the integral part of our role, and should not be something to be taught or developed? Has it vanished or have other priorities commanded more value and time from our workforce? I would argue that there are elements of both for which all strata of staff must take responsibility for. So, what is the future of Nursing? Does compassion exist or is it an outdated concept that is no longer aligned to contemporary Nursing care?
If compassion is a concept needing to be taught and developed, then our students will learn this from their new colleagues in placements or from their educators, or ideally they will arrive with a good understanding from their own life experience to date. From my own experience, many student Nurses arrive to placement unable to achieve even the most basic competencies, and when I sit down with them to try to unearth the fundamentals of ‘Why do you want to be a Nurse?’, I am disappointed (and at times flabbergasted) by the lack of enthusiasm for their new career. The scene descends into a parody of Jeremy Paxman v Kevin and Perry go large!
What inspires you in Nursing? Grunt.
Why did you choose Nursing? Grunt.
What would you like to learn on this placement? Grunt.
Is anyone in your family a Nurse? Grunt.
Have you been a carer? Grunt.
Have you spent time in hospital? Grunt.
Have you seen good or bad Nursing? Grunt.
What do you think of Casualty, ER? Grunt.
Perhaps this is a result of youth combined with disaffection and lack of future goals, and could be remedied by recruiting and training experienced Health Care Assistants. But my starting point for resolving any of the above would be to screen much more tightly, so that the core principles are already evident in our students. With such a high drop out rate in nursing education, the cost of the NHS Nursing bursary must be treated with real regard , and used only to fund students we are confident will succeed and become the caring, compassionate, competent, committed, courageous and communicative practitioners this report idolises. But let us indulge ourselves in a world where our youngest and newest Nurses are compassionate and full of will to do good, and cause no harm. Where is compassion to be found in our more experienced staff? Have they lost sight of their aims due to frustration with bureaucratic red tape? Or have the senior roles changed in ways in which compassion is an abstract term, very easily ignored when more pressing matters such as rota’s, data-metrix and quality assurance take precedence?
Those notions fail to explain the apparent loss of compassion for those already nurtured and funded by the NHS however. Has compassion actually left the NHS?
It would seem to me from purely anecdotal evidence that it has not, but the over-riding measure of quality has been removed from ‘hands on’ Nursing to form filling and tick boxing. Historically, Nursing was always the vocation for those that wanted to aid and facilitate improved healthcare and this was carried out in a very practical and holistic fashion. We are now so entrenched in a culture of non-risk taking, paper evidencing and standardization, that it is challenging to demonstrate compassion in the ways in which our patients recognise, ie tangible concepts such as time to listen, time to share a tea and respond to tears, time to hold a hand and time to care at a pace the patient can cope with. This doesn’t mean that compassion is missing, or in need of development as a new idea, rather we need to reflect upon how we administer compassion in graspable terms.
I think this means a robust inspection of acquity on medical wards, introduction of multi-disciplinary staff across all wards, increase of specialist staff, and a greater respect and value for Nurses at ground level. It is easy to become disillusioned when feeling isolated and uncared for as a staff member, let alone as a patient. And let us remember that many behaviours are reflections of others, so the downward trickle of not showing compassion from senior strata, may dissipate unfavourably onto junior staff members and subsequently onto patients.
In addition to that, the Patients Voice is louder than the Nurses, so compassion is only a term applied in relation to patients in the Nursing spectrum. Even if Nurses are encouraged to challenge, and fear of reprisal is removed, there is not a forum at local level in which to innovate and model best practice. For example, when a new initiative is trialled, such as a new admission booklet of 40 pages, there is no facility for Nurses to refuse to use, or even express an opinion on it. Therefore, the tangible demonstrations of compassion are removed from the Nurses day in favour of the completion of charts. I can’t remember ever meeting a Nurse that would choose the latter over the former! To take this one step further, when I wrote personally to David Cameron earlier this year to challenge views he had expressed to the press, I did not receive a reply that in ANY WAY responded to my concerns. Therefore if I cannot be shown any respect, despite collating my thoughts articulately, and addressing them directly to the voice/author, how I am I supposed to feel cared for as an NHS Nurse?
Health Minister Dr Dan Poulter said:
‘The Prime Minister has made nursing one of the Government’s top priorities and we look forward to working with the profession and patients on this. We want to do all we can to support nurses and midwives – they have one of the most demanding and sensitive roles, commanding our respect and support.’ Whilst I would like to believe that this statement is sincere, I see no evidence of this being demonstrated through actions that facilitate respect or support in meaningful ways. There are many nurses that want to pursue their career in a stable manner, where they can grow in experience but stay in the same role and grade for many years. There are equally a large number that want to innovate and add value to the NHS, but the provision of training, mentorship, funds and creativity is not there to support that, hence why Nurses are largely unable to make changes at a local level. Therefore I would vehemently argue that compassion, care, competence, commitment, courage and communication are very much still there, but a smokescreen of bureaucracy is hiding the talent and raw empathy. Remember…no-one begins Nurse training hoping to be disaffected and uncaring: we all joined to make a difference, but the ability to be better, has been masked from view.
Everyone would like a better service. We are united on that ideal, and Nurses should be allowed to develop into competent administrators and managers, as well as flawless practitioners. We should be able to aspire to become one or other, as in other professions, if we so choose. Our strengths need to be cherished and valued so that we feel we want to stay in the NHS, and offer 100% effort even on a bad day. But these are all dreams unless taxes are increased to provide the service our patients’ want; sheer fantasy for those that want to feel financially rewarded as an employee; and pure myth that Nursing is a top priority for a Government wishing to revamp respect and support.
Penny Johnson
Interesting debates. I think a lot of people see nurses getting the ability to be awarded diploma/ degree status for their studies (like all other health care professionals) as the problem with care rather than seeing the bigger picture with change drivers such as changing population demographics, raised expectations and increased changing health technologies. Health services in totality have needed to adapt to these pressures.
Having just been a surgical patient, I saw that care is now divided up amongst so many professionals and although I was overall very happy with my care, I sadly saw no nursing leadership. No ward sister in blue came to communicate with me around my totality in care. Nursing was seen as a drug round activity, pain and wound check – fill in the documents – sadly. Soothing care such as asking how my night/ morning etc was, help with arranging pillows/ bed comfort was very limited. I even had to ask “my” nurse if she could help with my hygiene / dressing / mouth care needs 8 hours after major surgery??. It was a physiotherapist who helped me while vomiting as the nurse was too busy trying to get a plastic apron to protect herself and never came back to see if i was better!
This care/ compassion is taught in the classroom but until sisters/ senior staff role model in practice this soothing-added-extra holistic care attached to the technical skills then students will not appreciate the importance of what nursing should really be.
So all nurses come on- you all have a role to develop our students while still celebrating our level of education putting us on level field with other health professionals.
Some thought on the debate. I am a recently retired nurse and I qualified in 1972. I very much agree that the loss of the ward sister’s role as ‘where the buck stops’ has had a disastrous impact on nursing standards. The lack of a role model combined with the lack of someone in charge of the ward who knows all the patients has resulted in in a fragmented service. Many nurses are highly skilled, efficient and compassionate others are not and I hear repeatedly form people who have had a spell in hospital that the care they received was variable, depending on who was their nurse for the shift. This was not the case when ward sisters had a supervisory role. This role went when all nurses staffing the wards were qualified (ie when student nurses no longer staffed the wards) and it was thought invidious that they should not take responsibility for their own case load – with chaotic effects. We have all known the frustration of trying to find a nurse on the ward who knows something about a patient, whether as a relative or professional.
I agree that Ward Sisters have to spend too much time ticking of boxes (sometimes necessary as in pre-op check lists) but not as a way of QA in all areas.
I am concerned about the document’s emphasis on evidence based practice. Much of nursing by its nature cannot be evidenced based. For example, ethical trials cannot be carried out which show the effect of withholding compassion. Many trials that are quoted
‘Technology to free up time for the whole team to care and learn’ is another area of concern. Some technology certainly does this but should be adopted with caution, the fact that it is new does not necessarily mean that it is effective. Discussion with newly qualified doctors suggests that digital notes seem to be taking doctors and nurses away from patients as everything needs to be written up twice.
I love working with pre-registration nursing students and despite the problems (which we have always had) that you get with a few I have yet to have one tell me they felt that due to them training for a degree they felt basic level caring was beneath them. I obviously wouldn’t just leap to this particular conclusion when I see a student (or a qualified nurse) perform poorly as I have the necessary communication and critical apraisal skills required to be a nurse. Anyone who jumps off the deep end into assuming the ‘too posh to wash’ myth needs to reconsider if they themselves has what it takes to be a good nurse.
If as a mentor you are unable to elicit any more than a grunt from a student it may be time to assess your own communication skills and career.
Lack of permanent staff, inadequate resources, working overtime not paid for is part of the culture in this NHS that I work for. Senior managers turn blind eyes, deaf ears on these showing no compassaion as long as the job is done well and on target. These affects staff morale and could possibly trickle down to patients care ultimately.
That is the most honest reply I have read. It is true, precise and if all these issues were addressed there would be no problem at all with care and compassion. More well trained staff, good managers who listen and react and recognition and fair pay! Easy, but then what would all the policy makers do with their spare time if all these easy problems were negated!
As a Lecturer Practitioner I have over 22 years expereince, teaching adult nursing students and nursing patients in a ward envirnment. I have experienced ‘old style training’ and been part of the new University system. One key issue, is a lack of compulsory attendance for nurses on their programmes which many of the public and even nursing Sisters are not aware of. It is not currently an essential requirment that all nursing students have a compulsory attendance on their programmes, as Doctors and other health professional do. It amazes me how I can have a 40% attendance on a final nursing mdoule where I am discussing how to deal with key complex issues such as self discharging, how to communicate to relatives and patients in distressing situations and there are students that are no where to be seen. Surely key aspects of nursing linked to communication within their programme should be made compulsory. Why is the NMC not making this a requitment as the BMA does for Drs??? It shoudl be at least 90% attendance in my view.
This is an interesting document, although quite sad that the professions require to revisit in such detail in the 21st century. I am pleased to see a focus on communication and compassion within the document. I have worked in the NHS for 30 years, the most recent 8 years have been as a midwife manager.
I have found that midwifery staff on the whole have technical skill and competence required to undertake the role .However , I have spent more hours as a manager investigating ,managing and presiding over hearings relating to poor attitude and behaviour, than I have on any other issues relating to the profession.
I am particularly interested in Action Area 5: Ensuring we have the right staff, with the right skills in the right place. I feel the point ‘Recruit staff with the right culture and values’ will require a concrete framework to establish absolute clarity around exactly what the profession means when it says ‘right’ culture and values. This should be coupled with a rapid and responsive process to deal with instances which are proven not to be ‘right’. The current process allows to many midwives with attitude and behaviour issues to continue working and this only serves only to undermine the rest of profession.
One of the points discussed is competence, and recruiting the right staff with the right skills. I think university woefully under prepares registrants for independent practice. Clinical skills such as Venepuncture and Intravenous drug administration is barely taught and is not allowed to be practiced within a trust. This means that yes we develop skills in communication and holistic practice but then as soon as we qualify and are expected to do these things we are have experience of doing it and are having to learn a brand new skill and apply the skills that we have developed throughout our training. Why not let students do IV’s and cannulation if they are expected to do it when qualifying, instead of letting newly qualified nurses feel like they know nothing. Many nurses when I was training felt like these weren’t important things to learn, but these clinical skills and task’s consist of a huge proportion of your shift.
I am in no doubt that having to learn all of these skills which could have quiet easily and relativly quickly been taught throughout my training had a huge impact on my ability to utilise my complex clinical skills such as holistic assessment.
Also it has saddened me to see the front cover and see a host of women from different back grounds but not one man on the cover. Men are very under represented in nursing and are treated like second class nurses, the DoH as a government body reinforcing this does not help things.
Great debate and comments above. I would strongly like to support the views of GeorgeLuddeke , Louise Gethin. The intention of this document feels well placed to a certain extent – I think it is sad as a ‘caring profession’ that we need to even write a stretegy/ development paper on howto become more caring and compassionate, but putting that aside I believe the themes are fairly well placed. None of the suggestions or recommendations in the paper will be achieved without a full root and branch review of ALL health and social care staff, professionals and systems. I do not believe that it will be enough to focus on the groups identified in the document. Change needs to happen from point of recruitment onto nurse training courses through to the very senior and executive members of boards. There needs to be as much emphasis on emotional intelligence, excellent leadership ability, personal efectiveness, personal responsibility as on technical skills.
The intentions of the document will be diffficult to realise in the current climate. I hear far too many stories of organisations that are shifting towards a much more command and control, autocratic, target driven management style, demonstrating low emotional intelligence and low engagement with staff. Poor leadership will not enable this change and poor leadership is still tolerated far too often in the NHS and Social Care. It is a sad indicetment of nursing today that after a nursing career of 28 years I can not identify more than 2 people I would consider as role models in my recent career history. The effectiveness of the implementation of this document will bedependent upon strng efective leadership and strong role models with the ability to demonstrate the 6 C’s on adaily basis and the abiltiy to demonstrate why they matter in a way that means something to direcotrs of finance and commissioners. We also need to utilise the systems we already have – can we not build in to Quality Accounts a way of measuring, through patient experience, the elements of care, compassion and competence.
It would be helpful to have some quotes from patients to demonstrate what good care looks/ feels like , what adiffernece it makes and how this can be evidenced.how care as a concept
I think your first paragraph calling for a major review is ‘spot on.’ As you may be aware, many nations are presently reviewing their systems as summarised on the global Lancet Commission website (< http://healthprofessionals21.org/>), including the US which is now implementing recommendations from the Macy Foundation review (2010) and Canada which is following its own UG/PG healthcare reviews and recommendations.
Both the Lancet Commission report and my book, which complements and builds on the latter are calling for major re-structuring-sooner than later. As one example, given the diabetes crisis that, according to Baroness Young, Chief Executive of Diabetes UK ‘could bankrupt the NHS’ with an estimated additional 700,000 people with the condition by 2020, major transformations are necessary not only in terms of how the health/social care systems and the communities respond to the noncommunicable disease crises but also in changing poor lifestyle choices and behaviour. The latter will require a collaborative effort by health/social care professionals, food and drink producers, the media, schools, counsellors, politicians, etc. It is estimated that ‘at least 90 percent of all diabetes cases are Type 2-fuelled by obesity, a lack of exercise and general unhealthy living.’ The estimated 4.4 million with diabetes by 2020 is not only unaffordable – c. 10% of the NHS budget (c. £10 bill per year) already goes toward treating diabetes and related problems (e.g. cancers, heart conditions) but this huge increase is also unnecessary. The World Health Organisation has been targeting young mothers and their children in developing countries and perhaps developed nations might need to prioritise this cohort as well and possibly things will change in the long-term. The question is ‘what else can be done in the immediate future?’ that will make a difference?
JM Martin-Moreno* has written a very informative and timely article about ‘Three levels of action against NCDs’ with Terry Sullivan.* Their observations -based largely on research in Canada – confirm the need for health/social care professionals to collaborate closely on three levels: societal, community and individual.
http://www.theglobeandmail.com/commentary/three-levels-of-action-against-chronic-disease/article4621961/
Their overall conclusion is that ‘effectively implementing programs requires strong governance, engagement with a wide range of sectors inside and outside of government, and a strong commitment to creating a healthy social and physical environment throughout the population and society.’
*José Martin-Moreno is a professor of medicine and public health at the University of Valencia and an adviser to the World Health Organization/Europe. Terrence Sullivan is a professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation and chair of the board of Public Health Ontario.
The strategy is fundamental to nursing and the visual framework should be embedded at every level of care provision. The plethora of documents are often repetetive and the impact of their messages undermined as a result. This strategy needs to be reflected in training and on going professional development as well as incorporated into a robust clinical supervision framework which is supported by reflection on personal values. Incidentally I have experienced at first hand the compassion, dedication and professionalism of nurses when my husband died of leukaemia at the age of 41. The level of care was superb and was of consistent high quality to all patients in their care, this was 8 years ago and I will never forget those nurses.
How welcome to have a concept which is so easy to remember with a visual to prompt our thinking. I would be keen to use each of the 6 categories as a basis for annual appraisals so nurses can bring a real example from practice in each of the outer circle categories or as a tool for reflective supervision.
Keeping the message clear will keep it in our minds and thus embedded in practice.
Having read through many of the comments made, I sense a ‘blame game’ culture of where it has all gone wrong. I really support Jane Cumming’s bid to try and strategically steer the vision for nursing in the future. However that said we need this level of senior nursing to actually deliver real change in management culture to free up and allow nurses on the front line to be able to ‘care’. I hope Jane can work on examining the fundemental barriers that inhibit nurses providing the best care for their patients and pave the way for this to be delivered, even if it means a heavy handed approach to management teams in organsisations. The negative statements made regarding University training again is outdated, certainly within our UG curriculum, (which is validated and monitored by the NMC) insists that student nurses complete a total of 4600 hours (2300 of theory and 2300 practice) if this is not achieved, the student is unable to be put forward to register. We like other Universities really try to work in partnership (as the programme remains 50% theory / 50% practical) with our practice partners. However if some are suggesting that this model is not working, particulaly those who undertook tradiditional training, please put forward the evidence?
The document/flow chart is nothing new it is what we should be doing as nurses and just strengthens the pivitol role we have. I agree that communication is key to the success of this. Nurses are the largest workforce in the NHS but tend to have the smallest voice as we never appear united. Whether conventionally trained or through a University matters not, although I believe there should be a choice, many good people miss out because that can’t meet University requirements, what is important is that for once we work together and start to realise our most valuable contribution to healthcare. We are at the forefront of delivery of care and are instrumental in success. If this document enables us to realise this and showcase our values it can only bring good!
Reading this kind of bumph is like flailing though porridge. Time and again over 20 years of nursing I’ve read the same empty rhetoric.
Of COURSE nurses should care, communicate, understand their role, base their work on evidence and so on and so forth….but you could say that about ANY job that involves contact with human beings.
What nurses often lack is actual clinical knowledge and the ability to integrate bio/psycho/social knowlege at the meta-level to formulate and evaluate hypotheses and interventions.
You can’t teach “values”; you can teach technical skills, theoretical knowledge and thinking skills.
For nurses to think better we should be teaching them to think like detectives.
For nurses to communicate better we should be teaching them to think like salesmen.
We also need to assert ourselves as a profession within the multiprofessional context to share applied knowledge and skills in action. This involves losing our precious chippiness.
None of the 6 standards are new, its the reason most of us went into a nursing career, but how often do we have to shout out “give us the resources, the staffing, the skill mix and the right level of support”, to enable us to achieve them. Foundation trusts are ran as a buisness, patients (despite trust rhetoric) are simply seen as a means to make money. Investments and recruitment seem more focused on beauracracy and buisness managers than front line staff. Competing to bid for the most profitable services whilst dispensing on the least (but sometimes) the most needed services.
When trusts base their ways of working by following the Car Manufacturing industry, kaiser events, Rapid process improvement workshops (RPIW) that seem more concerned how an office is set out than how we can free up time for direct patient contact (and no having all pens in the same place doesnt increase my response to patients requests) , they focus on stanardised and task orientated processess without seemingly treating each patient as an individual with individual needs.
One appraoch doesnt nor should it suit all patients, being a nurse should allow for flexibility in adapting to each situation and each patient on an individual basis, without fear of reprimand because we have not followed “the process”.
Unfortunately in the process of cutting costs, Comittment, Competance, Communication,Courage, Compassion and Care dont factor into a lot of Trust budgets. But as ever nurses will continue to swim against the tide, and continue to strive to deliver these basic components of nursing care, as we always have.
I am 1st year Nursing student and all of the above comments make for interesting reading so thanks everyone for your honesty. Nice to se some us are not afraid to be brave in the face of being watched from on high. I am not afraid either, to voice my opinion, but only in the appropriate manner and only when i feel something needs addressing responsibly.
Your ‘Action Area 6′ talks about the need to “Support each other and new entrants to the profession”. From a financial perspective, i’m afraid this has not been the case in 2012.
I started my degree in March 2012. The university brochure promised, “2012 students will receive a maintainance grant of £1000 from the NHS to cover learning costs, (books, general living, etc)”
This was false advertising. In fact, not only did we receive a massively reduced Bursary, compared to previous years, (so those of you who are older, don’t start telling me how apparently ‘lucky’ i am -you got a MUCH bigger bursary than I ever will), but we were also denied this maintenance grant. When I telephoned my university as to why this was the case, I was told, “Oh, that’s for September 2012 students, not you”. So, “2012″ students do not all get the grant that was falsely advertised by so many NHS affiliated university brochures accross the land in 2011 and early 2012. This just beyond insulting.
It is appalling that the NHS feels that it is acceptable to award £1000 more to students starting in a different month to other students starting IN THE SAME YEAR. So just because I started in March instead of September, that makes me any less important or any less vulnerable to the VERY harsh realities of the recession?! I am stuggling to get by greatly and I am also working in a part time job to supplement my studies, while students starting a few months later get an easy ride. By having a second job, my studies will inevitably suffer and will not be as good as those students who get free money and therefore are no where near as financially strained and have more time to dedicate to studies. This is nothing short of a DISGRACE.
My suggestion is that if the NHS wants to be the fair organisation it is striving to be, then it should look at cutting Chief Exec wages and using this money to fund March 2012 students, thereby improving their chances of better marks, leading to better degrees and at the very least, a fighting chance when finally entering what will an enormously challenging job market in 2015. What benefit to huge Chief Exec wages bring to the future of the NHS? This money is just spent on expensive holidays and retirement. While the tories are still in power, nothing of what I have said will be even noticed, let alone brought up in national consultations.
There will no doubt be higher powers that will smirk at what I have typed and and sneer at any suggestion to cut higher earner wages. To most however, this will prove common sense, and the sooner the right managers and the right people are allocated the appropriate future roles, the better. Change does need to come in the NHS, but it is not the change that is currently taking place under this nightmare of a government.
I have absolutely ZERO confidence any of the changes I have suggested will occur, whilst I am studying as a studnet for the next 3 years. Beyond 2015, it is in the hands of voters.
I have been a qualified Nurse for 25 years and completed my training under the old style system, which also had its flaws, which I do agree with many of the afore mentioned comments, that a University degree, does not make you a better or worse nurse, but this training as any has its flaws. I came into Nursing as I wanted to care for and improve peoples Health and Wellbeing. I feel that compassion is part of the whole package of a Nurse. If I was not compassionate, I would probably have gone into corporate Banking or bought and sold share on the stock market. The changes that the Government are planning to introduce to the Health Service, are themselves heavily laden with flaws and like many others am very disolusioned with the NHS. I feel that things will get much worse before they get better. Staffing levels will I am sure decrease as staff go off sick, leave the profession etc. We do as Nurses need to promote ourselves in a different light and I feel that continually talking about compassion and excellent Health and Well Being outcomes, means little to the General Public, come on CNO and NMC, get it right and look at what the Public want not what you think they want
Throughout my 40 year career in the NHS which commenced in 1972 as a Student Nurse in the field of Mental Health and still continues to date in a semi retired capacity I worked with and learned from some excellent people. That learning continued up until the day I retired and I never took the view that anyone was better than anyone else irrespective of their level of education. We can all learn from one another and everyone has something to offer, be it the ward sister educated in a school of nursing or newly qualified nurse educated in a university. Some of the care interventions we witness may be of a high standard and others may be less so. The key to it all is that we take the best of care from those who teach us the skills and work everyday to better ourselves and become the comitted, competent, communicators,who are courageous, compassionate and caring.
Like much of what we hear in political circles today there seems to be this strap line just like “its the previous governments fault” that “the nursing profession is failing us”, at every turn we hear about the poor standards, the inquiries, the sackings and so on and so forth and it is right that they are are brought into the public domain. However we rarely hear about the good things that go on everyday in every health care establishment the length and breadth of this country delivered by nurses and other members of the healthcare profession who are comitted, competent, communicators, who work everyday with courage, compassion and care to ensure the general public receive some of the best quality healthcare anywhere in the world.
In short I think its time we started praising ourselves a bit more for the good things that we do. In all professions, jobs, careers there are those that do good things everyday in the right way and for the right reasons and then there are the rest.
Good will always win through! There are more good people in the NHS than the media and those politicians who are out to score points would have us believe.
Lets not throw the baby out with the bath water!
Well said The Pensioner! I agree totally!
The qualities of care, compassion,competance,communication,courage and committment have always been in nursing, it is our fundamental belief in their ability to help people cope with illness and the difficulties of their lives that keep us turning up for work and doing our best even on the hard days when our energy is low and the mental effort needed to manage is enormous. There is absolutely no reduction in the 6 Cs regardless of how nurses are educated but sometimes its hard to show them because we are struggling with the emotional demands made on us or they get lost due to work requirements that take us away from person to person care and demand we care for the organisation instead.
The challenge to nursing is to avoid the blame game and foster an environment within our own profession that seeks to develop these qualities for ourselves. If we can support and show the 6 Cs to each other, this will take a lot of courage, then we will be better able to achieve what we all started out in nursing wanting to do.
My suggestion is to take a long, hard look at mentorship programmes, training and educational support, HR processes, clinical supervision etc.. etc.. Areas where we can actually make a difference and focus on this. We been talking about who cares for the carers for decades. The answer is Us and it has nothing to do with budgets and government policy.
The 6, or 7 Cs have always been the same, wherever you trained and to what level, Its all about the right person in the right job, and that comes down to recruitment and the interviewers skill in the selection of new staff, We must concentrate on this.. How many front line Ward Managers and Sisters, in fact Patients are involved in this process, I suspect not many
Yes, I agree but also with the ‘right’ skill set – encompassing knowledge, skills and attitudes – in terms of meeting patient and service-user needs. We may need to think not only of ‘doing things better’ (traditional approaches to improvement ) but also of ‘doing better things’ (innovation!) in this decade and beyond. As mentioned previously, in order to achieve these aims will require re-thinking our approaches to training and education, as argued convincingly in the Health Committee (House of Commons) report ‘Education, training and workforce planning’ (2012)*. One important caveat in this report is that changes in policy and directions ‘need to be grounded on solid evidence.’
*http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/6/602.htm
There are 660,000 nurses and midwives registered with the NMC in the UK currently. The Nursing Strategy directly affects us all, and yet only 47 colleagues (including myself) have commented on it and expressed an opinion. WHY? I am staggered that so few have registered a view here.
Hi Penny, many more have responded to the consultation which is available at http://consultations.dh.gov.uk/nhscb/nursing-vision
I can’t see a link to any other responses. I am particularly interested in finding out the numbers of respondants and general themes.
Do you mean the survey link? If so, are the responses available to view without completing the survey? I am interested to know the main themes and number of responses, but have already expressed my views here so would prefer not to complete the survey too.
It would be helpful to view the on-line survey replies in which case the survey could become more of a Delphi study and individuals could comment on emerging themes etc.
As mentioned in my responses, it is vital that the proposed vision and shared purposes become more inclusive and focused on health and social care professionals in general, not just three key groups. Following the latter approach would reinforce the silos-based practices we currently have rather than pursue, as advocated by The Lancet Commission, and echoed by Dr Richard Horton (editor-in-chief of The Lancet and one of The Lancet report commissioners). The global commissioners main argument is the need to build ‘a new kind of professionalism-patient-centred, interprofessional and team-based.’ Lack of progress in this area, Dr Horton asserts, can be traced to ‘the rigid and damaging tribalism that afflicts the professions today.’ In his view ‘what the Commission argues for is nothing less than a remoralisation of health professionals’education.’ Given today’s inequities – within and across nations- maybe the timing is right for major transformations.
I have just responded to the other on-line consultation. Can these be viewed? If so, where?
Can these two be merged somehow?
I agree-The lack of engagement to date is rather surprising given the population size??
Totally agree George…the percentage of dis-engagement is staggering. I worked out data last week for this and the results were nothing short of worrying.
I was a mature student and have just completed my training. I have done the diploma in nursing. I do not think that taking nursing to degree level will make a difference. In my opinion you can not teach a person to be caring and compassionate. You either have these qualities or you do not. The 6c’s are not new, they are or should be the qualities in your personality that make you want to be a nurse in the first place.
Thank you to everyone who has commented. All responses, from the online survey and these comments, will be analysed, and we will be publishing details of the feedback we’ve received later in the year.
All comments left on this page will be fed into this process.
Kind regards
Simon
Can the feedback be automatically sent to those of us that have voiced our opinion? I am very keen to ensure I see the full feedback document!
Hi Penny
Thank you for your question. It is not possible for the feedback to be sent automatically to everyone who has commented or given their views on the survey.
However, we will be publishing the feedback document on our website so please follow us on Twitter or subscribe to our RSS feed so that we can let you know when it’s available.
Kind regards
Simon
This is an excellent vision. A huge problem for caring staff working in uncaring environments, is the safety to try to do anything about it without becoming a target for disciplinary action against them, based on false allegations.
It is a tragic fact that our website has been in existence for 10 years and we see no end to the injustices prepetrated against staff. The effects of such action is to destroy good people who provide those 6 qualities in abundance.
It also gives a strong message to other staff to keep their heads down and leave if at all possible.
Making managers more accountable, make them work with their staff so they know what is happening in their work areas, make it a statutory duty to report all suspensions with reports of who is suspended, for what reason, how it is being dealt with and outcomes, with the staff member concerned being given an opportunity to defend themsleves. These might all help to change the culture that is so destructive in some work areas.
I sincerely hope you are able to bring in protection for people.
Thank you for the opportunity to comment
I believe it is essential that that we focus the 6 Cs on ourselves as care givers and our colleagues first.
How can we be expected to care or be compassionate if we do not have compassion for our colleagues or do not feel we are cared about?
How can we be expected to be competent if we do not have the time to attend mandatory training sessions or to debrief with colleagues over difficult situations let alone find the time for professional development.
How can we have courage if we are not confident who will support us when we wish to speak out or want to make changes
We must first invest in our staff and then they will be fully committed to providing the best care possible to those they care for.
The majority of nurses and care givers I know within the acute setting all started with an abundance of care, compassion and commitment but after years of working with staff shortages, a lack of the correct equipment, no time to attend training let alone many opportunities for personal development it is no wonder many staff feel under valued and unable to give the quality of care they strive for.
I often used to go home after a long shift feeling guilty that I had not delivered the quality of care I had wanted to. This was not because I hadn’t bothered or didn’t know how to but because I had had to prioritise my workload. This meant sacrificing the extra time to talk through an illness with a patient, comforting someone who had been given bad news or talking to the lady with dementia as the patient having a heart attack, going into a diabetic coma, dropping their conscious level had to be prioritised and the staffing levels did not allow you to do both.
Care givers need to be supported with the correct staffing levels and equipment, time for training, the opportunity to share good and bad practice and effective leaders to support this, then the 6 Cs will come naturally.
Action area 5 and 6 (page 18-19) mentions this and within my local Trust there have been an number of initiatives that are going some way to mprove this, such as Patients 1st, Staff Stories, the appointment of a Safety Ombudsman and the HELP service (details below if you) but further investment in resources needs to go alongside this if we are to allow the care givers the opportunity to demonstrate compassion that they have and want to give.
Best Wishes
Natasza
Patients 1st – a monthly all-staff email which tells a patient story where elements of their treatment or care have gone wrong. The aim of sharing these stories is to also share the learning each one contains about why things go wrong and the changes we are making to try and prevent the same mistakes happening again.
Staff Stories – This is a new monthly forum where a multidisciplinary team from within BSUH will share their experience of a particularly complex and/or interesting case, the personal and professional dilemmas the case presented, and how they responded to them. The story will then be used as a springboard for the wider audience to talk about and share learning from the issues and themes raised
Safety Ombudsman – Safety Ombudsman and Guardian of Good Quality and Safe Care. Their role is to enable an open culture and to allow lessons learnt to be implemented. She provides an Intermediary, Impartial, Independent service to all Staff and Service Users of BSUH
HELP – The Trust is actively interested in the Health and Wellbeing of its staff and realises to continue to provide excellent and continually developing care for patients we have to be compassionate with ourselves and support each other.
The Health Employee Learning and Psychotherapy (HELP) service provides staff with confidential support, counselling and psychotherapy for a range of issues. Sometimes work related- from stress management to relational issues, employment difficulties or following critical/ traumatic events, to personal issues that may be affecting the individual.
Degree or Diploma, old teaching style or new. It all seems to irrelevant after qualifying. We are all called nurses, and have done the training to allow us the privilege of doing the job and being called such. However it is now necessary to take note and begin changing things at ground level. Waiting for something to go wrong to highlight flaws and changing it afterwards is not my idea of improvement. NMC code states we are accountable for our acts and omissions along with upholding the reputation of the profession. However what if you took it as read and thought we have become products of our acts and omissions and possibly should be looking at character and not the reputation we have from some cynics..
As a long time retired Director of Nursing approaching 80 years of age in a week or so I feel that I can compare nursing as it was and as it is. A good nurse is born a good nurse. Alright – the training is important but we have xperienced all manner of changes in training and we always had a majority of naturally tallented nurses and some who will just never ‘get it’.
As we get older of course we do need more help from the NHS. I find that, in the main the attention I get reflects my person attitude to the staff. God bless them (almost) all.
The vision that is being proposed applies to all health and social care professionals. The nursing profession should therefore be working with other professional bodies, nurse education, and NHS organisations to deliver a consistent and coordinated approach. Greater interaction with these bodies and the general public might help dispel this “outdated view” that some believe individuals have about nurse education .
For any of the anticipated changes to happen there needs to be a significant change in the culture within the NHS – addressing inappropriate attitudes and behaviour, removing age discrimination, learning the skills of listening rather than distancing patients their families and carers. If this is not addressed it is unlikely that any sustainable change will occur.
Embed Gandhi’s words:
A patient is the most important person in our hospital. He is not an interruption to our work, he is the purpose of it. He is not an outsider in our hospital, he is a part of it. We are not doing a favour by serving him, he is doing us a favour by giving us an opportunity to do so
The NHS needs turning on its head so that the patient rises to the top rather than being an afterthought after prioritising finances, targets or the egos of the professionals working within it. This is also crucial for students who are required to undertake practical placements in hospitals to ensure that they have appropriate role models to emulate.
Students need to be supported by good leaders who understand that they have a duty of care towards patients, their relatives, carers and their colleagues. Students need to be working in an environment which not only values those using the services, but one that and appreciates the staff. Such an environment would have little need for a whistle-blowing policy.
In view of the number of hospitals that are being reported as failing how will the public be confident that the ward environments are fit for students to undertake placements?
Many of the failings that are regularly published relate to the fundamental, but most essential aspects of care. It would therefore be appropriate to ensure that pre-registration nurse education emphasises this along with the kindness and compassion that is needed if an individual is to make a good recovery, or experience a dignified death. There is a view that too much emphasis appears to be put on the technical aspects of nursing.
There also needs to be acknowledgement that most users of NHS services are over 65 years of age, and have complex health needs – nurse education needs to reflect this.
Student recruitment should be by rigorous interview where the individual qualities as a person rather than solely on qualifications achieved. Perhaps the 6Cs could be used in the recruitment process – using exercises where potential candidates demonstrate how they have been courageous, shown compassion, communicated well etc. Perhaps service users could be involved in the interview process?
There also needs to be transparency with regard to how student nurses gain practical competences. Are mentors appropriately trained and independent in their assessment or coerced by Universities to pass rather than fail?
Nurse education and the NHS should be meaningfully involving the public in the planning, delivery and evaluation curriculum and services.
Monitoring and performance should not be self assessed as currently happens – it gives a skewed perspective. Reporting should be open and honest – reporting both successes and failures to the public. This will demonstrate the commitment of an organisation to maintain good standards of care quality will help rebuild trust.
The ability to communicate effectively (oral and written) should be part of the recruitment process both for students and for qualified staff. Service users should be involved in the interview processes and induction. And, the need for good communication for everyone working in the NHS needs to be emphasised on a daily basis within the NHS as this seems to be the key to rectifying many of the problems that occur.
This consultation invites both professionals and members of the public to respond. However, it the document Developing the Culture of Dignified Care does not appear to be written with this in mind
Fully agree with your comments as others have as well in previous comments. Let’s hope that HEE/DOH? think along similar lines. As mentioned earlier, anything less may take us back to silos-working, education and training – the root causes of many of our challenges today.
While there are many excellent services, there is usually only ‘one’ patient or client. The need for ‘joined-up’ support, especially at community level, including financial, could not be greater given the paucity of our resources, expanding and more complex population needs.
The strategy I believe encompasses everything that we talked about at our recent workshop. The framework they have used encompassing the 6 C’s and the 6 areas of action , help to focus the energy and commitment into what we as nurses believe to be the main components of care. The strategy mentions the need for developing careers in nursing and emphasises the need for us to empower the patient and to design services around their needs. This is essential for us to lead nursing and ensure that the way of caring engages the patient to deliver cost effective high quality services that fit the needs of our population.
The areas of action can be used to focus our attention with all our staff in evaluating the way we deliver services and how we ensure that we meet the requirements of patients accessing our care. I felt that the emphasis placed on reviewing staffing that is not based on minimum staffing levels but evaluates clinical dependency and complexity of care was absolutely right and will ensure that we give the right care, in the right place at the right time.
I think this strategy focuses the mind and reinforces the belief that as nurses we have great opportunity and can empower services to transform lives and deliver care. It allows us as nurses to reflect our aspirations and allows to re explore our profession at what ever level. It gives us the opportunity to use this strategy to not only re evaluate the nursing agenda but the patient experience
Once again, I am concerned that the strategy and previous comment reinforce the fragmentation of the health / social care workforce to the detriment of patient / client care. Sir Donald Irvine, then chair of the GMC, observed more than a decade ago, the importance of ‘multi-professional collective responsibility’ in terms of patient care along with the building of ‘self-regulated teams.’ These teams – working in hospitals and increasingly in the community – need to aspire to ‘a set of common attitudes, values and behaviours’ to complement their learning of specialties of expertise, as strongly advocated by The Lancet Commissioners (< http://healthprofessionals21.org/>)
The 6-hopefully 7 Cs! – should be the attributes – the glue- that bind the professions together and all need to be involved in shaping and owning the strategy under discussion. One recommendation to the facilitators of the survey/feedback doc is to widen the consultation to involve the other professions. Perhaps members of HEE could discuss this possibility as the strategy doc could be a fundamental mechanism or ‘agent of change’ to drive forward much-needed improvements to the health and social care systems.
Having a clear vision is one thing; making it work is quite another so I am mindful of Dr Richard Horton’s astute observations. Dr Horton, a UK physician and editor-in-chief of US-based ‘The Lancet’ as well as being one of the 20 Lancet Commissioners, calls for a ‘re-moralising’ of the healthcare system, one which builds ‘a new kind of professionalism -patient-centred, interprofessional and team-based.’ Further, he argues that we need to rise above the ‘rigid and damaging tribalism that afflicts the professions today.’
Dr Ruth Collins-Nakai, former chair of the Canadian Medical Association, now chair of the Canadian Medical Foundation, echoes Dr Horton’s observations, envisaging a type of leadership that ‘would be courageous enough to act in the best interests of the populations they serve rather than the best interests of business or economics.’
In short, providing more compassionate and competent patient/social care in this decade and beyond necessitates structural changes in the way we prepare our health/social care professionals. It also requires broader and more ‘joined-up’ thinking and commitment -social, political, economic- on what needs to be done, by whom, how and by when – in terms of health and social care. Given the state of finances in the UK and across many nations, deliberations along these lines cannot start soon enough.
In a famous management book of its time “Up The Organisation” a senior executive who was out of work found himself temping in a range of jobs. He wrote about his experiences and what he saw. I bank across many hospitals and am fortunate to have had a management career before – I am very pleased to say – making the choice to retrain as a nurse. I have seen many examples of good and bad practice whilst ‘banking’ upon which I have reflected.
Unless we get ward leaders who have courage, the scope and resources to take decision, and the ability to LEAD (not manage) we cannot bring about major change. Good leaders DO make the difference.
On a recent shift on a hectic orthopaedics ward I struggled to care for 13 patients mostly immobile, and many with dementia. What saddened me was the ‘mass of blue’ I saw on the ward … not one of which was aware of what was going on, or who came to help. Meetings appeared to be more important or being sat in offices unable to see what was happening. Contrast this with a band 7 ward manager who I met in resus in A&E. I was trying to give personal care to a very sick man with sepsis lying in a large amount of faeces. I didn’t know this manager – I think she had just popped into the department to check something and I’m not sure she even worked in A&E – but I asked her for help and without a seconds thought or any suggestion I get someone else to help – she put on an apron and helped me provide the care these poor patients on the orthopaedics ward had sadly failed to receive. We left the patient comfortable and I felt proud of the care I had provided.
Contrast this to my orthopaedics shift … where a second care assistant came to help me. We were still battling to provide the care these very dependent patients needed; instead of a positive word of thanks at the end of the busy shift – we were both chastised, by the regular ward staff coming on shift, like small children, for not having got something done – my colleague who seemed a caring and competent woman – left the ward saying it was the last time she would ‘bank’ there.
Good leaders are out there but few and far between; we need leaders, with the courage and compassion to care for our staff not just patients. Until we start caring for our staff we cannot expect care not to be affected. Leaders can be taught management skills, but you cannot turn managers into leaders. You must get the ‘raw material’ right first – something our armed forces do very well.
Maslow taught us that we cannot self actualise unless we have our basic needs met – love, shelter, food, sleep, to have friendships and feel valued. Let us examine the environment we expect some of our staff to work – no staff room to get a break (and a canteen that is too far to get to on a 15 minute break on a 7.5 hour shift), or a staff room often the size of a broom cupboard, toilets that are often disgusting with water stains down the wall, peeling paint, and frankly if used by patients who lead to torrent of complaints, regularly working a 12 hour shift – and then realising you have been too busy to go to the toilet, staff who are struggling financially so having to work so many extra hours they are exhausted – which then affects their ability to achieve the 6Cs, and wards which at times can sadly be unfriendly and lonely and where poor leadership allows bullying and poor practices to go unchallenged, and good effort unrecognised. Along side this we see frequent inaccurate reporting of ‘nurses’ who have provided poor care in the press when all too often these are not registered nurses at all. The media is allowed to relentlessly ‘bash’ the nursing profession leading to low self esteem and patients who ‘expect’ to get poor care as a result.
In short – stop selecting band 6′s on competence and qualifications alone – we must start promoting LEADERS not just those who can do paperwork and budgets. Without these 6C will just be yet another care initiative that in 2 years time is gathering dust on a shelf.
Please can our new CNO ensure that every bit of inaccurate media reporting gets challenged and also that we get our professional title protected so that it is an offence for people to describe themselves as nurses when in fact they have had little or no training, and have no state registration. I see too many people describing themselves nurses, and when asked where they have trained admit they have no registration at all. Until we start valuing the qualification – instead of knocking it (degree v diploma debate) – then we can hardly expect our colleagues to feel good about themselves …. or provide good care.
I do believe that Nurses and indeed all staff should be educated to the highest possible standard.
I worry that the Lecturers are so defensive. We need you to do your job well, but however well you do it there is no substitute for real practitical experience. By their patients they will be taught. (If the trainees are the caring open people that the profession needs)
I would like to make plea that all NHS Staff give proper eye contact to patients and their families. They should learn to respond to what they see there! I am fully aware of the additional demands this would make but if you are to effectively use the higher learning and technology then only the patient can tell you the most effective way.
With all the current insecurities about jobs, the South West Consortium, and certain members of Trust Management worrying about saving money, it seems to me that people have forgotten why we trained as Nurses in the first place. You don’t need a degree to be a good Nurse, just a lot of empathy and common sense and the over whelming desire to help and make people better.
What is now known as ‘Rounding’ is re-inventing the wheel by those of us old enough to remember that is how we used to care for patients. It was a basic element of nursing care and second nature. Back to basics seems to be an ‘in’ word but I would ask why it ever went ‘out’?
I agree we all need to keep up to date in our education and learning as one doesn’t just become qualified and leave it there. But there seems far too much emphasis on bits of paper now, duplicated, triplicated, and for what purpose? As a Theatre Nurse of many years standing, and whilst a junior Staff Nurse in Theatre, our priorities were ensuring everything was at hand for when needed and that all swabs and instruments were counted correctly. This ensured in turn that everything went as planned, and if it didn’t, someone knew before you did that you were going to need help. Now (I still do Bank shifts whilst doing a totally different job as a CNS) we have to write an essay, usually duplicated or triplicated, and the patient becomes secondary. So I would ask – what is really important? Patient care or paperwork?
The Campaign for a Charitable Chaplaincy
In Wales we are campaigning to clear up the confusion and ambiguity surrounding the concept of empathetic and holistic care in our hospitals.
The NHS in Wales has issued a set of “Standards” devised in the main by the College of Health Care Chaplains which offers a confused definition of “spiritual care” and claims chaplains are the specialists in this ill-defined role. It claims chaplains are essential for “holistic care”. This is a gross mis-use of the term “holistic” which applies only to the nature of care provided by practitioners (doctors and nurses).
Speaking as a potential patient what I require is a nursing profession in which empathy with patients and professional competence is the basis of vocation.
The employers of nurses have a responsibility to recruit, train and manage nursing staff such that these two objectives, empathy and competence, are achieved. Nursing work-loads must be such that these objectives are never compromised.
Religious care by chaplains, we believe, should be funded by a charitable trust thus releasing money for nursing.
I strongly suspect that this is what the vast majority of nurses want for their profession and for their patients.
All this discussion about proper attention to patients,which should be automatic,becomes an irrelevence when you consider this coalition governments plans to privatise our NHS.This should be the primary concern of all patients associations.How will patients get the treatment they need when NHS money is going to private companies ? This is very worrying as it will also influence GPs.
The word compassion seems now to be used more often in discussions on patient care within the NHS. Many of these discussions take place within reviews of NHS structures and responses to poor care highlighted in the media and care reports. Compassion is not easily defined but I believe it has been ‘redefined’ for managerial and possibly political purposes to promote better standards of care.
In recent years compassion has been increasingly discussed in the UK political and healthcare arena particularly since 1998 when Lord Darzi brought the issue of lack of compassion to policy makers. This for myself raises questions of appropriateness of language relating to compassion there can be the assumption that compassion can be ‘enforced’ as a concept rather than nurturing the conditions of care and kindness within which compassion is more likely to flourish.
I believe that compassion does not universally apply to all NHS staff despite the opening words of the NHS Constitution stating: “The NHS touches our lives at times of basic human need, when care and compassion are what matter most” (Parliamentary and Health Service Ombudsman 2011, p.8). Though the report highlights examples of poor care standards which they claim are based on lack of compassion, it does not define compassion and exactly how compassion can be exercised.
It is however this link with the need to be efficient that perhaps compassion is being used as a tool for improvement rather than a virtue to be nurtured. This potential façade of compassion undermines a virtue that should not be used as a technique from the skill set of the carer given its intrinsic quality linked to the disposition of the person seeking to do good.
This for myself raises the concern of compassion being a popular topic and a ‘quick fix’ for recent scandals around poor quality of care without clearly defining its essence or reach common understandings.
Compassion a difficult concept to define and to effectively apply to care settings without being trapped in sentimental ideals with the absence of efficacy. The dutiful act or act of self-interest may though still be in the patients good, and beneficence demonstrated, but not necessarily compassion. This I argue shows that organisations need to focus more on concepts of dignified and quality care without ‘over-ascribing’ a virtue which may be unattainable for some. High quality and dignified care should therefore be the starting point nurturing the conditions in which compassion is more likely to flourish and not compassion as a starting point which risks failure.
I see the difference here between compassion rooted in individual qualities in conflict with what may be an imposition of an ideal which is organisationally driven. I suggest that a politicising of compassion may in the short term generate enthusiasm but in the long term may become little more than an economic driver to reduce costs and complaints.
Once again, I suggest that it may be possible to create the conditions in which compassion may flourish through improving qualities of kindness and care. It will also be possible, despite no common understanding between philosophy, ethics and religion, to describe what compassion may look like in care without insisting that everyone becomes compassionate……..
Since its’ prefix ‘com’ relates to togetherness and the outworking involves human solidarity, there is autonomy and freedom of choice how compassion is expressed. This raises questions about how the sufferer is related to ….Though there have been increasing uses of the term compassion within healthcare reports and the media, there has seems to be little to describe suffering within healthcare apart from when care goes dramatically wrong such as with the Mid Staffordshire enquiry. The call for more compassion involves choice to recognise suffering and to be with someone in their suffering – this comes naturally for some carers and nurses – whereas for others they require the cultural / environmental conditions of high standards where kindness is expected out of which compassion is more likely to exist rather than enforced.
Please don’t get me wrong, I agree that we should expect compassion within nursing and healthcare but question how this can be ‘enforced’. I suggested and argue that we should enforce other standards and then see how compassion naturally evolves from the right conditions of care in which compassion can be caught and nurtured.
Happy to discuss further.
Care and compassion cannot be learned in university, nor do I believe they are completely integral to a person, instead they are learned skills. I have spent three years trying to learn to do all the things expected of a nurse, the knowledge needed and professional accountability which can only be achieved (and justify the professional salary) by degree level education. However, caring, compassion, fundamental care and prioritisation are all things learned in clinical areas, where registered nurses are the ones with the responsibility for demonstrating appropriate practice – but don’t.
Some students will be lazy, or uncaring, or lack basic skills. So fail them! That is the responsibility of mentors and the nurses they are working with to gain a picture of a students skills. But to suggest that I, with a previous MA hons and undertaking a BSc in Nursing, and the majority of my fellow students, have no compassion simply because we are able to cope with the intellectual demands of a degree is insulting, offensive and unjustified. Students in placement often learn what they are shown – maybe its time all the ‘we didn’t need a degree in my day’ nurses put there money where their mouths are and demonstrated these amazing skills to the people they are supposed to be teaching!
I believe that the 6 C’s does provide a vision of the future for nursing. For me, it encompasses what I came into nursing to deliver. As always it is what support is there to helps us achieve this vision. My questions would be:
How do we ensure that nurses feel empowered to have the courage to challenge as so many are feeling vulnerable and even intimidated if they do?
Effective mentorship and preceptorship are vital if competence is to be achieved and sustained. However, although protected time is often included in policies and best practice guidelines, in reality this is often not the case. I have supported mentors who have been overwhelmed by the pressures put upon them, they have felt like a failure because in their view they had not had enough time to properly mentor and assess
competence. How will a stronger commitment to supporting protected mentorship time be achieved with a steady reduction of registered practitioners and continually increasing patient workloads and conflicting demands?
Protected mentorship time is also key in ensuring safe delegation and good quality care. The healthcare support worker (HCSW) workforce is increasing, new ways of working and role re-design are being introduced to try and maintain safe and effective care into the 21st century. Again, if mentor time is not effectively protected then HCSWs will also not be given sufficient support to develop and maintain their competences to deliver the delegated care and remain effective and valuable members of the nursing team. Patient care and safety will suffer.
Many registered nurses are starting to feel that learning and development is becoming a ‘tick box’ exercise to meet the needs of their organisations. Mandatory training needs to be completed, but many nurses are being limited in the support they receive to develop their clinical and professional skills. This is leading to disengagement, disillusionment and frustration. How do we start to put the enjoyment back into professional learning and development?
I acknowledge that the above is not the experience of all registered nurses, but it is experienced by a large number of nurses. I believe the 6 C’s vision is the way forward and gives us something to aim for, but I do think there a lot of difficult questions to answer before it will become a reality. I will be encouraging my colleagues and organisation to get involved in providing feedback. Thanks.
Nurses at Blackpool Teaching Hospitals NHS Foundation Trust have had lots of conversation about the draft nursing vision, overall we support the 6 C priorities.
This feedback exercise is now closed. It ran from 21 September 2012 to 16 November 2012.
Thank you for your valuable input. We are now considering all of the responses and feedback received. Any comments left on this page after 16 November 2012 will not be added to the feedback exercise.
Kind regards
Simon
Collective response from South Tees Hospitals NHS Foundation Trust
1. Through initial discussions have they identified the right shared purposes for nurses, midwives and care-givers to maximise their contribution to high quality compassionate care and excellent health and well-being outcomes for all people? Please explain your answer.
The answer to this was ‘‘yes’’; that it was not anything new and should be evident already.
It was felt that it took nursing back to its fundamental steps and refocused and strengthened the profession around areas in which the profession has been lacking (PHSO Report February 2011). It was felt that it firmly focuses on behaviours & values and that the six themes sit at what is, and always should be, at the heart of nursing.
However concern was expressed over this being another separate document and should these values not be embedded and emphasised within the code.
2. What do the 6 values and behaviours for the professions – care, compassion, competence, communication, courage and commitment mean to you?
It was felt that these are inherent in every nurses role (every human’s role) and should be a given. It is about being professional.
1) Care – this is the underpinning to care giving, without this all other values and behaviours are meaningless. Care although central to what we do, is also going above and beyond our daily working activities. It is about having the right skills and expertise such as listening and interpreting information and providing the best possible response/service-this is different for every patient & different depending on the role the nurse is in. It was felt that this could not be taught and that if this inherent value was present, then all other values and behaviours are automatically visible.
2) Compassion – is about understanding how things affects an individual and having respect for their needs and wishes – their priority may not be the same as the nurses as this needs to be acknowledged. It is about delivering a service that is centred around the patient and not the service.
3) Competence – is essential in care giving and should be constantly evolving to meet the changing nature of care giving across all disciplines. It is about having the right level of skill, knowledge and expertise in a given area of nursing and will vary depending on the role but it must be evidence based. Ways need to be developed to assess competence in caring however and not focused solely on tasks to re-establish the art of nursing.
4) Communication – threads through every aspect of a nurses career with patients, colleagues, managers, etc and can never be underestimated. It ranges from the need for technological advancement and simple processes for communication to time built into working lives to facilitate communication between care givers. It was felt that appropriate and timely face to face communication, although time consuming, can enhance the patient experience reducing stress, delays in treatment, etc and subsequently can later save time and resources. When everyone is so busy though, talking seems to be forgotten.
5) Courage – is about being brave and having the confidence and conviction to voice opinions, concerns and ideas whenever, and to whom ever it is needed, when it is needed.
6) Commitment – is the goal to achieve all of the other values and behaviours discussed above, all of the time and to not lose sight as to why we are caregivers. It is about sustaining an excellent service or striving for improvements in what is done without giving up despite difficulties and barriers.
3. What steps are needed to embed the values and behaviours – care, compassion, competence, communication, courage and commitment – into every contact and all the care we deliver?
This needs to be clear from the very first point when potential nurses are applying for university places. After selection, students should be constantly assessed for their sense of care and this should be assessed as any other competency.
It needs to be a constant theme in all training, supervision and interaction with and between nurses. The expectation should be that no less than the 6 Cs are acceptable and people will be tackled rigorously if these behaviours are not displayed.
This vision should be shared, with the expectation that all other professions (with no exceptions) involved in care delivery adopt a similar patient focused vision that focuses on these key elements and increased accountability when things to do not go correctly. This can be done through meetings, posters, linked to SDRs, etc.
Staff, however, also need to feel valued by the NHS as even the most caring member of staff will find it difficult to demonstrate embedded values if they feel unappreciated and unvalued. Seemingly small and insignificant acts from management at times can make such a difference to how staff feel valued and this is even more relevant at times when the focus is cost saving. Making staff feel valued can have a positive effect on them being more effective and efficient at care delivery.
4. Will a focus by nurses, midwives and care-givers on the 6 priority areas we have identified deliver the vision and the shared purpose? Is anything missing? Please explain your answer.
Nothing was felt to be missing but there needs to be an emphasis on sharing and promoting ownership at every level. Indeed all professional groups need to display these behaviours.
The priority areas will help to deliver the vision but only if staff are able to value themselves and have respect in their professions by having the resources to deliver high quality care.
5. What national and local initiatives are you aware of the support the 6 priority areas? Please provide brief details.
Essence of care
Energise for Excellence
Time to Care
Intentional Rounding
Nursing & Quality Care Forum
Friends & Family Test
Nursing Accreditation Program
HCA regulation
Culture and Human factors work
Trust Nursing & Midwifery Strategy, Patient Experience Strategy and Patient Safety Strategy for ST NHS Foundation Trust
In children’s services in their mandatory training, there is already a section in expected standards of behaviour, attitudes and it is anticipated that the 6Cs will add to this.
6. How do we strengthen working between the health and care sector in these 6 priority areas? Please provide brief details.
Engagement from the out set is important to enable understanding of each other’s perspectives etc., and there needs to be more energy around joined up partnership working, involving joint peer reviews of services.
Shared values and attitudes have to be the key. It has to be become part of the ‘culture’ of the hospital/NHS.
There is often a blame culture when things are not easy and this requires more work – people need to be reminded that we are all here with the same purpose and sometimes things go unintentionally wrong.
7. Are there any obstacles to delivering the vision and embedding the values and behaviours? What would you want to see in place to address these? Please explain your answer.
There should be none; except for staff understanding that not behaving in a way as described in the 6Cs is not acceptable. Therefore there needs to be early engagement and promotion that it is everyone’s responsibility to live and breathe the vision with immediate and positive challenges when care deviates from the vision.
Time can often be a factor – taking the time to sit and both listen and talk to patients. However some nurses do not possess the skills to sit and talk and some do not see this as a need when there is an opportunity.
There can be frustration at not being able to move at the pace patients want and this can be a challenge to staff and can be portrayed negatively. In the real world patients priorities can not always match our priorities and again this can be seen as uncaring.
We need to ensure that systems, structures etc are streamlined and support staff to work effectively.
8. Are the terms ‘people we care for’ and ‘care-givers’ helpful to use in this context or are there alternatives?
It was felt that the wording was correct and that they are perfectly acceptable.
How can we recruit with the values in mind?
Work needs to be done to describe the behaviours required this could be done nationally or locally
•Example in place at this Trust: -
oapplicants are invited in for focussed discussions in groups and have the opportunity to have a general chat with the recruiting manager. The candidate also gets a tour of the service
obehaviour focused questions where the applicant has to reflect on their previous experiences and describe how they made a difference to a patient or service
•Team involvement in the recruitment process rather than just being the team leader of service manager
How can we promote better public health?
•We achieved herd immunity in some diseases e.g. measles (until there was a scare) which is phenomenal. The HPV vaccine is the most recent success story in using schools and institutions to reach the population.
•A more novel approach might be to put health promotion into the less obvious institutions like sports centres (the people that visit them tend to be quite engaged with health) and libraries. Also supermarkets – there are not many people who don’t visit the supermarket in the month and pharmacies are there already.
•More national campaigns with posters, brochures and leaflets available for downloading this approach was successful for infection control
•Health promotion could be developed to be included in the roles and training for groups such as opticians; pharmacists; social care workers
How can we make sure nurses have courage to stand up and complain when needed?
•By listening and supporting them and taking seriously their concerns when they do. If one nurse stands up and makes the claim and nothing happens then there are 50 more who will say nothing. When we say anonymous we must mean anonymous.
•Creation of Advocate roles within organizations who support staff through process of raising concerns or raise them on their behalf
Position statement on The Nursing Vision
As a body of nurses we appreciate the acknowledgement of the importance and influence of the role of Nurse, Midwife or care giver; and the dedication required to deliver the role. We agree that the fundamental values identified in this document are the right areas to focus on but achieving these values requires detailed strategies. Indeed we need to introduce strategies that are common place and not the exception to promote independence such as self administration of medications during hospital admissions.
The terms ‘people we care for’ and ‘care givers’ is not currently well-known and common place vocabulary. On the most part within the health service we use the terms of allied health professionals and patients/client. A recommendation may be to use terminology that is already familiar to the public.
The document states that real actions are to be instigated to support nurses to deliver on these fundamental values, but there is no further mention of what support is going to be available, which is a concern. This support needs to be explicit, to engage the attention and “buy-in” of the intended audience.
We acknowledge that there are high profile cases where care has not achieved the standard that as a profession of nurses we aspire to, or as care givers feel that out patients deserve; however we want to be reassured that The Nursing Vision is not just a reaction to appease public concern, but a genuine move to allow nurses to show case the care and skills that the majority have always provided, within the independent thinking philosophy that current nursing practice and technological advances require. The document refers to embracing and making use of technologies. One obstacle to achieving this is that technology is moving at a rapid pace and often funding in the NHS cannot keep pace with this.
In recent years it has become increasingly apparent that the National Health Service does not have the financial resources to sustain existing health services. As ‘care givers’ we are seeing an increase in productivity and decrease in available resources and often finance. Our concern remains that there is an expectation to deliver this vision with no resource, which will add a further burden to the role of nurse, midwife or care giver. One of the fundamental values is courage, and the document introduces the premise that support will be provided to allow care givers the courage to speak up for poor practice if they are afraid to do so. Further details of the support to facilitate this will be required.
The vision also introduces 6 key action areas. Many of these are already embedded in our practice; helping people to stay independent is an initiative that has been recognised and supported in renal medicine for several years. People we care for have the option (health and social circumstances allowing) of receiving their life preserving dialysis treatment in their own homes in the form of either peritoneal dialysis or home haemodialysis. By offering such choices care givers are able to buttress a sense of well being for our clients and foster some independence with their long term condition. We have long acknowledged as care givers that patients or the recipients of that care are partners who require consultation and inclusion in decision making processes as well as care provision
The document also identifies that there will be local areas for action, and further details and examples will be required.
We embrace the vision as a starting point, but remain concerned about the lack of clarity about these real actions, and the resources that are going to be invested in achieving the vision.
There is also a lack of clarity about the impact on other members of the multi-disciplinary team and this needs to be explicit in the document.
Submitted by
Richard Fluck, President of the British Renal Society
Lyn Allen, UK Key member of the European Dialysis and Transplant Nurses Association
Sharon Benton, President of the Anaemia Nurse Specialist Association
on behalf of the British Renal Society
I think it is important when so often referring to ‘evidence-based practise’ by which we are usually referring to action based on research, that we must not neglect the best ‘evidence’ in front of us – the patient, and have the courage to recognise, through our instinct, experience and education, when a ‘non-conformist or conventional’ path of care is not actually in the best interest of the patient. Whilst such a course may be easier when a patient can confirm their individual preference, need and agreement, this ability to be able to adapt and advocate a plan of care differing from the usual is more difficult, and takes greater courage and communication skills when caring for a patient such as a baby or severely incapacitated adult. In many ways however it becomes even more important as they rely on us to be their advocate and spokesperson, and to utilise those skills and knowledge we have and which we can employ in our unique position of care.