Nurse Blaming

It was clear from the Francis Inquiry that, within the Mid Staffordshire Trust, nurses failed and neglected patients. There is - of course - no excuse for such cruelty, but to really understand what went on, these acts must be seen not in terms of individual failings but within the context the final report describes, of a hospital trust putting ‘corporate self interest and cost control ahead of patient safety.’

Yet the government’s response to the report focused mainly on nurses’ capacity to care, coming up with a recommendation that anyone entering the profession spend a year as a healthcare assistant ‘before entering university’. There seems to be a misunderstanding here about how university trained nurses spend their time – do they realise that fifty per cent of those three years is spent in a clinical setting dealing directly with patients, not in a library or lecture hall?

The student nurses I meet are full of enthusiasm and compassion. ‘I just love it,’ they often declare of their new profession. I don’t see nurse education as the source of the problem. The key question for me is what is it that happens between graduation and all too frequent burn-out?

When I talked to nurse Shaun Maher about compassion, he said that not being able to do your job well gradually chips away at satisfaction, turning nurses cynical or else driving them out of the profession. ‘There’s a gap between the care you want to deliver and the care you are able to deliver.’

The Willis Commission – set up to examine the best way to train nurses to meet the challenges of contemporary healthcare – published its findings in November 2012 and did not recommend any change to the way nurses learn within a university degree framework. But just three months later, among it's many other recommendations, the Francis Inquiry suggested that nurses should spend some months as healthcare assistants before degree training. The government seized on this, increasing this dubious apprenticeship to a whole year before formal nurse education starts. How this will be effected, costed, or whether it will become a barrier to entry hasn't yet been worked out.  Meanwhile the government has ignored other Francis recommendations such as registering all healthcare assistants who do so much basic care for minimal wages and status. Deborah Orr, in a scouring article in the Guardian, wrote of how little we value and reward the whole idea of care in our society, and how little we pay for it. Yet David Cameron does not hesitate to lecture nurses on compassion.

Nor has the government supported the Francis recommendation of action on staffing levels, which seems to me key to the kind of burnout Shaun describes above. Their resistance to this move can only be because legislation would get in the way of private companies making profit in whatever way they see fit.

In her recent inaugural lecture on the state of nursing, Tonks Fawcett quoted the Willis Commission: ‘Our education system must produce nurses who have both intelligence and compassion, not one or the other.’

Aside from all the academic and practical skills they must take in, nurses must also learn to speak up for themselves more effectively, especially at times when they are being scapegoated – when dangerous systemic failings are blamed on their lack of ‘feeling’. It is only by having a better voice that 'nurse blaming' can be countered with constructive ideas and action.

In an interview with the Nursing Times last week, Robert Francis expressed disappointment with nurse leaders' response, or lack of response, to his report (for example, the Chief Nurse of England's report has been delayed until June). He said, “There is a need to strengthen the voice of nursing so that what nurses need in their workplace to do their job effectively for patients is articulated better and stronger.” 

Nurses' Day, Nurses' Stories

I was out of the country for the last week, and so missed the chance to post something for Nurses Day on Sunday the 12th. However, visiting the RCN website, I see that they have gathered up the stories of many nurses, a collection of heartfelt pieces about how nursing feels from the inside - much better than anything I could say.

Here is one of the stories, reblogged from their website. I particularly like the way it captures how a nurse's involvement with a patient can be life-changing for the nurse, too. You can read all of the stories here

Being human

posted on the RCN website by Dave King 

There have been some deaths that have had an impact on me over the last few years. My mum, my uncle, his wife and their daughter, and my brother-in-law.  And Sean.

I first met Sean when I had been qualified for but a few years, in the early nineties, and was working as a staff nurse on a locked ward in a large hospital, where it felt like we played darts, table tennis and football for much of the day, and tried to keep control of the ward for the rest.

I don't honestly remember where Sean was admitted from, and don't feel inclined to find out, because that's not the point. I have a few strong memories of him: he was young, wirey and fit, with a head of shaggy black hair. He could climb a drainpipe as if gravity hadn't been invented, and persuading him to come down from the roof of the Victorian institution was not an unheard of event. On one occasion he came down (in his own time, as was always the case) on the 'wrong side'; the side where the rest of society lived. Luckily for society I was there, waiting; recently trained in Control & Restraint (C&R - look it up in the history books), and ready to fulfil my responsibilities under the Mental Health Act (Section 138).

The tussle began as might have been predicted, but quickly took an unexpected turn. Sean started to cry. They hadn't covered this on the C&R course. If Sean had put me in a neck lock, I was prepared. But crying? This was a new one.

Being a conscientious mental health nurse removed many options, but a sense of humanity seemed to leave me with one solution. It was obvious. I hugged him. I hugged; he cried; support finally arrived, and we returned to the ward.

A less clear memory of Sean occurred when he was found cutting his forearm in his bed space, and we intervened. The scenario unfolded safely enough, but, afterwards, a colleague informed me that I had been cut, pointing to the wounds on my arms. It quickly transpired that the sweat and the duration of the restraint had resulted in some of Sean's scabs transferring themselves from his arms to mine.

Fast forward about 15 years. Our careers had separated. Sean has spent time in a high secure hospital, and I have been a charge nurse in a medium secure service for some years. Sean is making good progress and has an identified discharge pathway, it could be a couple of years, but things are looking good. I have been charged with managing our service's new Long Term Medium Secure Service, and Sean has agreed to advise on the admission process from a patient's point of view. His advice is succinct; "Tell 'em how it is straight; don't mess them about; as long as they know the score, they'll be okay." And so it proved to be. Sean the service use expert.

A few more years and Sean had been discharged. A flat, a job, a girlfriend. An unexpected illness and a tragically early death. After all his hard work, Sean hadn't had the time to enjoy the fruits of his very hard labour.

The patients, staff, family and friends who attended his funeral felt a deep and genuine sense of loss. That included me, and it also made me begin to wonder about the way in which being a forensic mental health nurse can affect us, and how (if, indeed, we do) we manage to remain personally balanced and undamaged by the work we undertake. Human.

We feel the impact on us of the acts of others. I wonder if we understand that we, too, can leave an impact on them.