Sunday, 31 March 2013

The 29 points about nursing

I am very grateful to:

Nursing Standard 27:24 (13 February 2012) pp 12-13

from which I take the 29 points; my responses are in red

1.     In nurse training, education and professional development there should be an increased focus on the practical as well as the theoretical requirements of delivering compassionate care.

This is simply badly written and barely deserves a comment; it is logically impossible to increase the focus on one aspect 'as well' as another; it has to be 'instead' of, and I strongly suspect that 'instead of' was what Lord Francis meant.  There is simply no appreciation of why nurses would need to learn or understand things at a theoretical level.

2.     Training should be reviewed to ensure sufficient practical elements are incorporated for a consistent national standard to be achieved by all trainees.
'Training', 'trainees'?  Was Lord Francis so badly informed that he deliberately used this language?  It is not sufficiency of 'practical elements' that will assure a consistent national standard.  What is required is agreement on - specifically - what 'practical elements' are required to make a nurse a nurse; if Lord Francis had spent a few days considering this with well-informed advisers, he would have done nursing and the UK public a great service.

3.     There should be a national entry-level requirement that students spend at least three months working in the direct care of patients under the supervision of a registered nurse.  Such experience would ideally include older people and involve hands-on physical care.  Satisfactory completion of this direct care experience should be a condition of continuing nurse training.
Not too bad an idea to specify that some 'hands on' supervised experience is gained in advance - but see what this has turned into: a year working as an Health Care Assistant (HCA) prior to entering (Lord Franics did say 'continuing') nurse training (Lord Francis cannot seem to bring himself to use the word 'education'). So; is Lord Francis' three months additional to the year as an HCA that the UK government is now proposing?  The view from outside the UK is that we are now a laughing stock. From my own experience, working for twelve months as an HCA (OK - called 'auxiliaries' in those days) is what led me into nursing.  However, what I mainly learned was bad habits and shortcuts and a superiority to my fellow students when I eventually entered training - and it was training when I did it.  As a nurse lecturer I have consistently found former HCAs the hardest students to teach: they have developed bad habits, take shortcuts and have a superior 'know-it-all' attitude to their fellow students...

4.     The Nursing and Midwifery Council (NMC), working with universities, should consider introducing an aptitude test to be undertaken by aspiring nurses.  The test should explore attitudes to caring, compassion and other professional values.
In contemporary 'textspeak': WTF?! How on earth could this ever be achieved?  It will tie the NMC and universities up in meetings for months. How does Lord Francis think that making a recommendation like this will help us achieve what decades of research have failed to do - ie define the core characteristics of nursing?   Lord Francis has decided that he knows all about nursing - like so many of his ilk.

5.     The NMC and other professional and academic bodies should work towards a common qualification assessment or examination.
Yes - I TOTALLY agree; thanks Lord Francis.  Some of us have been saying this for quite a while, and being ignored for as long by the ignoramuses in charge of the NHS and nursing in the UK Department of Health - maybe, now, this eminently simple to implement solution will be realised.

6.     There should be national training standards for qualification as a registered nurse to ensure that newly qualified nurses are competent to deliver a consistent standard in the fundamental aspects of compassionate care.

Yes - again, agreed - but this is not new and the outcomes of a major report conducted by the nursing regulatory body in Scotland (prior to the inception of the NMC) towards this end were completely ignored.

7.     Employers recruiting nursing staff should assess candidates’ values, attitudes and behaviours in relation to the wellbeing of patients and their basic needs.
Really?  As opposed to what - their ability to strip down and re-assemble an AK47?

8.     The Department of health (DH) and the NMC should introduce the concept of a ‘responsible officer for nursing’, appointed by and accountable to, the NMC.
Most of us wonder what the role of Chief Nurse is for; some think it already had this function.

9.     The NMC should introduce common minimum standards for appraisal with which responsible officers would be obliged to comply.  The officers could be required to report regularly to the NMC.
We already have the highly rigorous and regularly implemented system of PREP - what else to we need?*

10.  Every nurse should be required to demonstrate in an annual learning portfolio up-to-date knowledge of nursing practice.  The portfolio should provide evidence of commitment, compassion and caring for patients, with feedback from patients and families on the care provided by the nurse.  This portfolio and each annual appraisal should be made available to the NMC, if requested, as part of a nurse’s revalidation process.
Oops - 'if requested' - sorry, not good enough.  Unless it is compulsory it is worthless.

11.  Ward managers should operate in a supervisory capacity, and not be office-bound or expected to ‘double up’ – except in emergencies – as part of the nursing provision on the ward.  They should know about the care plans relating to every patient on his or her ward.  They should make themselves visible to patients and staff alike, and be available to discuss concerns with all, including relatives.  Critically, they should work alongside staff as role models and mentors, developing clinical competencies and leadership skill in their team.
Agreed without reservation but what about recommendations to bring a halt to the endless 'paper-pushing' necessitated by the very kind of target setting by the NHS that - in part - have been blamed for the crisis at Mid-Staffs that led to the Francis report?

12.  The NHS knowledge and skills framework should be reviewed with the intention of recognising explicitly nurses’ demonstrations of commitment to patient care and, in particular, to dignity and respect.
Yes, towards what end and how will we know if nurses have demonstrated commitment to patient care and, in particular, to dignity and respect?

13.  Training and continuing professional development for nurses should include leadership training at every level from student to director.  A resource for nurse leadership training should be made available for all NHS healthcare provider organisations.
More money for the consultancy companies...roll up folks!

14.  Healthcare providers should be encouraged by incentives to develop and deploy transparent measures that define the ‘cultural health’ of frontline nursing workplaces and teams.  The measure will build on the experience and feedback of nursing staff using a robust methodology, such as the ‘cultural barometer’.
Jargon, platitudes and, I hate to ask, but is the ‘cultural barometer’ robust?  Please, someone, send me a refereed paper describing the psychometric properties.

15.  Each patient should be allocated a named key nurse for each shift who would be responsible for co-ordinating the provision of the care needs of the patient.

16.  The creation of the status of registered older person’s nurse should be considered.
YES - thanks; at last.  Folk like Mike Nolan and me have been saying this for years - but why just 'considered' - watch this space - not in my lifetime, I think.

17.  The RCN should consider whether it should divide formally its ‘royal college’ functions and its employee representative/trade union functions between two bodies.
YES - again; but Dear Lord Francis - is this any of you business (expletive omitted).

18.  Recognition of the importance of nurse representation at provider level should be given by ensuring that adequate time is allowed for staff to undertake this role.
I have absolutely no idea what this means.

19.  A forum for all directors of nursing should be formed to provide a means of co-ordinating the leadership of the nursing profession.
What - another 'forum'?  Nurse directors spend enough time talking to each other in countless forums - they need leadership, from the top - from the Chief Nurse.

20.  All healthcare providers and commissioning organisations should be required to have at least one executive director who is a registered nurse, and encouraged to consider recruiting nurses as non-executive directors.

21.  Commissioning arrangements should require the boards of provider organisations to seek and record the advice of their nursing director about the impact on the quality of care and patent safety of any proposed major change to nurse staffing.  Boards should record whether they accepted or rejected that advice; and if rejecting the advice, recording their reasons for doing so.
I'm astonished that this does not already happen and can hardly believe that it isn't.

22.  The effectiveness of the chief nursing officer should be kept under review following the role’s move from the Department of Health to the NHS Commissioning Board.  The review should ensure the role provides a leading representative of the whole nursing profession, and that the post holder is able and empowered to give independent professional advice to the government on nursing issues; and that he or she is accorded equal authority to that of the chief medical officer.
YES - result!

23.  There should be a uniform description of the role of healthcare support workers (HCSWs).
Agreed.  But the different areas of practice need to be recognised too - hard to compare critical care and community and this takes us back to trying to define nursing and caring; this ought to keep a few folk busy for a few months.

24.  Commissioning arrangements should require provider organisations to ensure by means of identity labels and uniforms that an HCSW is easily distinguishable from a registered nurse.
Thanks, at last and eminently sensible.

25.  A registration system should be created under which no unregistered person can provide for reward direct physical care to patients currently under the care and treatment of a nurse or a doctor in a hospital or care home.

26.  There should be a national code of conduct for HCSWs.
Agreed.  But nurses have one and that has not stopped some abysmal incidents - somewhat naive on behalf of Lord Francis to rely on codes of conduct.

27.  There should be a common set of national standards for the education and training of HCSWs.
Yes but see points passim.

28.  The code of conduct, education and training standards and requirements for HCSW registration should be prepared and maintained by the NMC.
Has anyone asked the NMC who seem to be struggling to regulate nursing right now?

29.  Until such time as the NMC is given the recommended regulatory responsibilities, the DH should institute a nationwide system to protect patients from harm.  This system should allow employees who have been dismissed on the grounds of being unfit for such a post a fair opportunity to respond.
Once again - and I am  not alone - I don't really 'get' this recommendation.

* - I hope readers realise that I was being sarcastic.