Can nursing be a tick-box exercise?

Nursing made the headlines this week and again it was not for good reasons.

It makes me sad that frequently nursing seems to be at the heart of what is wrong with the NHS. Widespread media reports worry me that nurses, as a profession are portrayed as uncaring and cannot be bothered to actually care for people. As someone who takes pride in their work and tries hard to ensure myself and my team deliver high quality of care, it worries me that these reports imply that we are all this bad. I’m not trying to deny that poor standards exist or say that improvements are not needed.

My trust has a mission statement based on the NHS Constitution.  At a recent trust event we were asked in groups to discuss this mission statement and if it had the correct focus for our organisation. The feeling amongst my group was that it is a tokenistic gesture that doesn’t actually have any relevance for us as practitioners. I was very taken aback by this. The pledges made in the mission statement relate directly to the poor standards of care that are reflected in the frequent reports of public outcry. The discussion group comprised of all professional groups, not just nurses. It left me wondering whose agenda are we working to? As health professionals are we not bothering to take notice of the basics that are fundamentally important to out patients? Have we lost sight of what is important in healthcare?

Combining this attitude with the concern over standards of nursing it made me wonder who is responsible for this? Is it due to a minority of individual nurses who are in the profession for the wrong reasons? I suspect that the problem is far greater than a few people and that the overall problem is partly due to culture than personal attitude. Is nurse education that bad that it does not cover the basics of caring? As someone who was a followed a degree programme for initial registration, I was frequently told by others that I wasn’t interested in nursing, I wanted to be a manager. Their presumptions could not be further from the truth. I’ve watched the diploma v degree debate with interest and am saddened that many nurses view degrees as a bad thing purely on the basis that they believe degree courses are only capable of creating managers. Is there a lack of nurse leadership or representations on trust boards? Staffing issues are nearly always the main excuse for poor care – why are these not addressed more fully? Realistically I feel that all of these factors contribute towards the situations that we regularly find are occurring with the NHS.

As part of my next fellowship module I’ve been reading the report into the Mid Staffordshire enquiry. The report was more interesting than I had expected. It also made me realise the point behind many of the activities we regularly have to carry out at work.  Audit is an example of this. I confess I find regular audits at work a bind and a pain to complete. The  report made me consider what potentially could happen in the absence of an audit structure. At Mid Staffordshire audits were not carried out. The trust relied entirely on external inspections and did not monitor standards in between these visits.

This week at work I started regular group clinical supervision sessions for the team. Prior to this we had not formally completed clinical supervision but it is required by our trust in a new policy. Yesterday we mentioned to a visiting rep about our session that day and she sighed and said ‘Oh, another tick you have to put in a box for the sake of it.’ This made me wonder – is this reducing nursing to a tick-box exercise? Again, viewing this in the context of Mid Staffordshire, what would the alternative be in the absence of clinical supervision?

Whilst audit and supervision may seem like a pain at the time, their purpose is ultimately important. I’m lucky to work in a good team where we are open, able to raise issues and safely challenge or seek help when a problem arises. If a work culture is not that supportive though, the importance and value such activities would increase. Staff, and more importantly patients, need a mechanism that regularly ensures standards are acceptable and improved upon. Professionals need a forum where they can raise concerns rather than accepting them and becoming caught up in a culture of poor care.

David Cameron’s answer to poor nursing care this week was an hourly ward round carried out my nurses to ensure standards. I’m not convinced that this is the answer. I feel nurses will view it as yet another box to tick without considering its purpose. I feel it would be more beneficial to explain the reasons behind completing audits rather than adding more forms to the pile.

I do feel nursing has lost sight of what is important to our patients. The basic rights discussed in the NHS Constitution may seem trivial to professionals but are fundamental to those we care for. Until that difference in perspective is acknowledged the complaints will continue.