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Saturday 22 November 2014
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How do we define excellence in nursing?

How do we define excellence in nursing?

My NHS organisation recently held a conference entitled "Celebrating Excellence". As a group of eight small specialist nursing teams we felt that this title had particular relevance to us, as a significant part of our work is around supporting our colleagues to deliver the best possible quality care.

Sometimes we try to do this by providing advice or education, and sometimes by leading by example. However, although we all usually bound with enthusiasm and ideas it can be a challenge in the current difficult financial climate to maintain that level of enthusiasm so we looked forward to this conference as a useful focus.

As the team leader, I saw this conference as an opportunity to share some of the excellent work of my colleagues. So I chivvied as many of them as possible to apply to participate and to my delight we had four posters and an oral presentation accepted. On the appointed day we turned up to do our bit and to listen to our colleagues and the invited great and good.

It felt like a very successful day but a particular highlight for us was an address from the Chief Nurse, Dame Christine Beasley. Christine covered a lot of ground, but we were particularly encouraged to hear her argue that although "excellence" might feel unachievable in the current climate, we should not lose sight of that aim. If we start to believe that excellence is beyond us, we are setting ourselves up to only achieve mediocrity.

As specialist nurses we often hear our colleagues say that they haven't got time to do things "properly" – a classic example is that it is so much quicker to simply dress a leg wound than to undertake a full assessment with a view to possibly applying compression bandaging.

The problem is that without excellent care, the problem is unlikely to get better. A venous ulcer that does not receive compression bandaging is unlikely to heal. Instead of healing fast and being discharged with support stockings and a follow-up appointment, the patient is likely to still be attending two or three times a week in six months' time.  

So "excellent" care will often be clinically and cost-effective care. However, sometimes the clinical and cost-effectiveness may be less evident. Two presenters described how they had used a Queen's Nursing Institute grant to improve the décor and facilities of their community hospital ward that cared for elderly men with challenging behaviour.

I don't know how easy it would be to prove the clinical cost-effectiveness of the improvements, which included the provision of a potting shed and pub, with darts board and slot machine.

However, I do know that if I had an elderly loved one needing such care, then such an environment would greatly improve the quality of life for my friend and thus by association, for me. The thoughtfulness and attention to detail in this project was deeply moving and a wonderful example of excellence in nursing practice.

As always, nursing remains a balance of science and art with a healthy injection of compassion. Excellence must apply to all these aspects of our profession and if we are to take pride in our profession, we must keep sight of the need to strive for excellence, even when the going is tough.

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