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Taking a stand on standards

The Prime Minister claims that politicians need to me more upfront about nursing standards and proposes a public debate on the issue.

On New Years Eve I made a resolution to be dignified, professional and wise in my maturing years as a nurse. By the third of January I was severely challenged by workloads, by the fourth I was wobbled by a colleague's attitude, but on the sixth day, I broke my resolution and yelled in frustration at David Cameron who was being interviewed on Radio 4. Oh dear.

The reason? He said politicians have to be so respectful of the role of nurses that they have not spoken frankly enough about the failings of our care that numerous formal enquiries and patient experiences have revealed, predominantly for the elderly and vulnerable. Apparently, concerns about nursing standards have been 'hidden' and not fully addressed to avoid 'rows' with nurses - but no more! He is to lead a public debate on the issue, and in the interim offered some practical tips to help us out:

·       Hourly ward rounds by nurses to check patients are being cared for.

·       Reduction in nursing paperwork to give time to patients.

·       Patients to undertake ward inspections.

A Quality Forum is to be developed to set standards for nursing which are to be debated frankly and publically.

Thank you, Mr Cameron - your well-intentioned commitment is welcome. Before the blogs, online chats, media editorials and revelations begin in earnest, here are some suggestions of my own.

There needs to be a national ratio determined for staffing levels. There are not always enough nurses available for the number of patients needing healthcare. This is irrespective of whether care is given in a hospital or at home. Acute units indicate it is not uncommon to have 3 nurses to 30 patients making it impossible to provide the standards patients deserve. Agency staff are no substitute for inadequate basic levels.

Nurses and managers need improved skills and evidence to manage co-morbidities - and sufficient staff to provide care. The needs of patients are far more complex than in the past.  Dementia is present in over 50% of elderly patients requiring physical care. Dementia is challenging for all carers but adding a strange environment with a vast number and range of unfamiliar faces over a 24-hour/7-day week timeframe for the patient, can exacerbate behavioural and healing processes.  

Nurses must be involved in the commissioning of services from all providers to ensure safe and appropriate pathways. Though the principle is excellent, when reducing hospital stays the rapid turnover of patients creates stress on services to ensure appropriate assessment and care planning is in place. More patients, more assessments, more resources needed, more joined-up care - simple. Relatives need time to adjust and confidence that support services will be in place once discharged.

Preserve the status of nursing - qualified practitioners on a professional register with accountability for their acts and omissions. There has been much confusion in the public perception of who is a 'nurse' - and unqualified practitioners do use the title. This is unfair, deceptive and potentially dangerous.  The association with nursing values of comfort, nutrition, social, emotional and personal care that is increasingly provided by healthcare support workers requires investment in their training and supervision. Dare I mention clarifying for the public the relationship between the nursing uniforms and the role and accountability of the wearer? And clearer job titles would help.

Skill mix and competencies that can be expected of the profession and service should be explicit and standardised. The role of a nurse today is inevitably different as technological advances, clinical evidence and public expectations have changed. The competencies of those working in independent nursing homes is but one example that society would find helpful.

Nursing should be redefined as an attractive profession and nurses valued. Physical and verbal abuse, stress levels with staff shortages, threat of complaints and legal action, frozen pay awards, increasing pension contributions for senior nurses, and poor press does little to retain and attract staff.

Nurses must be able to nurse - and that will require appropriate form filling and record keeping.  NMC professional practice cases often cite poor records: if it was not recorded, it was not done.   Staffing levels must allow thorough recording as evidence of care. In addition, various government targets and initiatives have rightly raised expectations around the quality and efficiency of healthcare - but increased the accompanying paperwork that provides assurance. Matrons, single sex accommodation, pressure care routines, falls and medication error avoidance, nutrition assessments, protected times and productive projects have all spawned paperwork and reporting mechanisms that require staff time and commitment - and so too, will the PMs proposed hourly ward rounds.   

Such quality initiatives have not guaranteed good standards of nursing care, as inquiries, scandals and the media have highlighted. We need a change of attitude and approach. David Cameron wants a national debate - well let it start at Nursing in Practice!  We have a huge nursing readership from all clinical settings, with vast experience of good and bad environments, management and colleagues - and a thriving website with active forums for debate and exchange. I've set out my solutions - what are yours?  How do you see the reputation of nursing improving?  What have you seen or done that raises confidence in nursing?  What empowers staff, patients and carers to have a realistic expectation of nursing?  Share your views in the comments section below - so we can pass them on to the PMs Quality Forum for nursing.