This site is intended for health professionals only

When does indifference become neglect?

Lynn Young
Primary Healthcare Adviser for the RCN

All nurses need to take time out from their energetic and demanding lives to read Patients, not numbers: People, not statistics, a report by The Patients Association from August 2009.1 It is a shocking read and reminds you how vulnerable seriously ill people are when they have to stay in hospital. The point being, that if you are not vulnerable there is no need for a hospital bed, and care provided by another person is not required in order to live.

While even a single case of poor nursing is one too many, it is easy to forget that, for most patients, their stay in hospital is a satisfactory, even pleasant experience - if surveys and regulatory reports are worth the paper they are written on. But, back to The Patients Association report, which has caused anxiety and distress throughout the nursing profession and for good reason.

Clare Rayner, President of The Patients Association, agony aunt, writer, media personality and one-time nurse, states the following: "I am sickened by what has happened to some parts of my profession of which I was so proud. These bad, cruel nurses may be - probably are - a tiny proportion of the nursing workforce, but even if they are only one or two percent of the whole they should be identified and struck off the register".1

Most of us would agree that no nurse is better then a bad nurse, because bad nurses create extra work, rather then helping their colleagues complete the actions demanded of them. If we are unable to trust our colleagues to behave with reassurance and kindness, and with patient safety uppermost in our minds, our working environment all too quickly becomes contaminated with low morale and indifference. Interestingly, some reports from patients state that the nursing care they received was not bad; in fact, it appeared to be perfectly competent, but the nurses seemed to be indifferent to patients' fears and worries.

Being indifferent to patients' and colleagues' needs is dangerous stuff and we must do what we can to guard against it. Indifference is bad enough, but if neglect occurs, the situation can all too quickly degenerate into cruelty and abuse. In modern times, we have become obsessed with competence, audit and productivity in healthcare. Surely we need to become equally obsessed with compassion, care and being connected to patients and colleagues? To be capable of compassion, though, we have to be nurtured, respected and protected. If we are without these things, it becomes increasingly difficult to feel and show compassion to those people in our care.

Workplaces need to be firm, fair, caring and considerate to their staff. They cannot receive high ratings from regulatory bodies if all they can demonstrate is how many patients have been treated and their rates of MRSA. Mind you, modern life is also focused on measurements, and how we rate compassion would be tricky if it became reduced to number crunching.
Perhaps it is time to put evidence in its place. While it is critical to ensuring that clinicians do the right thing, we should place equal amounts of importance upon what patients and their carers tell us about the kindness and compassion - or lack thereof - they received.

Nurses also need to connect with the Prime Minister's Commission on the Future of Nursing and Midwifery (see Resource). Over 2,000 submissions have been received and a PR company is now charged with reducing all this information to a document, which will be read and understood by many. A worthy document is far from good enough, however; inspired action must take place so that come the time my family and I are in need of nursing care we can be utterly confident that it will be both competent and compassionate.

In the meantime, visit: where you can read the RCN submission.

1. The Patients Association. Patients, not numbers: People, not statistics. London: The Patients Association; 2009.

Prime Minister's Commission on the Future of Nursing and Midwifery
W: Nursingandmidwifery/DH_098961