Paul's blog
Paul Vaughan is the Regional Director of the RCN in the West Midlands.
Every month Paul writes a short article for the Birmingham Mail newspaper on current nursing and health care issues.
As each article is published, we will re-produce it below. If you have something to say on any of the subjects that Paul writes about, you can contact him. Email: paul.vaughan@rcn.org.uk
Supervisory ward managers: good for nursing, good for patients
Published: April 2013
In thinking about what I’m going to write for this column each month, I always try to put myself in your shoes as the reader.
I ask myself, what do we do as the Royal College of Nursing that is useful or interesting for people who are not part of the nursing community to know? How might we matter to the public?
Our campaigning activity is one of the ways we strive to influence positive improvement for nurses and patients alike, and for many years we have been calling for ward sisters (and charge nurses, their male equivalent) to have a truly supervisory role.
In practice, this means they have the opportunity to lead. They know about every patient on their ward. They are visible and approachable to staff, patients and relatives. They are not tucked away in an office under a pile of paperwork. They do not double up as part of the general nursing numbers.
We have put forward a cast-iron case in favour of this principle, and we’re encouraged that the government has accepted the recommendation in the recent Francis report that these pivotal clinical leaders should be supervisory.
I hope all NHS trusts now follow the example set by the Heart of England trust here in Birmingham, which is recruiting almost 50 extra nurses so its ward managers can lead in the way that we, the RCN, and you, the public, would want them to.
We have a lot to be proud of
Published: March 2013
If you’ve experienced, as a patient or relative, good care from a nurse in hospital or at your local health centre or at home, how did it make you feel?
Did it make you feel thankful and moved to offer a compliment or was it no more than you thought you should receive from a professional?
I suppose we all have our own barometer of what is excellent service and what is acceptable, of what is exceptional and what is expected.
It’s our differences as human beings, our different experiences, values and states of body and mind, that make it difficult to offer a truly impartial judgement on the quality of the health services on which we all rely.
But, from time to time, things happen that allow the nursing profession’s achievements on behalf of patients in the West Midlands to speak for themselves.
One of those things happened in London last week when nurses practising in Birmingham and the Black Country won no fewer than four of the 13 categories at the annual Nursing Standard Nurse of the Year awards ceremony.
In ward sister Sara Davis, learning disability liaison nurse Raj Jhamat, nurse director Adrienne Willcox and nursing student Gemma Borland, we have a lot to celebrate and be proud about.
The Francis report: Let's make the 'system' work for patients and nurses
Published: February 2013
The report of Robert Francis’s public inquiry into the past failings at Stafford Hospital represents an opportunity that simply must be seized by the NHS and those who direct, safeguard and deliver the health care services on which we all rely.
The report, understandably, reminded us of the unacceptable incidents of poor care that gave rise to the inquiry. As a nurse, I find these no less shocking now than when I first began to hear about them. I can scarcely imagine how the families affected must feel, and I sympathise with them.
Mr Francis is explicit in saying that patients suffered needlessly at the hands of a system that prioritised corporate self-interest and cost control over their care and safety.
His findings set a very clear expectation that the NHS frontline – doctors, nurses, health care assistants and other clinicians – must be empowered and supported to deliver the quality of care they aspire to give.
The starting point is to ensure there are sufficient numbers of staff, with the right skills, to meet patients’ basic care needs; to so do with dignity and compassion, and to do so consistently.
Imagine a ward with 28 elderly patients and half need help with eating. It’s lunchtime, there’s a registered nurse off sick and just two remain. Inevitably, those patients are not going to get the standard of care they deserve and those who need help with eating may not get it.
Nurses must, of course, be held accountable for their practice but in a case like this, which is far from fanciful, it is unfair to blame any individual who struggles to be in several places at once.
As Robert Francis has concluded, we need to change the system that allows it to happen.
Giving power back to patients
Published: January 2013
From this April you will be able to know whether patients who’ve used your local NHS hospital would recommend it to their friends or family.
Hospitals in Birmingham and beyond will have to publish how patients answer this very question, a test of treatment and care that the government believes will help drive up standards.
The government may be right, given that any hospital perceived by the public as worse than another will surely take action to improve. Income follows patients, and patients have some degree of choice over which hospital is paid by the NHS to administer their treatment and care.
At the Royal College of Nursing, we welcome the principle of patient feedback influencing the delivery of care. The ‘friends and family’ test will undoubtedly be an important part of how hospitals monitor and reassure the public of the quality of their services, but it would be wrong for it to be hailed as the only thing that matters.
I was really pleased to learn that Heart of England NHS Foundation Trust in Birmingham is planning to publish on its website a range of indicators of care quality on its wards - including the incidence among patients of pressure ulcers and falls and the results of patient surveys. In doing so, the Trust will set an extremely high standard of transparency to the public.
My only real concern is that clear and present factors beyond the control of nursing staff, such as waiting times for treatment and workload pressures caused by understaffing, may not always be taken into account when judgement on their care is pronounced. The playing field must be fair.
Nursing cuts affect care
Published: December 2012
There’s no doubt that 2012 has been another extremely challenging year for the nursing profession. The unprecedented scale of the savings drive in the NHS has undeniably led to cuts in staffing levels, making the jobs of nurses and health care assistants even more difficult to do well.
For nearly three years now the RCN has been warning of the risks to the safety and quality of patient care from short-sighted workforce cuts, and sometimes we’re accused, unfairly, of missing the point when we cite understaffing as one of the reasons why care can, on occasions, fall short of the mark.
Don’t get me wrong, every patient deserves to be treated with dignity and compassion. Some nurses do not meet the standards of care, competence and behaviour that the public and the profession expect of them and it’s right that they are held to account.
But I believe genuinely that nurses do not go to work intending not to care. Let’s say you’re a nurse on an elderly people’s ward, the ward is short-staffed, there are high levels of dependency and several patients need your attention at the same moment. What do you do? It is virtually impossible to deliver high-quality care to them all.
In its authoritative annual State of Care report, published less than four weeks ago, the Care Quality Commission found that almost one in every four care providers did not have adequate staffing levels.
Our concerns are valid and they have now been vindicated. The Government and NHS trusts must listen.
One nurse short is one too many
Published: November 2012
The Royal College of Nursing was in the local and national news last week after warning that continuing cuts to nursing posts and training places for nurses of the future could seriously destabilise the NHS and damage patient care.
Over the last two years we have been tracking this loss of nursing capacity and the rationing of services on which patients rely, voicing our members’ concerns about the mounting workload pressure this is placing on them as frontline nurses and health care assistants.
The facts are that demand for health care is rising due to our ageing population and a greater number of people living with long-term health conditions, and yet nursing numbers are falling. This seems to defy logic, even when one accounts for the unprecedented scale of the cost-cutting drive taking place across the NHS.
Fortunately, the NHS in the West Midlands hasn’t shed as many nursing posts since 2010 as some areas, but there has been a decline nonetheless. We believe this is bad news for patients.
As our sometimes exasperated members tell us, when the difference between delivering a consistently good standard of care on a hospital ward and not quite managing to do so can be something as simple as an extra pair of skilled hands, the loss of even one nursing post is one too many.
Let's talk about being different
Published: October 2012
This month is Black History Month, and the Royal College of Nursing will once again be celebrating the occasion and using it to facilitate a conversation between nursing staff in Birmingham about their experiences of caring for the diverse, multi-cultural population that lives in and around our city.
Birmingham has large communities of African-Caribbean and South Asian people, who have a higher risk of developing some health conditions such as diabetes and kidney disease. Nurses in hospitals and in the community play a vital role in caring for patients from these communities, helping them to live as full a life as their condition will allow.
Respect for people’s differences and ensuring equality of access to good health care are principles that chime with the core values of nursing, which is why they are so important to us at the RCN.
It’s also why we are teaming up with the Heart of England NHS Foundation Trust to bring nursing staff together at Birmingham Heartlands Hospital for a morning at the end of the month to share good practice.
Recognising and responding to people’s individual differences understandably makes for better patient care, but the importance of not automatically regarding everyone as ‘the same’ can sometimes be overlooked when there are lots of patients to attend to and precious little time – a scenario familiar to most nurses I speak to.
As we see it, offering nursing staff even a short window of opportunity away from their wards and clinics to exchange knowledge and expertise in caring for patients from Black and Minority Ethnic backgrounds is a sound investment in improving their practice.
All aboard to celebrate nursing
Published: September 2012
You may notice some advertisements on the buses in Birmingham over the next few weeks that aim to illustrate the important job that nurses do.
The Royal College of Nursing has taken out these adverts on bus services across the country because, as the main organisation representing the profession, we believe we have a responsibility to champion the true value of nursing to society.
So, what do we expect you to do with this information? The short answer is, it’s up to you.
It’s not our intention for people to think we are excusing poor care or trying to persuade them that if they or someone they know have received poor care, they are not entitled to have a negative view about it.
Having worked as a frontline nurse, I know that my patients’ views were far more likely to be formed from their experience of how competent and compassionate I was than by seeing a picture and a message on an advert. I have no doubt that’s still the case.
But what we are seeking to do with our This is nursing campaign is to bring some balance to the general perceptions and misconceptions that may be out there. After all, the vast majority of patients do still express very high degrees of satisfaction with their nursing care.
So, if it’s right and fair that episodes of poor nursing are exposed to the glare of media, political and regulatory scrutiny, it’s right and fair that the exceptional – and often unheralded – good that nurses do is celebrated, too.
Leap in the right direction
Published: August 2012
London 2012 – what an outstanding, inspiring Olympic Games it was, whatever country (Ireland, in my case) you were rooting for.
The athletes delivered some truly remarkable feats of speed, agility, power and endurance while the organisers, early ticket allocation problems aside, deserve a gold medal for their logistical slickness.
By popular consent, the spirits of those fortunate enough to attend an Olympic event were buoyed all the more by their experience of efficient transport, highly-visible signage and interaction with the army of strategically-placed Olympic volunteers – the ‘Games Makers’.
The spectators’ appreciation of the whole occasion got me thinking about the importance of reliable information and good communication in the delivery of health care; about the value of establishing and meeting patients’ expectations.
Excellent clinical care by doctors, nurses and health care assistants, leading to the very best outcomes for patients, can sometimes be undermined by a lack of planning or communication elsewhere in the system.
Imagine you’re in hospital and you’re looking forward to a visit by a relative, only to find yourself whisked off unexpectedly for a physiotherapy appointment the moment they arrive.
It might not sting as much as missing watching Usain Bolt race because you were queueing to get into the stadium, but it’s frustrating nonetheless.
I am, therefore, delighted to hear that University Hospitals Birmingham is one of only a handful of NHS organisations in the country to have won national funding to improve how clinical teams and corporate support services work together to improve the quality of patient care.
The trust’s idea to develop patient diaries, giving inpatients a schedule of the various tests and procedures they should expect, is a simple but long jump-winning leap in the right direction.
Too much for nurses to work to an old age
Published: July 2012
The morale of many nurses and health care assistants working in the NHS in Birmingham has been sapped by the news that the Government is to impose changes to their pensions that mean they will pay more, work longer and have less income in retirement.
The average NHS pension for a woman is less than £4,000, so a 3.2% hike in pension contributions over next three years will scarcely be affordable.
And let’s not forget that most NHS workers – all registered nurses included – have not had a cost of living pay rise for more than two years and face the prospect that they will receive, at best, only minimal annual increases in pay for the foreseeable future.
But if the financial outlook feels unfair to nursing staff, the associated increase in the retirement age to 68 by the year 2046 defies logic and belies the reality of ageing.
On hospital wards and in the community, nursing is frequently an extremely strenuous job, with patients having to be handled and supported to move, for example. Will a 68-year-old nurse be able to withstand the physical demands of delivering hands-on care and ensure the safety of their patient and themselves? Without wishing to stereotype, I have my doubts.
As it is, frontline nursing already loses too many skilled and hard-working professionals to injuries picked up in the course of duty; injuries that often mean they do not enjoy a happy and healthy retirement.
The physical and mental demands of working in the police, fire service and armed forces will continue to be recognised by a retirement age lower than the state pension age, so why not nursing?
Our principles of dignity, compassion and respect
Published: June 2012
My postbag at work frequently includes letters from patients whose experience of their care, good or bad, moves them to share their story.
Although the Royal College of Nursing is not a provider of health care or the regulator of care standards, I am always able to use the feedback we receive from patients constructively.
Where care has been good, passing patients' comments on to the nursing staff involved reinforces that their skills, knowledge and experience are valued, and that can be a very energising message for them. Where care has been poor, I contact the hospital or service provider to ask if we, as nursing’s professional body, can offer any support to avoid it happening again.
If you’re a patient or a relative or friend of one, it’s not easy to know what you can expect from nurses and nursing. How do you know what good nursing looks and feels like?
To help answer this question, the RCN, in partnership with patient interest groups, the Department of Health and the Nursing and Midwifery Council, has recently produced a set of eight statements that describe what everyone can expect from nursing, not just in theory but, more importantly, in practice.
Called the Principles of Nursing Practice, these simple statements serve as a kind of checklist for patients to measure the quality of the nursing they ultimately receive. As you would expect, the principles promote things like dignity, respect, compassion, safety, good communication and good coordination between health professionals, all of which characterise high-quality care.
The principles are intended to be every bit as informative to patients and the public as they are to nursing staff and their employers. They're on our website at Principles of Nursing Practice and I hope you can make use of them.
Care in corridors must stop
Published: May 2012
Nursing staff from across Birmingham attended our annual Congress in Harrogate last week, when one of the big talking points was the apparently high number of hospital patients who are being treated in corridors and other unsuitable areas due to a shortage of available beds.
One in five of our members in the West Midlands who responded to a survey we conducted into the extent of this problem said it was a daily occurrence, with a further 15% saying it happened every week.
Almost half had also encountered patients being cared for or asked to wait on trolleys for hours on end.
Frankly, even one of these episodes is one too many because it poses a risk to the quality and safety of care. Patients need to be able to talk to staff, reach call bells and know they are visible and being monitored.
Not only that. Patients rightly expect to be afforded a standard of dignity that simply cannot be provided in a corridor or on a trolley, however hard nursing staff try to ensure it.
And there is another reason why the government, hospitals and the wider NHS must act on nurses’ concerns and cease allowing beds to close in pursuit of short-term cash savings when those beds are evidently still needed.
As Minty Macleod, a student nurse from Birmingham, observed astutely in her maiden speech to Congress: the other reason is that nurses risk losing their job and registered status if, in the event they are caring for someone in an inappropriate setting, something goes wrong and they are judged to be at fault.
Care in corridors is a risk too far for patients and nurses alike. It must stop. Now.
Nurses need time to care
Published: April 2012
If an elderly relative of yours has ever been admitted to hospital you will probably be able to appreciate how precious the time that nurses spend with their patients truly is.
Naturally, I hope you’ve seen how comforting even a few moments of a nurse’s attention have proved to be. But I also know how upsetting and frustrating it can be when nurses do not manage to spend quality time with their patients.
So, when nearly four out of five hospital nurses say they rarely have enough time to talk to and comfort older patients, something is fundamentally wrong.
You may be shocked to learn that in a survey of our members in the Royal College of Nursing, 78% said they struggle to accomplish this very task, as basic and important as it is.
The survey found that one registered nurse cares for around nine patients on each older people’s ward in hospital.
We do not believe this is sufficient to allow nurses to deliver consistently safe, good quality care, especially as older patients very often have the most complex needs. We believe that the balance should be at least one nurse to seven patients, in line with the ratio on general adult wards.
Disappointingly, in pressing ahead with its controversial changes to the NHS that many health care professionals regard as flawed and risky, the government has refused to adopt our recommendation that safe staffing levels be made compulsory.
Nurses need the skills to deliver the standard of care to older people that everyone wants to see, but they must be given the time, too.