Nurses perceived not to care?

1 July 2013

JO ANN WALTON reflects on the state of nursing in the wake of the United Kingdom’s damning Francis Inquiry and the need to reiterate respect, kindness, and dignity as nursing core values.

Some heavy things have been weighing on my mind in the last few months.

Along with all nurses who know about it, I have been thinking about the disaster at Mid-Staffordshire in the United Kingdom, where a catastrophic failure of care led to the neglect, abuse, and death of patients, a major national inquiry, and a crisis of faith in the NHS health services – particularly in the ability of nurses to fulfil the role expected of them by the public at large.

If you do not know about Mid-Staffs, I urge you to find out about it. Just type ‘Francis Inquiry’ into your search engine and you will find more than you could want to read. It is distressing and upsetting reading. But in spite of this, I think it is important that we face the unpleasantness. There are things we can learn and questions we need to ask ourselves about the state of nursing in our times.

What kind of questions? Well, some nurses are asking “Could this happen here?” Others might ask “What makes us think it is not?” Are there ever lapses in our (individual or collective) professional behaviour? Have you witnessed behaviour, demeanour, attitudes, or acts of omission or commission that were not at the highest level of professional comportment? I think we all have. Which is not to say that everything is bad; not at all. The trouble is that it takes so little to destroy public trust and so much to gain it back.

Whenever we face bad press, it is easy to become defensive. Of course none of us wants to see nursing represented in a bad light. Not one of us entered this profession intending to harm, to ignore, or to wound. Our fundamental desire is to help other people, to alleviate suffering, and to heal. And yet sometimes things go wrong – and when things go wrong, they can go very wrong.

Devastating effect of ongoing small neglects

Alongside the official report of the Francis Inquiry, I have been reading the account of a woman whose elderly mother received shockingly poor care at Mid-Staffordshire Hospital. Julie Bailey’s book From ward to Whitehall tells the story of her mother’s hospitalisation and eventual death, her family’s struggle to comprehend what was happening to them, and then, over a period of years, to reveal a culture of denial that pervaded the NHS.* Along with others, Julie Bailey helped to bring the whole situation to light, to precipitate the Francis Inquiry, and thereby to help us look again at what is happening in our health care systems. I think we have much to thank her for.

Julie’s story is one of fear. I find it hard not to feel ashamed when I read of the appalling sequence of small offences against professional care that led, in the end, to the shocking neglect faced by patients and families in this system. The real horror to me is that so many of the incidents are in themselves small, but together, their effect is devastating.

It is clear that the wards at Mid Staffordshire were understaffed. Nurses were too heavily burdened. Things were too busy. But as we all know, a shower missed on one shift might be compensated for. A shower missed for days on end leads to discomfort, skin breakdown, and infection. A bell not answered for a few minutes is distressing for a patient. A wet or soiled bed because no help is forthcoming is shameful, demoralising, and unacceptable. And so it goes on.

In her book, Julie Bailey refers often to nurses avoiding eye contact, to her own fear of confronting poor care or even asking questions lest nurses’ responses be cruel, blaming, and vengeful. This is not what we chose for our professional image.

And indeed, the publicity is hurting our own. A wonderful video clip tube shows Molly Case, a second year student nurse at Greenwich University reciting a poem relating her distress at the poor publicity nursing is receiving at present in the UK. It is well worth a watch:

By now you may be saying, well, this is not about us here in NZ. And no, it isn’t, but could it be? What can we do to make sure that our proud reputation as New Zealand registered nurses continue to stand? How can we make sure that we continue to bring bright and brave young nurses like Molly into our ranks? And that the trust the public put in us is warranted and maintained?

Reclaiming kindness and dignity

I want to revisit our ideas of professional behaviour. To reclaim the attitudes, motivations, and altruism that have been part of the nursing ethos for centuries. To remember that the little things count: that respect and dignity and kindness and gentleness are core values of our profession. To answer bells promptly, to come back when we say we will, to guide the lost visitor, to never say “that’s not my patient”.

To practice remaining calm in the face of chaos, to look with careful regard at our patients and their family members, to speak with them honestly, to show them that we are effective and capable and that we take their concerns seriously. They need to know that we are on their side. Family members want to be included and to help but they will step aside, when we need them to, if they trust that their precious patient is safe in our hands.

Is this all just a saccharine solution? I don’t think so. I am not suggesting for a moment that we don’t also need to work on remediating systemic dysfunction, uncovering workplace injustice, lobbying for institutional and national political change. Saving the planet and stopping war works for me, too (seriously).

But these are different matters. If we are to continue the proud traditions of nursing and maintain public trust, we need also to demonstrate to the healthy, the ill, the vulnerable, the worried, the wounded, the dying, and their families that nurses are there to witness, to help, and to serve, not only in times of crisis but also in the little everyday things of life. That is what professionalism means.

*Julie Bailey, From ward to Whitehall: The disaster at Mid-Staffs published in 2012 by Cure the NHS.

Jo Ann Walton is Professor of Nursing at Victoria University of Wellington and an elected member of the Nursing Council.