Nurse Blaming

It was clear from the Francis Inquiry that, within the Mid Staffordshire Trust, nurses failed and neglected patients. There is - of course - no excuse for such cruelty, but to really understand what went on, these acts must be seen not in terms of individual failings but within the context the final report describes, of a hospital trust putting ‘corporate self interest and cost control ahead of patient safety.’

Yet the government’s response to the report focused mainly on nurses’ capacity to care, coming up with a recommendation that anyone entering the profession spend a year as a healthcare assistant ‘before entering university’. There seems to be a misunderstanding here about how university trained nurses spend their time – do they realise that fifty per cent of those three years is spent in a clinical setting dealing directly with patients, not in a library or lecture hall?

The student nurses I meet are full of enthusiasm and compassion. ‘I just love it,’ they often declare of their new profession. I don’t see nurse education as the source of the problem. The key question for me is what is it that happens between graduation and all too frequent burn-out?

When I talked to nurse Shaun Maher about compassion, he said that not being able to do your job well gradually chips away at satisfaction, turning nurses cynical or else driving them out of the profession. ‘There’s a gap between the care you want to deliver and the care you are able to deliver.’

The Willis Commission – set up to examine the best way to train nurses to meet the challenges of contemporary healthcare – published its findings in November 2012 and did not recommend any change to the way nurses learn within a university degree framework. But just three months later, among it's many other recommendations, the Francis Inquiry suggested that nurses should spend some months as healthcare assistants before degree training. The government seized on this, increasing this dubious apprenticeship to a whole year before formal nurse education starts. How this will be effected, costed, or whether it will become a barrier to entry hasn't yet been worked out.  Meanwhile the government has ignored other Francis recommendations such as registering all healthcare assistants who do so much basic care for minimal wages and status. Deborah Orr, in a scouring article in the Guardian, wrote of how little we value and reward the whole idea of care in our society, and how little we pay for it. Yet David Cameron does not hesitate to lecture nurses on compassion.

Nor has the government supported the Francis recommendation of action on staffing levels, which seems to me key to the kind of burnout Shaun describes above. Their resistance to this move can only be because legislation would get in the way of private companies making profit in whatever way they see fit.

In her recent inaugural lecture on the state of nursing, Tonks Fawcett quoted the Willis Commission: ‘Our education system must produce nurses who have both intelligence and compassion, not one or the other.’

Aside from all the academic and practical skills they must take in, nurses must also learn to speak up for themselves more effectively, especially at times when they are being scapegoated – when dangerous systemic failings are blamed on their lack of ‘feeling’. It is only by having a better voice that 'nurse blaming' can be countered with constructive ideas and action.

In an interview with the Nursing Times last week, Robert Francis expressed disappointment with nurse leaders' response, or lack of response, to his report (for example, the Chief Nurse of England's report has been delayed until June). He said, “There is a need to strengthen the voice of nursing so that what nurses need in their workplace to do their job effectively for patients is articulated better and stronger.”