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There’s No One Driving: The Failure of Nursing Leadership in the Aftermath of the Francis Report

May 27, 2013

Name a nurse leader. Go on, get your thinking cap on – you can’t have anyone who’s dead. We’re looking for a real pace-setter who is standing up for good practice, questioning poor practice, articulating the views of the rank-and-file and coming up with inspiring new ideas to develop the profession and take it forward. Any names spring to mind? To get you off on the right track, how about one of these:

David Cameron. Noted champion of intentional rounding. Wants to see nurses ‘really focus on the caring’.

Robert Francis QC. Author of forensically detailed and much-debated report containing many recommendations about nursing. Now reportedly believes nurses are guilty of ‘apparent[ly] misunderstanding’ of some of them.

The Daily Mail. Fixated with idea that higher education has somehow turned nurses into flinty-hearted misanthropes. Recently informed readers that the Royal College of Nursing (RCN) ‘is so obsessed with nursing being treated as an academic pursuit that it risks giving the damaging impression that performing simple acts of kindness, like feeding and cleaning patients, is now beneath its members’.

Attractive though all these candidates undoubtedly are – and it has to be said that they have been exceptionally successful in getting their views on nursing into the public arena – they all share the same rather major drawback: none of them is actually a nurse. Finding a nursing mover and shaker who is also a real nurse – with credible hands-on experience – is surprisingly difficult. And it’s becoming a cause for concern.

In an interview with the Nursing Times a couple of weeks ago, Robert Francis singled out the nursing profession’s response to his Report, and not in a good way. According to reporter Shaun Lintern, Mr Francis ‘criticised what he perceived as a lack of response from the [nursing] profession as a whole and its representatives’. He also unfavourably compared nursing leaders to NHS managers and doctors, saying “they [managers and doctors] are taking this very seriously. The [medical] royal colleges are taking action”. Nursing, he complained, was being altogether less proactive. So who are nursing’s big hitters, and what have they done to lead the profession’s response to the earthquake that was the Francis Report?

Jane Cummings, Chief Nurse for England. Tasked with driving forward government initiatives on nursing, so you would not expect much dissent from official policy. Main focus is the implementation of the National Nursing Strategy and ‘6Cs’. Although these were developed following a consultation period with practitioners, they have had a mixed reception on the shop floor with many nurses viewing the ‘back to basics’ approach as patronising and simplistic. A scheme to recruit student and newly qualified nurses as voluntary ambassadors or ‘care makers’ for the new era of compassion to be ushered in by the National Nursing Strategy also angered experienced nurses. Little official comment on Francis Report – assume views identical to government’s.

Nurse Academics. Before the publication of the Francis Report, the public would have been hard-pressed to name a single nurse academic; since the publication of the Francis Report – nothing has changed. By failing to get their voices heard, nurse academics confirmed the populist view that they have nothing to offer. Did anyone expose the populist wisdom that educated nurses cannot also be caring nurses for the sexist claptrap that it is? No. Did anyone campaign for an unlocking of nursing potential by discussing examples of improved patient care led by nursing research? No. Verdict: If nurse academics can’t be bothered to fight their own corner, why shouldn’t the public believe what they read in the Daily Mail?

The RCN. According to Wikipedia, Dr Peter Carter’s PhD thesis was entitled Understanding the Reasons Why Nurses Abuse Patients in their Care – so you would expect the RCN General Secretary to be ideally qualified to address the issues identified by the Francis Report. Instead, the College allowed its response to be completely dominated by something that wasn’t even in the report – the government’s plan to make would-be nursing students work for a year as HCAs before commencing training. While this proposal certainly raises many questions, the College President’s crass characterisation of it as ‘stupid’ and the ensuing spat with the government left RCN looking defensive and whingey. In an interview with the Nursing Times last week, Dr Carter said that “What we should have been a bit better about doing was to make clear what our process was. It made sense to wait until congress in April and then issue our full response to the report in June”. Verdict: Embarrassing.

The Safe Staffing Alliance. New pressure group composed of the RCN, UNISON and a number of other prominent individuals. Single aim: to persuade government to adopt a mandatory minimum daytime staffing ratio of one trained nurse to eight patients. A guaranteed crowd-pleaser, the initiative claims to be based on the research of Professor Peter Griffiths (Southampton University) who is an expert in the field and a member of the Alliance, plus the results of a recent RCN survey which found evidence of widespread unsafe staffing levels .
Lack of a website makes the Alliance look rather shadowy (or just plain disorganised)* and also means it’s difficult to pin down future strategy or exact basis for demands. In the past, Prof Griffiths has publicly cautioned against over-simplifying the relationship between between high numbers of trained staff and favourable patient outcomes. In these cash-strapped times, shouldn’t we be seeking more creative solutions than simply bellowing for extra staff? Verdict: Need to think outside the box.

The Nursing Press. As you would expect, extensive coverage of, and reaction to, the Francis Report. The Nursing Times has used used the report’s recommendations on whistleblowing as a springboard for its ‘Speak Out Safely’ campaign. In an editorial, the magazine slammed the RCN’s failure to invite a single politician to participate in the 2013 Annual Congress as ‘a squandered opportunity’.

Molly Case. Electrified RCN Congress and became overnight internet sensation with eloquent rap on power of nursing. As a mission statement, the chorus(?) lines ‘You say we’re not doing enough/then we promise we’ll do more’ may require certain
qualifications. Such as ‘provided we’re not too knackered’.

The underlying problem for all professional bodies is that they have to be seen to be supporting their members even when their members are in the wrong. Because of this, we have been forced to witness the excruciating spectacle of the RCN attempting to portray nursing as the victim. Given that there may have been as many as 1200 excess deaths at Stafford Hospital between 2005 and 2008, the public must have found this hard to swallow. The Safe Staffing Alliance, on the other hand, seems like a knee-jerk reaction designed to divert attention away from the many problems in nursing and back to an uncontentious issue that everyone can rally around. None of this is good enough. Nursing is in a mess. New ideas are badly needed.

* Correct at time of writing. The Safe Staffing Alliance has since produced a very informative website, which can be accessed at: http://www.safestaffing.org.uk/

The RCN is due to publish a detailed response to the Francis Report in June. UNISON will publish its response ‘before the summer’ (Source: Nursing Times).

Griffiths, Peter (2012) Inaugural lecture: doing away with doctors? Workforce research and the future of nursing. Working Papers in Health Sciences, 1, (1), 1-11. Available to download at: http://eprints.soton.ac.uk/345284/1/Doing_Away_With_Doctors_Workforce_research_and_the_future_of_nursing.pdf

For Molly Case poem see http://www.youtube.com/watch?v=XOCda6OiYpg

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