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Isn’t it Supposed To Be About the Patients?: Why Named Nurse Negativity is PR Suicide

July 7, 2013

Here we go again. Some stuffed shirt who knows naff-all about nursing is telling us how to do our jobs. Last time, it was David Cameron bigging-up intentional rounding; now it’s Jeremy Hunt’s turn. His latest good idea – unveiled in a speech on June 21st – is for every hospital patient to have the name of their ‘responsible nurse’ emblazoned above the bed. Reaction from the profession has been unremittingly hostile.
Writing for the Nurse First blog, Dave Dawes predicted that the initiative, if it ever saw the light of day, would be an ‘irritating, time-wasting fiasco’; over at the Nursing Times, Eileen Shepherd blogged that it ‘is born out of a need to be seen to do something rather than any real understanding of the problems ward nurses face day to day’ and added that implementation was likely to be ‘cosmetic’. Contributors to the NT interactive website were similarly unanimous in their condemnation: ‘knee-jerk’, ‘gimmick’ and ‘stupidity’ – these were just the politer verdicts. Others suggested that Mr Hunt’s name should be the one posted above the beds. And the real answer to the crisis in nursing? A chorus of agreement on that one too, of course: more staff, more staff, more staff. Oh, change the record will you?
Adequate staffing and appropriate skill mix are of paramount importance. But what the Health Secretary is flagging up – albeit in characteristically inept fashion – is a different problem: how do we ensure that we have the right systems and the right philosophy in place to deliver not just good care but the best care we possibly can? Because however unrealistic Mr Hunt’s proposal may appear (and yes, I know all the reasons why Named Nursing won’t work, see my March 2013 post ‘Does the Francis Report Signal the Revival of the Named Nurse?’ if you don’t believe me) responding with a barrage of negativity to an idea which is, at heart, about enhancing the nurse-patient relationship is PR suicide. Do we want to look as if we don’t care about engaging with patients?
All the big, headline-grabbing policy ideas in nursing this year have been initiated by the government. We’ve had Intentional Rounding, student nurses to work as health care assistants, and now (possibly) the return of some form of Named Nursing. All of them come recommended (or not) by varying amounts of research evidence. All of them (with the exception of Intentional Rounding, which appears to have found acceptance amongst the management classes at least) have been greeted with howls of derision by the profession. So the obvious question to put to nursing is this: if you don’t like other peoples’ suggestions, what do you think is the best way to restore public confidence? Any ideas anyone?
Actually, it’s looking like ‘no’ is the answer to that question. The RCN promised that its detailed response to the Francis Report would be published in June. It’s now July. Heard anything from them yet? Me neither. Something similar was scheduled by Unison for ‘before the summer’. As I write, Glastonbury’s over, Wimbledon’s in full swing and the heatwave is set to continue. How much more like summer do they want it to get? In reality though, it’s not a joking matter. Because like it or not, there is plenty of research and anecdotal evidence to suggest that, for whatever reason, many nurses really are failing to connect with patients.
The most striking example of this can be found in the results of the 2012 National Inpatient Survey which reported that ‘the proportion of respondents saying they “definitely” found someone on the hospital staff to talk to about their worries and fears, if they wanted to, decreased from 40% in 2011 to 38% in 2012. Almost a quarter (23%) said they were not able to find anyone (up from 22% in 2011)’. Let’s be clear about that shall we? Nearly a quarter of hospital patients who wanted to discuss their anxieties had their needs overlooked by every single person who came into contact with them. Fair enough, nurses are not the only ones to blame; but they probably are the ones who had the most chances to do something about it. Chances that were not taken.
By making explicit the lines of responsibility, Named Nursing offers an opportunity to address this situation. OK. Re-introduction won’t be easy – but simply waving it away with ‘didn’t work last time, won’t work this time’ isn’t good enough. A more constructive attitude might be: ‘didn’t work last time – so what can we learn?’ At a time when the rest of the NHS is edging (painfully slowly) towards an integrated, case-management based model of care, isn’t it a bit embarrassing that hospital nursing seems to be digging its heels in and refusing to move with the times? What are we so afraid of?
Because it strikes me that at the bottom of this is fear: fear that names on boards mean necks on blocks; fear that over-identification with patients risks unpopularity with peers; fear that if we give too much of ourselves, our patients will somehow take advantage and play us for idiots. And what drives fear? That’s right: insecurity.
Occupational insecurity has always been endemic in nursing (for more on this, see another March 2013 post ‘Does the Francis Report Offer a New Paradigm for Nursing?’); distant, unapproachable managers, a newly-hostile media and the encouragement of unreasonable expectations amongst service users have only exacerbated the problem. In these circumstances, defensiveness is  natural – but it’s also unhelpful and serves only to create further entrenchment.
In order to do their job with confidence, nurses need to know what their role is, and to feel secure in it. A more supportive management culture has a big part to play, but what is needed most is a re-conceptualization of nursing around a solid evidence-base of what is important to patients. So returning to Eileen Shepherd’s blogpost – we know about the problems nurses face from day to day. But isn’t it supposed to be about the problems faced by patients?
And it seems clear that lack of continuity is one of those problems – as a King’s Fund study from 2012 found when the authors interviewed a patient’s grand-daughter. She said: ‘During both periods [of hospitalisation] we found the nursing care to be erratic, and communication between nurses and doctors to be poor. My grandmother had a different nurse each day, even though nurses she had become a little more familiar with were still working on the same ward’.
This is not a complaint about insufficient staff. This is a complaint about care organisation. Yes, we are jaded; yes, we are bruised – but if we really want to improve patient experience, we can find a way. And one plan to stop nursing being hijacked by politicians who know naff-all about it is to come up with the goods ourselves.

Cornwell, J et al (2012). Continuity of Care for Older Hospital Patients: A Call for Action. London. The Kings Fund. Available to download at:
http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/continuity-of-care-for-older-hospital-patients-mar-2012.pdf

For the National Inpatient Survey 2012, see http://www.nhssurveys.org/Filestore//Inpatient_2012/IP12_National_Summary_Final.pdf

For Dave Dawes’ blogpost for Nurse First (which seems to have fallen prey to a certain amount of confusion about what Mr Hunt actually said), see http://nursefirst.wordpress.com/2013/07/04/why-the-reintroduction-of-the-named-nurse-could-be-a-terrible-idea/

For Eileen Shepherd’s blogpost for the Nursing Times, see http://www.nursingtimes.net/opinion/practice-team-blog/please-mr-hunt-invest-in-nurses-first/5060236.blog and also http://www.nursingtimes.net/nursing-practice/clinical-zones/management/put-names-of-nurse-above-every-bed-says-health-secretary/5060170.article. The second article has a lot more comments.

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6 Comments
  1. Dave Dawes permalink

    Thanks for the link to the blog post. Which areas do you feel are confused about what Mr Hunt said?

    • Thanks for responding. To answer your question, your post says that ‘Mr Hunt is launching the idea of a “named nurse” for every patient’ and then goes on to contrast this with your own concept of the ‘responsible nurse’. But if you look at this post from Conservative Home on http://conservativehome.blogs.com/platform/2013/06/from.html, you’ll find that ‘responsible nurse’ was the phrase Mr Hunt used himself. Please feel free to continue the debate!

      • Thanks for that. I don’t think that is confusion about what he said but just a way of describing it. For example the government never used the words “Bedroom Tax” but that is how everyone describes thier policy 🙂

        The policy is to have a named individual nurse who is identified to patients and families and that is a “named nurse” whether you call it one or not. My issue is that we have had precisely this initiative (even if it is given a new name) before and the reasons why it didn’t work haven’t changed.

  2. Agree that there are lots of potential problems and implementation would be difficult for all the reasons you describe in your article. But clear terminology is important here because we have to be sure that we are all talking about the same thing – some people might envisage a situation where the name on the board changes from shift to shift; others see the named nurse as a single individual who remains the same throughout the admission. Still others think the Ward Manager should be the named nurse for every patient on his/her ward. Fundamentally, I believe we need to think about changing the way care is delivered in the hospital setting, and my own experiences of Named Nursing lead me to believe that, despite all the problems, it does have something to offer.

    • Dave Dawes permalink

      Thanks GA and I do agree that in the right setting with the right clinical culture, I think the Named Nurse idea can really contribute something wonderful to the relationship between patients and nurses. To be honest, I would be surprised if areas that had a really good positive culture and who valued their staff weren’t doing this already. My concern is when ideas that work well in fairly specific cultures and settings are applied in a blanket form across all settings and cultures and I have seen this far too often in top-down government initiatives. Anyway, this is a really interesting debate and if you want to bring some of it to our comment area as well, we would be delighted 🙂

      • Thanks Dave. Agree that we should be wary of top-down, one-size-fits-all initiatives dreamed up by people who know nothing of conditions on the ground. Intentional Rounding falls into this category, and I am definitely not a fan! But still feel that there is no systematic philosphy of care-delivery built around evidence of what is important to patients – although what is important may vary from setting to setting. This is what we need to look at and Named Nursing could provide a starting point. Again, thank you so much for joining the debate.

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