A partnership of Equals?

Looking back, I have been tempted to write about the current situation in nursing, specifically the rise in registration fees for nurses. Having attended the meeting at the NMC offices and thought at length about the situation and voiced my own opinion in the nursing standard, I have decided that its is an issue that goes far beyond my own reflections. I will leave every nurse to voice their own opinion...enough said. Instead I opted for another issue close to me, inter-professional equality.

Outside of attending NMC meetings, writing this blog and having my fingers in other proverbial pies, I still have time to work full time as registered nurse in an acute hospital. My day to day practice  consists of two parts, I have a permanent role as a scrub practitioner at the trust, but I also enjoy maintaining my skills in ward and specialist based practice through a staff bank (given most nurses current situation, I dare say not many don't!). Nonetheless, it is important to me to widen my professional horizons as well as pick up a few extra pounds.

This particular issue arose out of my practice in the operating theatre. The trust I work for have recently reviewed the swab, sharps and instruments policy. Any nurse practicing in the peri-operative environment will be fully aware of such a policy and every hospital trust that carries out invasive surgical and/or diagnostic procedures will have such a policy in place. For those of you who don't work in such an area, it is essentially the policy that stipulates responsibility for swab, sharps and instruments checks and counts during a procedure and responsibilities (among other more specific duties) of each profession in order to facilitate safe surgery.

Due to some issues with clarity in areas of responsibility the trust took the liberty of reviewing the policy and thankfully decided to be highly specific about who takes responsibility for what and when. This is where the issue of multidisciplinary equality began. As part of our checks that are undertaken as a "team", we religiously perform the stages in a WHO surgical safety checklist...without fail I might add. All of the above is necessary to ensure we get everything right the first time, when getting it right is of high importance.

As a team we share the responsibility of performing the necessary checks and supporting each other to fulfil our duties. One benefit of working in such an environment is based upon trust and spending a large quantity of time in one room together. However, the revised version of said policy states that it is the responsibility of a surgeon and anaesthetist to ensure that the WHO surgical safety checklist is completed and documented appropriately. One anaesthetist pointed out two interesting points, one; ensuring this new responsibility is communicated to them and secondly and just as importantly, that does this newly delegated responsibility undermine the "team" approach in carrying out this work and reinforce the concept of a hierarchy in the health care professions?

I remember in my first year of nursing school, undertaking a module in multi-professional team working, whereby students of each discipline worked together to solve a problem in patient care and role play solving this problem as a team. The aim of the module is partly to ensure each profession contributes equally and is left feeling empowered in patient care. I was in some respects, in for a rude awakening when I qualified however. In many situations on the ward, nurses can be made to feel insignificant, that doctors/surgeons make the final decision and there is no room for debate. Sadly on more than one occasion I have felt belittled by the fact my reasons for doing something were not considered as important. I have worked bank shifts on wards where the communication between the professions is poor and in some cases some professions do not believe it necessary to communicate with other professions despite it causing friction. Not to mention the lack of understanding of role or knowledge base. I believe this has a huge impact on respect for each other. This is not when multi-professional comes into its own, and why operating theatre work does encompasses everything that multi-professional work is supposed to.

Lets face it, we don't work as hard as we do for our health? I'm sure we would all love an environment where we all communicate properly and that patients are then right back where they should be. In the centre of the care! I would encourage anyone to challenge the hierarchy in multi-disciplinary working otherwise we will always be left with professions feeling demoralised, undervalued and disrespected much to the contrary of what we should be working towards. I can certainly tell you that I resent having  other professions talk to me or treat me without respect as a person let alone as a nurse.

I hope to be senior nurse one day and multi-professional team working is a passion that I will promote enthusiastically, I cannot tolerate the hierarchy when it goes against everything I have learnt from tutors, professional colleagues and other nurses. I have a great deal more respect for professions that don't work on a culture of fear but instead makes other people feel respected and valued and that their contributions are equally important. one fantastic example of this is the comments from Dan Poulter in this week's Nursing Standard. I commend his thought into the role of nurses, not necessarily his full opinion. There is a doctor who understands professional empowerment.

If nothing else, it is nice to see changes. Comparing stories that colleagues describe, we have made changes in the right direction in equal working. There is still work to be done but, it is a step in the right direction. It is just disheartening when you read new policies that don't reflect the hard work of all professions. Perhaps, it is the hospital trusts that need a lesson in multi-professional team working and not the health care professionals?  

The Good Nurse

Dedicated to all the new nurses, starting out with a whole career ahead of them. The fresh new faces that remind us why we do what we do every day. My best wishes to each and every one of you! My thoughts are with one in particular, for whom I am sure the future holds bright things! 

We all have a reason for becoming a nurse, everyone has a different reason. I am asking myself what this is at intervals in my work...usually when the day isn't going my way. But self doubt has been a part of my routine since qualifying as a nurse 3 years ago.

I am thinking about this more at the moment as it is the time of year the all newly qualified nurse have waited for; the day they take the title staff nurse and begin work as a fully qualified practitioner. It always reminds me of the day I began my first day of work in late september 2009 on an elective orthopaedic ward in a new hospital and new town. I also think about the new students at university embarking on the first few days of their nursing course, ready to take on the challenge that studying nursing is. I hope the course lives up to everything they hope it to be. I wish everyone the best of luck with their studies!

When I think about new nurses and how new people come into the profession, I think about how the profession has evolved, the values it hold and have our attitudes evolved too? I truly believe that every nurse in the profession has something special and unique that only they can offer, their hallmark. During my time working on a surgical ward at my current hospital, I co-mentored a third year nursing student, who I believe showed endless promise as a great nurse. I feel one of the most valuable things I tried to teach her, was that nursing is like a baking a cake, you need to follow a correct recipe for the best outcome, but best thing about it is, you can decorate it your own way. Making the most of that special gift that only you can give to those in your care and those colleagues around you. Its what I feel makes us as diverse as we are.

I suspect there are a few nurses who have cared for nurses of older generations or perhaps (such as myself) are related to nurse of an older generation. I am all too familiar with the statements "Too posh to wash" or "nurses don't care like they used to" or of course find the fact that nurses must now attend university distasteful and hold that as the justification for the above quotes. I however, would beg to differ. I guarantee that myself and many of my colleagues despite being university educated nurses still hold care and compassion as the highest priority of our work. I cant speak for everyone, but I would much rather be performing the tasks we might describe as "nursey nursey" but nursing today is such that I am not afforded with the opportunity every time...much to my disappointment. Does this make me a bad nurse?

I personally find it difficult to believe that nurses are driven by financial motive, I also find it far more palatable to believe that nurses really do care and would love to return to more traditional nursing. but sadly time has moved us on and we can at best hope to achieve the highest quality we can with resources we have. Of all the nurses I have worked with, I am confident that an individuals own underlying reasons for becoming nurses (and indeed keeping them in the profession) is the desire to care for people. I can tell you hand on heart that it certainly is the reason I became a nurse.

Does the individual personality make a good nurse? Obviously the desire to care for a person and the good level of education is need to undertake the course, but what about a personality? How does this fit with the profession? we pride ourselves on being a diverse profession, but are personal interests taken into account when choosing the right applicant for nursing. I might be thought of as cynical if I said that   nurses were chosen on the basis of having the right attitude to be moulded into what the profession would like...someone reflective and calm and kind and certainly an individual with a heart. In my opinion, much the same as profession has always desired. Perhaps I am wrong, perhaps all the profession would like is someone who is self-aware enough to make the right choice in the right scenario, to an extent a robot?

Sadly, there will always be those who do let us down in the profession...I will leave those matters to the NMC, and I'm sure said matters are dealt with appropriately. To a lesser extend, I'm sure every nurse understands, the day that leaves you feeling like an awful human being and nothing seems to have gone the way you would have liked, or just feeling generally deflated no matter how good your intentions are. But I ask, does this make you a good or a bad nurse? Are you only having these feelings because everyone has a bad day, or are we just reflecting on our practice?

I frequently come across the CARE campaign in the Nursing standard journal (and my words are by no means aimed at belittling the work of the good people at nursing standard) but I feel worried why we need to promote a campaign of CARE. Promoting communication, and caring for peoples basic needs such as nutrition, using the toilet if need be and of course feeling warm and cared about with their feelings and wants taken into account...for as long as I can remember, I believe, if you aim to get the basics right, you achieve a good relationship with your patients. I would be surprised if nurses did not relate to this. All I ask nursing standard and the wider profession...aren't these the basics?

The Florence Nightingale School of Nursing in London, some time ago launched the Culture and care programme promoting nurses to reflect and celebrate diversity through study and development of individual interests and talents. the theory is that it encourages students and staff to explore culture and artistic values to improve non scientific skills in the profession there by improving patients experiences, they boast a collaborative module entitled "nursing and the arts"meant to enhance these skills through exploration of arts in relation to nursing. It certainly appears that the profession is expanding its imagination when it comes to the development of good quality nursing. It would seem it encourages a nurses interest in the arts as a way of developing practice. Call me naive, but maybe it is worth applying this idea to the wider profession? Making this compulsory in nurse education?

Before I reach I point of infinite confusion and being a major source of chronic boredom. I would ask anyone interested, that if they do lose faith in nursing to try and talk to their nurse, get to know them and if you have a good relationship with nurses so far, then I hope you empathise with this piece of writing  and really do appreciate the kind of nurse I believe them all to be...I have a lot of faith in them. I also believe that despite negative attention. People really do believe that the work that nurses do is truly invaluable and genuinely think that a nurse can be nothing other than a good nurse.