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We do, indeed, need to talk about nursing

With bad nursing stories becoming too regular a feature in the UK media, Philip Darbyshire writes that Australia should take note.

Criticising nurses was once like kicking Bambi. Bolstered by consistent reports that we are among the top 'trusted professionals', nurses enjoyed protected species status and indeed have complained vociferously about the 'Angel of Mercy' stereotype holding nursing back from its rightful place with other health professions.  Be careful what you wish for indeed.

In a recent editorial understatement, the BMJ raised the issue of the number of reports in the UK that had highlighted poor or non-existent nursing care. The editorial was aptly titled: "We need to talk about Nursing". We do indeed, but we need to do more than talk.

When, in the UK in 2009, Claire Rayner and The Patients Association lambasted "dreadful, neglectful, demeaning, painful and sometimes downright cruel treatment at the hands of NHS nurses", a seismic change occurred. If such criticism of nurses was unheard of, so were public and media responses. Some defended nursing by pointing out the obvious - that such abuse by nurses is absolutely not the norm, but for many others, Pandora's Box was open and they could now tell how their loved ones had been victims of similar hospital nursing horrors.

The most troubling feature of these reports is that what seems to be suffering was once called 'basic care'. This includes having a call bell attended to before the next ice-age, having someone communicate with you so that you understand what is happening, being helped to the toilet rather having your bed become one, receiving relief from pain without needing to cry out in it and even having adequate food and water that doesn't need a doctor's prescription.

Basic possibly, low level and minimal priority, absolutely not. If these are not essential parts of a nurse's 'core business', in the argot of our times, then I have no idea what is and if nurses are unable to meet these immediate and elemental human needs then we need to know why. Among

The 'Usual Suspects' are a political obsessive compulsive disorder characterised by an insatiable need to reorganize the health service, the powerlessness that many nurses experience (the 'I'm just a nurse' syndrome) and a workplace culture accepting of standards of care that nurses would never tolerate for themselves or their loved ones.

Considering the millions spent on 'Lean', 'Six Sigma' and other Toyotaphile cults, surely some black belted manager-ninjas could have emulated Toyota's 'red cord' or 'Jidoka' principle. Any worker on their assembly line can pull the 'red cord' and stop production immediately they see a quality problem. Translating that principle to nursing could engender real 'empowerment'. Instead of compromising care and standards by doing less with less and 'making do' while 'assuring' the mirage of quality, clinical nurses would insist on and be held accountable for taking action to prevent less than excellent care or possible patient dignity and safety lapses before they occur. All other staff from clinicians to executive would support such foresight and contribute to the immediate resolution of the issue for the patient's benefit.

Good nursing is crucial because its absence means a patient experience that verges on inhumane. When nurses get it right, we do no less than touch and transform people's lives at what is often their lowest ebb. Conversely, uncaring, negligent and 'couldn't care less' nurses blight the lives, health and dignity of those who depend on them. Sadly, our health system defaults to mediocracy and bureaucracy over meritocracy. Nurses who cannot or will not provide good care and who should therefore have no place in a humane health system, instead have a job for life.

A 15 year old working in a fast food chain who ignored customers, was rude or dismissive and had nothing but contempt for the company would be employed for around a nanosecond. That is how seriously a company takes selling hamburgers, yet in healthcare where we deal with the most profound crises in people's lives, we tolerate uncaring staff behaviour (not only from nurses) year in and year out.

I regularly ask groups of senior nurses how easy or difficult it is to remove from practice that minority of colleagues who are incompetent, uncaring, unkind, unhelpful and unengaged. They literally shake their heads and laugh at the impossibility. Few are ever willing to sacrifice two or three years of their time and energies on the soul destroying 'performance review - clinical challenge - HR review - sick leave - harassment claims - stress-leave - discrimination lawsuit - industrial tribunal' morale-sapping merry-go-round that results in nothing more than the problem person being 'redeployed' somewhere else.

The biggest red herring outside of Sydney Fish Market is that this decline in nursing is due to university education for nurses. Yes, these uppity nurses have delusions of adequacy and have gone and filled their pretty lil heads with all kinds of high falutin book larnin. If only Hattie Jaques was Matron and nurse training was rightfully back in the hospitals, then pundits such as Minette Marrin of The Times could abandon their cottage industry campaign. We can only hope that the hospitals and nurses responsible for taking us back to such educational good old days would not be the same as those that feature so prominently in the exposés of sub-standard and degrading nursing and lack of care.

We cannot afford to adopt nursing 'NIMBYism' and imagine that these UK developments have nothing to do with us or 'couldn't happen here'. I will never forget speaking to a group of directors of nursing about the implications of such reports for nursing and feeling the very room temperature drop. I was told bluntly that these were not issues in Australia and that I was being "negative about nursing". So there we have it. How we are to respond to criticisms of nursing and reports of poor nursing is to have more cheerleaders with bigger pom-poms. I think not.

Nurses at all levels need to 'talk about nursing' as a personal and professional imperative. We need to understand and articulate our practices and their rationales. We need to shout from the rooftops the standards and care that we will not compromise and we need to discuss and learn as much as we possibly can from the nursing failures identified in other settings and systems.

Nurses should be the canaries in the health coalmine and the frogs in the hospital ecosystem.  Yet where was the singing and croaking when most needed? In these 'bad nursing' reports, the silence of senior nursing leadership has been deafening. That it has taken patients and relatives, consumer organisations, the media and external auditors to 'uncover' such wretched 'nursing care' is a professional embarrassment for nursing, especially as we once claimed 'patient advocacy' as one of our key responsibilities.

It is one of the ultimate ironies that nurses with high standards and a clear professional conscience who dare to speak out about such poor care at their hospitals may discover, to their own cost, that there are after all, swift mechanisms available for removing people from their jobs in healthcare.

Philip Darbyshire is director of Philip Darbyshire Consulting and Adjunct Professor, University of Western Sydney.

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