Many of you will have seen reports on the national news or in your local newspapers about ‘the state of the NHS’, reflections on the changing role of nurses, the pressures of an ageing society and the implications of the many restructures and financial constraints. But on a daily basis, the NHS’ heart beats to the drum of its millions of caring, motivated, inspirational clinicians. I always have been and remain so proud of being a nurse, of being in a position to positively influence someone’s care, their experience of the NHS and their overall outcomes. I believe that in general ‘tissue viability clinicians’ are a passionate bunch, they put patients front and centre and are constantly striving to improve care for their patients but also the working lives of their colleagues, motivating them, delivering brilliant education, praising and giving feed back. Just look across some of the big national awards like the HSJ or NT awards — Tissue Viability is always up there leading the way and shining the light. So maybe I have a flawed view of what it’s really like out there — and yes, I admit it has been almost 4 years now since I have been in clinical practice — but has it changed so much?
I have this last month, unfortunately, had to witness a close relative’s experience of hospital care — it left me angry, shocked, demoralised, despairing of my professional colleagues. Yes as a nurse/visitor it’s difficult to be ‘just family’ my eyes and ears have a life of their own, twitching at every mattress alarm, spotting every NPWT pump as you walk through the ward, but in the end, I am just a family member in this instance.
The ward staff were ‘pleasant’ and surprisingly plentiful, it was the Saturday of the Bank Holiday, my relative had the day before reached the painful decision that an amputation was the only option — so it was a bit bleak. The nursing staff were kind, chatty but so disempowered, I didn’t know what to do. They were so not invested in improving the care, I asked for things (not complicated things) “oh couldn’t do that, it was up to the doctor”. “Could we change this?” “ohhh couldn’t do that it was a bank holiday weekend so probably wouldn’t happen until Tuesday — oh and it would be chaotic on Tuesday … ” they just wouldn’t take responsibility or accountability for any aspect of care (not all Tissue Viability-related).
It was tricky because my relative didn’t want to make a fuss and was becoming distressed at the apparent lack of response, so I had to back down from the questions but I just couldn’t understand the total apathy I witnessed, I asked A LOT of questions — and they didn’t even ask if I was a nurse!
We can talk about education and processes, risk assessments, checklists and tick boxes (and I firmly believe there was great things in place in this organisation) but if the nursing staff are so disenfranchised, if they don’t feel the power they hold as nurses or realise the impact of good nursing care, those things become worthless.
I am in awe of the specialist teams who are out there on a daily basis, battling this inertia, this ‘not my problem’ mentality, the lack of pride and professionalism in nurses and nursing. It makes me so proud of what I see Tissue Viability colleagues achieving, winning awards for making changes in practice for improving care for patients, for making the daily grind better / easier for colleagues – but who is supporting you? Who is saying: “This is really unreasonable?” This isn’t about your skills as a specialist team, this runs deeper — this is organisational culture. We have seen it in so many of the public enquiries about when we failed patients, poor culture, poor leadership, failure to recognise or manage risk. How do we move this forward so clinical staff can continue to shine, to innovate and improve, confident that the fundamental things are in place, embedded and absolutely business as usual?
I don’t want my family member to experience what he has, and I firmly believe you are judged by the standard of care you walk by and ignore, so I wont be walking by, I will be raising the many, many issues I observed — but that in itself has been a really hard decision. I feel guilty that I couldn’t make it better, that I wasn’t able to motivate the ward staff to do some really simple things. I feel guilty that I raised his anxiety levels at probably one of the most difficult points in his life. I feel guilty that I can’t be there more often – it’s 3 hours each way, so we are heavily reliant on WhatsApp! But I wont walk on by.
If you are experiencing significant challenges in your workplace please don’t feel alone, reach out, take offers of support, talk to your amazing TV colleagues and please don’t make yourselves ill.
