Week 7: Does Nursing Have A Self-Image Problem?

Roy Lilley's daily blog on Tuesday 25 March was about the problem he has with compassion, which he sees as too superficial and lacking substance. He questioned whether 'love' would be a suitable substitute asking: "Can we do love in the NHS?".  Whilst I don't entirely agree with Roy and I do truly believe that compassion can be taught, developed and nurtured in many; this got me thinking about whether there's an issue with how the public perceive nurses.  Much media coverage of nurses continues to be either negative news stories about the tiny minority involved in scandals or frivolous representations.  This is a significant driver of public opinion.  Along with many others, the Royal College of Nursing is trying to provide positive images of nursing to the public and the profession through the This Is Nursing campaign.

Beyond the media and the public is nurses' own image of themselves and the profession.  I make no apologies that I will include generalisations in this blog.  I am well aware that nursing is a complex profession made up of many diverse fields and a multitude of specific roles; however, in this short post I will generalise for illustrative purposes.

After reading Roy's blog and then seeing a meme on Facebook; on Wednesday evening I tweeted, intending to provoke discussion about the values and qualities important to nursing.

Sometimes I am deliberately provocative in what I tweet to see the response that arises and to stimulate debate.  I don't always necessarily personally subscribe to every view I tweet, but am always interested in others' thoughts, feelings and opinions.  It was Trish Greenhalgh, shortly after I joined Twitter, who said that it is important to follow people whose views you don’t agree with to avoid groupthink.  It is the diversity of Twitter that makes it so interesting.

At the time of writing this blog, the tweet in the image above has over 160 retweets, almost 100 ‘favourites’ and also sparked an interesting debate about whether this sentiment devalued the skills & intelligence of nurses.  During this debate, I tweeted "IF you had to choose between 2 essential nursing attributes: RT for Care/Compassion or Favourite for Intellect/Skills (hypothetical Q only)".  This furthered the discussion with the majority of responses being along the lines of 'can't choose/won't choose'; however, of those who did make a choice one way or the other there was a small majority in favour of compassion over skill.

What was particularly interesting to me about the high number of retweets, the choices made in replies and the discussion that took place was that this mainly involved nurses along with invaluable participation from others.  This then got me thinking further about whether nursing as a profession has a self-image problem.  Whilst I don't want to second-guess the motivation of most people who retweeted or commented, but for the purpose of drawing a conclusion, I will assume that many did so in agreement with the sentiment expressed (some retweets did include comments like "so true!" so I feel I'm on fairly safe ground with my assumption).

A few, but far from the majority, of people who engaged with and me about this expressed a view that this overall response and many other frequently tweeted and retweeted sentiments are causing a problem.  The theory put forward was that by perpetuating a self-image of nurses as super-hero angels who hold people's hands and talk soothingly to them leads to a suggestion that the profession is less skilled and competent than it is.

We now have degree-only entry into registered nursing with many universities and employers using values-based tools to recruit new nurses to ensure we get nurses who have compassion and competence.  At risk of becoming a mouthpiece for the 6Cs it is essential that all six of the Cs are present and valued by nurses and nursing as a profession (two of the Cs being Compassion and Competence).

I'm not sure if nursing does have a self-image problem; I'm not personally connected to enough of the profession to form a view (and I'm probably not qualified to assess it either – greater research minds than mine may be needed here).

So nurses, academics, people of England and the world, carry on the conversation; does nursing have a self-image problem? If it does, does it matter? If it does and it matters, what’s to be done?  Discuss…

Week 6: Nurse Leadership in Commissioning

At 8.00pm on Tuesday 25 March @WeCommissioners, along with @WeNurses and @6CsLive are hosting a Twitter chat on the opportunities and challenges for nurse leaders in commissioning. The chat will explore this in more depth, but as some pre-reading, this blog will explore the different roles of nurse leaders in commissioning.


Nurse leaders come in all shapes and sizes and this is no different for nurses working in commissioning. Those nurses working in commissioning roles come from a diverse range of backgrounds and do a wide variety of roles. This includes engaging with patients, public, professionals and colleagues to design new services, improving existing ones, to monitor the quality and to ensure good governance of services.


Whatever the background and role of nurse leaders working in commissioning there is one thing that they all have in common; a drive to improve things for people. At the start of most commissioning nurse leaders’ careers they were student nurses and I doubt many, if any, at that stage intended on working in commissioning roles. There are many and varied routes into working in commissioning for nurses and they have had key leadership roles right from the start of the NHS and specifically in commissioning following its introduction in 1991. Since then organisations responsible for commissioning have involved nurses in key leadership roles. Today there are a huge range of roles for nurse leaders in health and wellbeing services commissioning, mainly in Clinical Commissioning Groups, NHS England and Local Authorities. These include, but aren’t exclusive to: Nurse Board Member, Director of Nursing/Quality; Quality Lead; Patient Experience Lead; Patient Safety Lead; Infection Control; Safeguarding Lead (Adults & Children); and many other roles not exclusive to nurses, but requiring clinical experience & knowledge.


The underpinning leadership skills required by nurses working in commissioning are not that different to those working in leadership outside of nursing and nurses working in other parts of the health service. Forbes describes the 10 key attributes of great leaders and these apply equally well to nurses working in commissioning as to other professionals and disciplines:


Honesty
Effective Delegation
Communication
Sense of Humour
Confidence
Commitment
Positive Attitude
Creativity
Intuition
Ability to Inspire

Do these ten qualities sound familiar? They is significant overlap with the 6Cs (Care, Compassion, Communication, Competence, Commitment and Courage), which apply equally well to nurse leaders in commissioning as in any other field of nursing. Finally, being a nurse leader in commissioning doesn’t equate to seniority. The attributes described in Forbes in the list above and through the 6Cs are applicable to nurses working at every level in commissioning. It is important that we recognise the value of this, provide more opportunities for nurses to experience commissioning roles from pre-registration training through professional practice and at any stage in a nurse’s career.


Nurse leaders working in commissioning roles have great opportunities to change things for the better for patients, public and colleagues within the NHS. There are also significant challenges in these roles and they involve some very difficult decisions, daily. Through the chat we will explore what some of these opportunities and challenges are and how they can best be approached.

Further reading & resources:
Commissioning Nurse Leaders Network
Webinars on commissioning topics for nurses
NHS Careers; Careers in management, including nurse leadership roles in commissioning
Healthcare Professionals Commissioning Network
For more detailed background history of the NHS, including commissioning

Week 5: ‘People’ Experience

No free gift this week I’m afraid, but there is a challenge for you, at the end of my blog this week.

The results of the 2013 NHS Staff Survey have been published.  The response from NHS Employers celebrates improvements, but openly acknowledges areas the NHS still needs to improve on.

Staff experience is a really important area and we have been looking at the results of the survey relating to our CCG staff and those of our local providers.  We’re seeing how we can use this information in our organisational development plans to improve the experience of people working for us.

Both where I work and in the wider NHS, there is still a lot to do to improve the experience of staff.  This includes looking at how we can be more open and transparent, as discussed in my postlast week.  In recent times there has, quite rightly, been significant focus on improving care, outcomes and experience for patients.  There has also been much activity aimed at improving staff experience, but not as much as that aimed at patients.  For those more directly involved in the NHS, you will recognise that much of this has come ‘post-Francis’.  I don’t mean to belittle the significant work done before this to improve staff and patient experience, but this has driven the focus in the past year.

I believe that we should look more holistically at ‘people experience’ and not always separate out patients and staff when we address at how our organisations ‘behave’.   An organisation’s culture is made up of the collective behaviours of staff within it towards each other and to patients, carers, the public and others who we work with day-to-day.  If we take a more rounded view of our values and behaviours; what drives us and influences our organisational cultures we will see that these probably don’t differ too greatly in terms of staff or patients.  If we want to show compassion and achieve positive outcomes for patients (and we do!); then we should do the same for staff. 

If we set up project groups, working parties or task and finish groups just in response to survey results trying to ‘fix’ problem areas we will not make the changes we need to really make a difference.  We need to look at the staff survey results alongside other sources of information about how others experience the behaviours and cultures of our organisations.  If patient surveys say that there are issues with how we communicate with patients and staff surveys say the same; there is something quite fundamental that we need to address about communication within the organisation.  ‘People Experience’ is not a new concept outside of the NHS so we can learn from those who do it well.  For example, FirstDirect have been doing this for years, i.e. driving improved experience for their customers directly through how they treat and engage their staff.

There is an opportunity for NHS organisations to do the same; really invest in staff, focus on their experience; senior leaders treat staff how we expect them to behave with our patients.  I know there’s a lot of rhetoric about leadership and culture, but I truly believe that if members of NHS Boards do this right it will have an amazing impact.

So, I challenge you to find out whether your local NHS organisation (or your employer if you work in the NHS) has set up a ‘Staff Survey Working Group’ or similar, exclusively looking at the results and with the intention to draw up an action plan of how to address these issues in isolation.  If you find this to be the case, ask whoever is the most senior leader responsible for this area how this will be integrated into work that you will inevitably also be doing on patient experience.  Do suggest that there may be value to both areas and therefore to staff & patients to look at these together.