Nursing Times Award Winner

Health & Safety and... Common Sense

There is a call to observe Florence Nightingale's quote that 'the very first requirement in a hospital is that it should do the sick no harm'.

Some safeguarding officers and infection control nurses seem to have seized this instruction and applied it to the letter. Understandably anxious about making any mistakes, and concerned that staff understand all the risks, their methods sometimes cause fear and panic among junior members of their teams. And that panic and fear can impede common sense. Of course they have to be careful, but our worry is that junior staff may interpret a rule in a way that means that a patient misses out on what can be a hugely beneficial experience.

Recently, one of our heavily supervised student beauty therapists' teams was stopped, with no notice, from delivering gentle hand massages and manicures to patients and their relatives. When I found out, I was furious and immediately investigated the reason. It turned out that the Trust's Safeguarding Officer, who had never met any of them, was worried about them using scissors. They don't. The students, all of whom had passed the relevant modules and were being fully supervised by their highly trained tutors, use emery boards. Their visits were started again but the confidence of the young students had been eroded by the experience and countless patients had missed out on some wonderful TLC while they had been kept away.

In another hospital, one of our wonderful choirs was stopped, at the very last minute, from visiting because, someone decided they needed to check if the PFI building's insurance covered a chior singing to patients. It did. But, by the time it had been sorted, it was too late.

And then there was a hospital where all potential volunteers were told they could not come in the building unless they could prove they had had all their childhood vaccinations, a BCG and a flu jab. As BCG jabs and flu vaccinations are not given routinely to everyone, this proved a serious problem. And that's just for starters...

Of course everyone needs to be sensible. No one wants anyone to come into close contact with a patient if they have an infectious illness or run the risk of passing an infection on to someone else. But there is no consistency. Anyone wanting to visita friend in hospital doesn't have to conform to any of these rules. They could turn up with chickenpox, in a filthy coat having just walked through manure and chances are no one would stop them. They are asked to wash their hands as they enter a ward, but few places check if they actually do that.

The growing number of rules and processes applied to potential volunteers have led to thousands of people giving up early on in the process. I have written about this on many occasions.

There are people who fear going out in case a car runs them over or they are forced to touch something that may not have been cleaned recently. Some people won't cross bridges or walk under a ladder. Taken to extremes, these people need professional help, guidance on how to manage risks in their lives. They need that help because the quality of their lives is being adversely affected by these issues. On that basis, how risky is a manicure, or a visiting choir singing familiar songs to help trigger memories for people with dementia? And is it right that safeguarding officers and infection control nurses should forbid certain patient experiences for everyone if the good they do outweighs any tiny risk?

Of course hospitals have to have rules. But, time and again, some staff apply them in a way that is not always in the best interests of the patients they are trying to help. Insisting that every member of a choir must have evidence of a BCG and flu jab before they come to sing to patients, means that the choir won't come, not so much because they are offended (though some are), but more because they simply have no idea where to find that information, assuming they ever had it in the first place.

Worrying that a public space in a building might not be insured for singers is ridiculous. Beautiful singing can be so good for health and wellbeing. So, on that basis, it is not a change of use, the issue that was worrying the member of staff who challenged me.

Somewhere along the line, something has gone very wrong. A growing list of requirements for all hospital volunteers, (CRB check, diversity training, ethnicity training, induction course, occupational health etc), often done on different days so requiring multiple visits to the hospital, results in a growing list of people who do not want to apply.

Recently, I was with a group of student beauty therapists who were given a talk by a hospital's infection control nurse. The students were neat and tidy, hair tied back, wearing crisp uniforms with short sleeves and no jewellery. The preparation we, and their tutors, give to them before they arrive is very clear about this. Anxious to make her message clear, the nurse told them that under no circumstances were they ever to consider wearing dangling ear-rings, necklaces, fancy rings or bracelets. One student put up her hand.

"But you're wearing a lanyard. Isn't that the same as wearing a necklace?"

The nurse hesitated and then replied: "That's different. I have to wear that."

Not it's not. Lanyards are handled all day long. They are swiped through machines where countless others have been. They are on a cord that is often difficult to clean. Dangling round someone's neck and constantly handled, they must be same, or even a greater, infection risk than jewellery.

The vast majority of safeguarding officers, infection control nurses, etc want to do the best possible job. There are huge infection issues in hospitals and their job is vital. Good hand-washing is essential. The rules are there for a reason but they must be applied with compassion and common sense. The nurse that spoke to us was simply following the rules she has been given and seemed terrified of leaving anything out. But, without realising it, she frightened, demeaned and demoralised the students. And that, in my opinion, is not just wrong, it's terrible. Some of those students, many who were young and so lacked confidence, were made to feel so anxious, I was worried that they would not want to return. And that would have meant that countless patients would have missed out on a free beauty therapy session while in hospital.

But, is it her fault? That nurse was applying the rules she had been given. It is her bosses, and those that set the rules in the first place, who should be meticulously checking that they are being interpreted in a way that is good for staff and good for patients.

Across the NHS, staff are constantly being put under unrealistic pressure to provide the safest possible environment for patients. All very laudable? I don't think so. Not if patients miss out on the kindness of countless members of their local community who genuinely want to offer their skills to make life better for them.

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Jill

Jill Fraser

Jill Fraser

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