Nursing Times Award Winner

If we applied some hospital health and safety rules to our daily lives, we'd need counselling

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, infection control nurses etc seem to have seized this instruction and applied it to the letter, especially when it comes to considering or, as it turns out in so many instances, not considering, new initiatives that could hugely benefit patient care.

Over the past few weeks, dozens of heavily supervised student beauticians in one hosptial have been stopped from delivering gentle hand massages and manicures to patients and their relatives. Why, because a news safeguarding officer , who had never met any of them, was worried about them using scissors. They don't. Fully supervised by their highly trained tutors, they use emery boards.

In another hospital, one of our wonderful choirs was stopped from singing because, apparently, someone needed to check if the PFI building was insured for singing

And then there was a hospital where all potential volunteers were told they could not come in the hospital 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 visit a friend in hospital doesn't have to confirm to any of these rules. They could turn up with chickenpox, in a filthy coat having just walked through manure and, the 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 it before.

When children start school, they make friends and then, in time, they may be invited to tea etc in that child's home. As parents, when our children are very young, we generally try to get some information about the family before they go, but we are not obsessive about it. We don't demand to see CRB checks, we don't check the bannisters on their stairs are secure, we don't insist on seeing the car's MOT test. We use our common sense, and if, all seems fine, we allow them to go. Sadly, very rarely, something goes wrong but, in the vast majority of cases, the children visit and have a lovely time. It is called a managed risk.

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 help because the quality of their lives is being adversely affected by these issues.

Of course hospitals are not quite the same. I do see why someone who may be on their own with a patient needs to DBS check. But, time and again, hospitals apply rules that are not 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. And, as mentioned above, many people don't automatically get offered those vaccinations.

Worrying that a public space in a building might not be insured for singers is ridiculous, especially as the space was a public restaurant where no one could have stopped a group of diners breaking into spontaneous song.

Somewhere along the line, something has gone 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 infecton control nurse. The students were neat and tidy, hair tied back, wearing crisp uniforms with short sleeves and no jewellery. Anxious to make her message clear, the nurse told them that under no circumstances were they to wear 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 handwashing 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, demeened 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, it isn't entirely her fault? That nurse was applying the rules to the letter. 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 contstantly being put under unrealistic pressure to provide the safest possible environment for patients. All very laudable? I don't think so. Not it 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.

Jill

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