Nursing Times Award Winner

The rollercoaster

I love my job. But it is incredibly hard work. We often feel we are pioneers. Almost every day we feel we tread new ground. We dare to challenge rules that many have simply shrugged their shoulders at and accepted. It’s not that we want to break rules, but rather check out when a rule is a rule rather than a bit of folklore. Sometimes the Chinese whispers have travelled so far and so fast that everyone’s forgotten why the rule was there in the first place.

So, it seems that, all too often, we make what we consider to be a major breakthrough in developing the patient experience, only to discover that a short while later, someone senior has discovered a reason why something can’t happen. On one occasion, when I seriously challenged why an initiative that had been running successfully for many months was abruptly stopped, I was told that I hadn’t been stopped, I’d been ‘paused’ while a member of staff, who hadn’t come across us before, decided if it was appropriate to work with us. I felt like I was being managed by someone with a remote control.

Flowers are a good example of an issue where there appears to be no consistency across hospitals. Some allow them and some hospitals don’t. Some allow flowers in certain containers. Some allow plants in soil. Some don’t. When challenged, many senior nurses don’t know why their hospital doesn’t allow them. Some say it is because they are an infection risk. Others say they ban them because they clutter bedside tables and often get knocked over when the curtains are pulled, often damaging electrical equipment in the process. Others say nurses don’t like changing the water after the flowers have died. Personally, I can see the logic of the last two reasons. I’m not sure anyone has ever convinced me that they cause disease. On the other hand, lots of people have convinced me that, managed sensitively, they can bring enormous pleasure, colour and fragrance to a ward.

Dust is another issue. Some wards ban Christmas decorations because of dust. So why can’ visitors bring in new ones, fresh from the packet. Surely, they don’t hang around long enough to gather much dust .

And then there’s Protected Mealtimes. One day I was told off for still being by my mother’s bedside after the dinner trolley had arrived on the ward.

“When are you leaving?” the healthcare assistant demanded. When I looked bemused, she told me that the trolley had been on the ward for several minutes and other patients were going to get cold food if I didn’t leave immediately. She was clearly under the impression that all visitors had to leave when the meals were served. As she was the ward’s designated Protected Mealtimes officer, I stool no chance. She made me leave. She was wrong.

Protected mealtimes were introduced to stop patients having medical procedures at times when they were trying to eat. They are not supposed to stop relatives from helping to feed their loved ones. Whenever I fed my mother, I knew exactly how she liked to eat. For example no gravy on her meat and always a teaspoon for her yoghourt.

Taking on the system, again and again, is enormously tiring. We have to be so careful. But we don’t give up. Countless patients, including our own loved ones, have suffered needlessly simply because ‘a rule’, wrongly applied, meant that something nice didn’t happen.

Many good bosses encourage good ideas from their staff and say that they will judge each idea on its own merits. They will look at the benefits and see if they outweigh any negative issues. In other words, they will allow something if , on balance, it is more beneficial to let something happen than to forbid it. They also know how much it encourages imaginative and driven staff if their ideas are adopted. It inspires them to think of more. It encourages them to stay with that organization, often gaining promotion in the process, because they see how they are valued.

Time and again, endless rules stifle creativity within the NHS, especially when dealing with the patient experience, because senior hospital staff ‘play safe’ far too often. ‘The answer’s “no”, ‘ is something I hear repeatedly, often before the question has been fully explained. And, even if a new idea is trialed, the moment the tiniest thing goes wrong, there seems to be an enquiry into how and why it happened, rather than praise for the major part of the initiative that went well.

We work with around a dozen NHS Trusts and we do see how many brilliant nurses are ‘going the extra mile’ to ensure that new ideas are adopted. But many feel they introduce ideas at their own risk. ‘I’ll be in so much trouble if anything goes wrong’ is a cry we hear repeatedly.

And we feel that too. But we fight on because, we also see how, in other hospitals, many good staff are leaving, often frustrated that, because of a ‘rule’ that may have been incorrectly applied, they have not been allowed to work in a way that they feel is best for patient care .

How sad is that?

Jill

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