Safe staffing hits the headlines. Or rather the decision to scrap NICE’s work on safe staffing hits the headlines. If you’re a nurse and you don’t know about this – where have you BEEN??!! Catch up on it here as Shaun Lintern, reporter extraordinaire of Health Service Journal, first broke the news over Twitter. There’s more here and if you want to check out the whole ten days worth just search the Twitter #safestaffing and see the announcements, counter announcements and horrified responses from a very wide range of interested parties. So much shock and disbelief that England’s CNO felt moved to defend NHSEs actions, and you can read that here. I’m not going to rehearse the whole story – suffice to say I am sad, angry, even bewildered that a Francis recommendation and a post-Francis commitment to formally and rigorously examine nurse staffing levels and to arrive at an evidence-based, expert opinion-informed suite of credible guidelines was pushed aside in such an ill-thought through way. My networks (throughout nursing – NHS, PVI sector, academia, UK and overseas) have been incandescent about it and a lot of nurses have been asking me why it happened, how it could have happened and why doesn’t that good old ‘someone’ do something about it… I have been, as ever, musing on this and trying to be relatively objective.
There were immediate strong reactions, calmly and cogently articulated – a letter to The Times from a collective of high level organisations associated with nursing and this one from Council of Deans UK, as well as concerns raised by NICE itself, Sir Robert Francis, MHNAUK, the President of the Royal College of Emergency Medicine and a number of patient’s organisations. On Twitter and in comments in response to Health Service Journal and Nursing Times articles nurses from a wide range of specialties were angry and disappointed. The sense of appreciation and valuing of their crucial contribution to safe, high quality care that the investment in the NICE staffing work had engendered seemed to have been pulled out from under their feet by an announcement that was difficult to understand. So far, so much well warranted indignation.
So what now, some ten days later? Well…nothing much – publicly at least. I’m hoping that there is work going on behind the scenes because the blogs and the Twitter conversations are dwindling. Arguably the biggest boost to patient safety and high quality care in the UK has been dismantled and there seems to be (what I hope is) a hiatus. Nurses have asked me why the nursing organisations are ‘peeling away’ from the rough and tumble, quietly but noticeably. I try to reassure them that these things are best not played out in the full glare of social media, or other kinds of media, but they are sceptical. Some reflect cynically that open criticism may lead to organisations being zipped out of the nursing ‘great and good’ tent and that’s not what people want. They suggest that the need to have ‘influence’ may trump integrity, even over something as important as this. I don’t think I believe this, though it’s tempting, and it would be a sad day if it is the case. I prefer to think that there is some careful regrouping going on, some consideration of what might be done, what approaches to take once the dust settles.
Those same angry nurses also ask about the absence of any public ‘for’ or ‘against’ comment from the most senior nurses in provider organisations. They either have an expectation that their most senior nurse should be shouting loudly and volubly that ‘the safety of our patients is at stake!’ (Who remembers Nursing Times’ cartoon Nurse Nightingale?) or they are cynically seeing conspiracy and/or helplessness. I am more optimistic though – I think these nurses will be looking for positive and constructive ways of moving forward with the safe staffing agenda – again as the dust settles.These are tricky times and knee-jerk reactions are rarely the right way forward. The best will lead through this.
Post-Francis we hear a lot about the power of whistleblowing, speaking out safely, the rhetoric of ‘we’re all leaders now’ and how professionals on the ‘front line’ (I hate that phrase) must advocate for patient safety and show leadership. The expectation that the rest of the hierarchy should do the same is strong. But it seems to me that it is just as hard to speak up from the top of an organisation as it is from the bottom, maybe even harder. There is more visibility, fewer numbers to feel safe in, much greater peer pressure, a lot to lose if you’re in the middle of the most successful part of your career. And before being too critical, remember that senior leadership is more about playing a long game, gathering information and evidence, working carefully, cleverly, and with integrity. It’s not always visible, not always obvious. Have a little faith.
The commissioning of NICE to generate safe staffing guidelines was a ‘moment’ for nursing, and as such it was also a ‘moment’ for securing high quality, safe patient care. Has that moment passed? I don’t think so, maybe postponed a little, but the time, not just the moment, will come.