Jan Quallington: ‘Compassion must be a central element of all nursing degree programmes’

17 January, 2013

The Francis report on the inquiry into the Mid Staffordshire Foundation Trust scandal is about to be published. One of its key recommendations is likely to be that change is urgently needed in nurse education.

Nursing has come a long way as a profession since I first started out as a nurse some 30 years ago, but one area that has suffered, as the demands on hospitals and nurses have grown, is the most fundamental of all – caring and showing compassion for patients.

 As the Willis Commission concluded, there is no evidence to support the suggestion that turning nursing into an all graduate profession is in any way responsible for this. Indeed, the knowledge required of today’s nurses demands at least a degree level qualification. What we must ensure, however, is that patient care is a central element of all degree programmes. Patients should be confident that every hospital worker, be they doctors, nurses or other allied professionals, has the right attitude towards care, as well as appropriate knowledge and skills based on the most up-to-date medical and scientific knowledge.

Nurse educators, who are themselves practitioners, are acutely aware of the need to impress on students the importance of a caring approach. Care environments are more pressurised than they have been and it is essential that nurses are supported to take the time necessary to work in this way. A practice nurse friend, who was recently hospitalised, told me that during her hospital stay she “just didn’t feel cared about”. There was no sharing of information and she was made to feel by staff that she was being a nuisance if she asked for anything. As a nurse educator I was saddened to hear this. In my experience, nurses enter the profession because they want to care. How have hospitals become an environment where nurses cannot provide the kind of personal care that they would wish to give and where a patient feels like a burden?  

“A key step to developing compassionate, expert nurses who can cope in difficult circumstances is by changing the way trainees are selected”

Part of the answer is that nurses need different skills to handle the pressures they face on today’s wards. A key step to developing compassionate, expert nurses who can cope in difficult circumstances is by changing the way trainees are selected. Assessing attitudes is difficult, and in the past this has not been a feature of nurse recruitment. Francis is likely to call for this to be addressed as part of reforms to the training of nurses. At the University of Worcester, we have already made a start. The attributes of a good nurse have been identified by patients, carers, clinicians and academics so that recruiters can assess whether applicants possess these qualities, including kindness and compassion, emotional intelligence, and confidence. Selection is undertaken by panels of nurse academics, patient representatives and clinicians who must all agree that the candidate has the potential to be a good nurse.

Having selected the right trainees, we must ensure they receive the right kind of high-quality training and mentoring. Student nurses in England spend at least half of their time in the workplace, including hospitals, GP surgeries and treatment centres, and are strongly influenced by the cultures that exist in practice. Teaching and supervision in a busy ward is always challenging and sometimes difficult. Staff are under pressure and do not necessarily always meet the best clinical standards. Patient needs are becoming more complex and an increasing number have dementia alongside their physical illness. This brings new challenges and nurses need to be effectively prepared for caring responsively to these new needs.

What does this mean for student education? At Worcester our response has been to teach students to be resilient and to accept personal responsibility for making sound judgements about the care standards that they witness. We have ensured that the university provides support in the event that students raise concerns about incidences of poor care.  It is vital that students are equipped to question practice and are supported to challenge the sub-standard.

The first Francis report was highly critical of the quality of leadership at Stafford.  Good clinical leaders are essential if we are to ensure that consistently high standards and good quality care are provided at the bedside. This can only be achieved if the knowledge and skills of managers, as well as nurses, remain up to date. Professional updating and ongoing staff development are therefore essential elements that must be maintained. Nurses today face more challenges than ever before, and the level of knowledge and expertise they must acquire is growing. But as the first Francis report showed, things can go tragically wrong if compassion and the fundamental principles of patient care are missing. Everyone involved in the training and selection of nurses has a responsibility to ensure that these elements are at the core of practice among the professional workforce in all of our hospitals.

Dr Jan Quallington is head of the University of Worcester’s Institute of Health and Society. She spent almost 30 years as a practising nurse, having trained at University College Hospital London