Over the years, I’ve heard about truly exquisite experiences people have had when they’ve experienced good nursing. Whether it’s been supporting someone to a peaceful death, holding a frightened hand before an operation, or supporting a young person through difficulties, there’s no doubt that good nursing is recognised when you see it. So why don’t we see it all the time? Should we see it all the time? From my perspective- absolutely; excellence in care from every nurse, for every patient, every time. ‘But Fiona, I hear people think, that’s just not possible, you just don’t understand………’
If the profession believes that it’s not possible to deliver excellence in care all of the time, then we will never do it. I’m not saying it’s easy, but I honestly believe it can be done. But we can’t do it alone. When thinking about what gets in the way of that excellence, it could be any one from a long list; not enough staff, staff not appropriately trained, pharmacy not available, doctor not available, equipment not available, staff too busy…….. the list could be endless. But what of the above is impossible to change? What of the above is an acceptable reason for poor care? I would argue none. At times we can be too understanding of the pressures we face when trying to deliver care. It really is a whole system issue, and one that the Scottish Government and NHS Boards are working to improve.
We’ve seen huge leaps and bounds in patient safety with the Scottish Patient Safety Programme, significant increases in the number of nurses employed by Boards when they apply the nursing workforce tools, significant numbers of extra student nurses, and a strategic focus on staff health and wellbeing thorough the national programme, Everyone Matters. So what’s stopping us?
From a national perspective, it’s clear that Boards are under considerable strain; financial pressures are making balancing the budget more essential than ever before. The changing demography is beginning to bite. Whilst the recession has perhaps delayed some of the workforce challenges that we are bound to meet with the reduction in working age population, vacancies across NHS Scotland and the Care Home sector are increasing and becoming more difficult to fill. Our older population, whilst in many ways are a real asset to our communities – you only have to look at what they deliver in providing care as carers or as volunteers in our local communities – are also being admitted for care in much larger numbers.
So what is to be done; in Boards like Dumfries and Galloway who have a relatively small population, spread out over many square kilometres, it can be a real challenge. But with challenge often comes opportunities. The many areas of outstanding practice that come out of D&G are testament to that. Whether it’s in responding to patient needs from a person centred care perspective or creating innovative solutions to responding to local needs – you only have to look and it’s there. Most of us like to cling on to what we know, but if we look at the health service since its inception, although many aspects are very similar, many aspects of service delivery have changed hugely and we wouldn’t want to go back. The list is endless; infusion pumps to keep people pain free and support a peaceful death, stroke care where people who would have been grossly disabled can literally walk out of hospital within a matter of days, the improved treatment of MIs in specialist areas have transformed the way we now treat coronary heart disease. And of course nursing becoming an all graduate profession is continuing to contribute to improved outcomes for our patients.
So if we are to truly protect our public services and make sure we continue to maintain local services we must embrace change, whilst holding on to what we hold dear; providing truly person centred compassionate care to everybody we care for. Because, although our care may seem routine to us, we never know when that one person we are caring for is at the end of their tether and we are truly the world to them.
I’m confident that we can really have a world class health service but only if we anchor ourselves in what’s important to people, and are creative and bold in our solutions for finding sustainable locally based services.
Fiona McQueen is the Chief Nursing Officer for Scotland