I was pleased the Prime Minister tackled the difficult issue of nursing and nurse leadership yesterday in his speech. Many of the problems I see in the public sector stem from poor management, just as companies which go bust are often badly led.
There are big differences between being a senior manager in the public and private sectors. In the private sector the danger is the boss has too much power. You have the power to hire and fire, to reward and to penalise. Your approval is sought by the ambitious, and your disapproval can cause angst and worry for your staff. In a private sector company the problem for the boss is to get honest advice from employees. The boss has to beware. A throw away remark or an ill formed thought can become a mantra or a command which people take too seriously. The danger is rash action based on the boss’s poor understanding or unchecked prejudice.
In the public sector the Minister has no power to hire and fire, to set salaries or award bonuses. There is plenty of honest – and some self serving or badly informed- advice available. A clear Ministerial decision or instruction can be treated as an invitation to a seminar by civil servants. It might become a challenge to them to see how they can rally forces against it. Ministers need to learn how to get the system to do as they wish, as it is not easy. The danger is nothing new or better ever happens. The forces of inertia can be very great. It is especially difficult for a Minister who wishes to do more with less, as the whole culture is in favour of spending more as a signal of success.
Nursing, as the Prime Minsiter observed, should be about caring for patients. Record keeping is important. A good hospital needs to be meticulous in recording drugs needed and treatments administered to avoid errors and to check on results. This need not get in the way of patient contact. Indeed, the records should mainly stem from nurse and doctor contact with the patient, and can be mainly carried out at the same time as the conversation with the patient. The drug taking needs to be recorded at the bedside when it is administered. The patient’s condition needs to be recorded along with their feedback when the nurse or doctor calls.
Good leaders or managers know when to listen, when to seek advice, when to consider, and when to decide. They decide based on good evidence, and carry through their chosen course. They need to explain it to staff and all affected by it. They need to carry as many as possible with them, but at times they may need to make a decision which does not meet with the approval of some involved. In such cases it is even more important to be right, when you need to draw on superior experience and knowledge to make it worthwhile going against the viewpoint of some of the team and those affected.
Nurses above all have to carry the patient with them, and must regard the patient as the most important person and the ultimate decision taker. Many patients will trust their medical advisers to do what is best. Others need explanations and need to be persuaded to consent to the interventions thought helpful. All this requires more time with patients. If the Prime Minsister achieves anything from his speech , it is important he achieves this simple thing. Nurses need to spend more time with their patients. The “paperwork” as it is called in a rather old fashioned way has to stem from the work done at the bedside, and has to to be fitted into the relationship with the patient.