Posted by: ayrshirehealth | January 6, 2016

No more Mrs P!$hy Pants by @fionacmcqueen

Just write2Professionalism

New Year stands before us, like the chapter in a book, waiting to be written……

What would you want to write in that chapter?

If it could be one thing, whatever it is, what stops it happening?Code pillars - professionalism

If I’m allowed to fuse Christmas wishes with hopes for the New Year, the one thing I would wish for is…….  Professionalism.

Which if I’m being honest, I think is cheating because within that there’s a lot more than one thing I think the professions need to do, but they can (almost) all be encompassed by the concept of professionalism.

There’s a lot  happening over the next year within our professionRevalidation

  • Revalidation starts from April 2016
  • The NMC will respond to the Shape of Caring Review – which may have implications for the four countries
  • A careful eye needs to be kept on Health Education England’s work on new roles (the nursing associate)
  • All Integration Joint Boards ‘go live’ by April
  • Midwives will prepare for a life with supervision being removed from statute
  • Policy within the NHS in Scotland will be implemented through Sir Lewis Ritchie’s Out of Hours Review, the launch of the National Clinical Strategy, a new GP contract that will support the delivery of care closer to people’s home by multi-disciplinary teams, a national maternity strategy….. the list seems endless.
  • The review of the undergraduate nursing and midwifery bursary will be published

Donner KebabAll against a backcloth of fiscal restraint (not much money), a changing demography, and a public health challenge that seems out of our reach.

But in very practical terms, what would I like to see in day to day clinical practice?

Banished to the history books

What does excellence in care really mean to the people we care for?

Well maybe drawing from examples I’ve experienced last year, I can describe what I’d like to stop and banish to the history books.

Unconditional Positive Regard

Unconditional regard“If you wet the bed we’ll call you p!$hy pants……..”  – I expect registered nurses to speak to all patients and their families with unconditional positive regard, and never again will a registered nurse say to a patient….’if you wet the bed we’ll call you pishy pants.’

At all times I want nurses and midwives to put their patients first.   No skipping off for a break when relatives need to speak to you, or worse when patients should be having their meals served.

But also, nurses in leadership roles need to ensure nurses are working within an environment where there are enough nurses to deliver care safely and effectively.

Apply Evidence Based Practice

When I ask a mental health nurse what their contribution is to patient care within an in-patient environment, I don’t want to hear “I give out the medicines and go on ward rounds” and be unable to articulate what their unique contribution to care of people is.

Truly Woman Centred Care

Baby in CotWhen entering a postnatal ward to visit a new mum, who has been unwell and has had her baby delivered at 35 weeks by caesarean section, it would be nice if the midwives would lift their heads and say ‘hello’ when I entered the ward, or if I asked if I could stay with my niece until the baby’s blood sugar results were known (which would have been five minutes after visiting), the midwife wouldn’t draw her eyes to the clock and grudgingly say ‘yes’ then remove my niece’s baby without a word of explanation or acknowledgement that mums and babies should be kept together……

A Commitment to the Profession

When I visit a ward and ask a member of staff how long they’ve worked there and if they enjoy it, I don’t want to hear ‘too long and it beats no job….’

Scottish Parliament BuildingSo how do we connect matters of national policy – whether Scottish Government or NMC, to day to day practice? NMC

How can nurses and midwives improve the health of the nation as well as take their place in delivering outstanding clinical care for the people of Scotland?

What matters to youWell, for a start every nurse and midwife, needs to believe that they have a part to play in writing that chapter.  I want to create the conditions that supports nursing and midwifery contribution to the national conversation, but also to a conversation amongst ourselves.

Last year, the Nurse Directors, the RCN and CNO commissioned work to be done called Futures Conversations, we need to act on the outcomes of these conversations, and keep them going.  I want every nurse and midwife to have a voice in our future, and be confident that they’re being listened to.

We need to outline our Vision for Nursing so that everybody can see where they contribute to improving health and delivering outstanding care.  screen-capture-21

Whether that’s in a leadership role, creating the conditions for nurses to flourish and state they have enough time to care for their patients, or in a care delivery role, reassuring an older person that they will be supported to go to the toilet as many times as they need to.

No Sacred Cow

There are new roles too.  We have many examples where nurses have taken up new roles and secured the delivery of sustainable services to communities.  This must continue, and must be prominent in our vision for nursing.  In particular, with the integration of health and social care, and care being delivered closer to people’s homes, there ought to be real changes in roles and approaches to care delivery.

There should be no sacred cows, but we need to be confident that in our new systems, practitioners practice safely and have opportunities to be creative and innovative.

I have met some outstanding undergraduate nurses and midwives who give me real hope that our future is safe in their hands.  Setting the DirectionThe delivery plan for Setting the Direction sets out ambitious plans for improving the commissioning of undergraduate education and also commissioning post graduate education that will support our workforce to flourish and be fit for the future.

But let me quite clear.

The evidence of improved outcomes for patients from a graduate level workforce is unequivocal.

The profession has come a long way over the last two decades since nursing and midwifery education moved to Higher Education.  We must build on this to strengthen outcomes for patients.

Care assurance

I have met some outstanding nurses and midwives and hear of examples of care being delivered that is so good it’s breath taking.  Vale of LevenHealthcare Improvement Scotland are creating a new system to support inspection and scrutiny, and the Cabinet Secretary has asked me to create a system of assurance for nursing and midwifery care, following Lord McLean’s inquiry into the failings of care at the Vale of Leven Hospital.

We must make sure this system of supporting the delivery of excellence in care across NHS Scotland is open and transparent, and truly supports nurses and midwives to flourish.

I’ve also had the privilege of meeting with some of our University Nursing Schools, and heard both their challenges, but also the fantastic work they are doing – both in preparing our undergraduates, but also, critically, in what’s happening with research.  I would want to see the nursing and midwifery academic voice being more prominent in our society; helping shape policy, and also shifting public perception- whether of the view of our profession, or in helping shift attitudes towards public health and the shape of service delivery.

So where does that leave us?

When facing the challenges ahead of us, it’s going to be essential that the profession pulls together and we all take our part – which can be made more effective if we understand the part that others also play.  Mgt Mead quote

And before it all seems overwhelming and too difficult, and ‘that will never happen’, please remember how far we’ve come.  And also, in the words of Margaret Mead;

‘Never doubt that a group of thoughtful, committed citizens can change the world.  Indeed, it is the only thing that ever has.’

Wishing all nurses and midwives a successful and healthy 2016- please let me know what you think throughout the year and invite me to your area of practice so that we can continue our conversation.

With best wishes.

This week’s blog was by @fionacmcqueen (Fiona C McQueen), Chief Nursing Officer for Scotland, Scottish Government.

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Responses

  1. Fiona, if you can influence this basic common courtesy in all wards in all establishments then I applaud you. Unfortunately what you have written is true and has been experienced by some of my family and friends. Even new nurses I know have witnessed this type of behaviour from their superiors. Kindness, mutual respect and good manners go a long way. Happy new year and best wishes for 2016.

    • Jacqueline, many thanks. I fully intend to ensure professionalism at all times. I do understand how difficult it is for nurses to challenge poor practice- but am confident we can get there.
      Thanks for your encouragement.
      Fiona

    • Why is it that any criticism of the nursing profession is met with an outcry of “that’s not fair we’re not all bad”. If you or a loved one has ever had cause to be seen or treated by a member of the nursing profession then you know that we encounter both the very best and worst of care, treatment and attitudes. Nurses are not above accountability and must be challenged where necessary. I am disappointed that Fiona McQueen felt the need to apologise, patients and their families need someone to be brave and bold enough to say what needs to be said.

  2. Fiona
    I love that Margaret Mead quote: it’s gives great encouragement when the task ahead seems dauntingly overwhelming.
    There’s lots happening in 2016, task wise, but am struck by the examples you’d like to see consigned to the history books. It seems to me that they, and many other example like them, can all be banished by demonstrating basic humanity, care and compassion.
    We need to be reminded daily what that looks like.

    • Gina, many thanks.
      I honestly believe we can take the profession to the next level- but we all need to be involved- to build on the fantastic work that is obvious daily; but we also need to challenge poor practice- and that from Jacqueline’s comments – is difficult
      Fiona

  3. Fiona
    I was rather disappointed to read your blog and it left me feeling quite disheartened , while I appreciate you were giving individual examples of unacceptable care, it could be so easily misinterpreted.I ,along with many of my friends and colleagues, felt that nurses were being ‘tarred with the same brush’ , in particular with reference to nurse skipping off to a break . On some shifts nurses often struggle even to have a toilet break never mind a tea break . There are lots of good nurses out there and we need to place more emphasis on the excellent care ,compassion and dedication that nurses display on a daily basis,especially under the current nursing workforce pressures. #proudtonurse

    Julie

    • Well Said Julie….Fully agree with what you have replied…Not all nurses are as quoted in your blog Fiona, however It is felt we have all been tarred with the same brush.

      • Caroline, I’m sorry you feel that all nurses have been tarred with the same brush. At no time was that my intention. Within the blog there is more from me in what is good than not. Please be assured that I have confidence in the profession. However I’m not going to pretend that the examples I gave didn’t happen- they did – but they need to stop. As with Julie, I’m happy to come and see you in your workplace to discuss

    • Julie, I’m truly sorry that you feel I was tarring all nurses with the same brush. I had been thoughtful about what to include in the blog- at no time did I mean to dishearten nurses.
      In my blog I am urging all of us to reach up and improve. I acknowledged that this was difficult- indicating that I expect nurse leaders to ensure there are sufficient resources so that nurses can deliver care. I know that nurses at times miss their breaks- that is not acceptable.
      You’ll note I also confirmed that I see outstanding care and practice. We do need to face up to a lack of professionalism so that we can improve. Thank you for caring enough to comment- I’d be delighted to come and meet you and your colleagues to discuss. Best wishes
      Fiona

      • Hi Fiona

        Many thanks for taking the time to respond,it is very much appreciated and I would like to accept your offer to come and meet with my colleagues and I .

        Julie

  4. a very unbalanced report from a person who is supposed to promote the excellent work nurses do day and daily, yet another slap inthe face to the vast majority of staff who are professional, hard working, caring individuals

    • Alan, I’m sorry you found my blog to be unbalanced. I only wrote about what I found.

      My job is to provide leadership for the professions- not to promote the excellent work nurses do. Reflecting on my blog, and having listened to other comments, I do think I also acknowledged the excellent care-‘
      In my blog I said ‘I have met some excellent nurses and heard of care that is so good it’s breathtaking’ . That is not unbalanced.
      Thank you for commenting- like the other responders, I’d be happy to come and visit you and your colleagues in your work place.
      Best wishes
      Fiona

  5. I thought this was an excellent blog, unsettling and disturbing that we still have nurses/midwives who adopt the attitudes described.
    I thought the blog was also balanced, there was recognition of the excellent work of nurses and midwives – there has also been lots of praise in previous blogs written by Fiona.
    However if we simply write about the nice things, the things we are proud of then we will miss the opportunity to influence, to challenge and to demonstrate to the few that we do not find their attitude acceptable.
    If you’ve ever had to sign off complaints or read HIS reports I think people would understand that, while the majority strive for excellence, we unfortunately have a few across the professions who do not.
    There is a reason why we (in NHSA&A) now have the Isabella Kimmett Award for compassionate care – and the background to it is not a positive story (see previous Ayrshirehealth blog).
    I see that Alan thinks it’s Fiona’s role to stand up for the profession – it absolutely is, and she absolutely fulfils that role. However authenticity demands that this is not blind pompom waving – we need to engage in difficult conversations as well as promoting and celebrating excellence.
    It is naive to think everyone shares our values, beliefs and commitment – if by reading this blog and talking about it in our teams we can change the behaviour of the few, it will have been worth making the many uncomfortable in reading the blog.
    Derek

  6. I’m afraid that the comments such as “No skipping off for a break when relatives need to speak to you, or worse when patients should be having their meals served” do seem to imply this as a “norm” for nursing behaviour, rather than an example of an extreme lack of professionalism. Thankfully in my practice, staying behind after your shift has long since finished, to talk to or assist paients and relatives is the “norm”. Whilst I would never condon poor practice, a lack of respect for patients, or a lack of professionalism, all the unpaid overtime and goodwill that my colleagues and myself pour in to the NHS, goes for nothing in the media and in public opinion when they see a heading like no more Mrs P!$hy Pants. Whilst poor practice should always be challenged, we should all be media savvy enough to know that the media love to cherry pick negative comments and imply that this reflects all nursing practice. When people say “nurses” don’t do this good thing, or “nurses” do this bad thing, the inference is that these “nurses” are all of us nurses. Sadly “nurses ensure clinical best practice” just doesn’t make a sexy headline.
    Brian

  7. I would want to express my sadness and disappointment with these comments from Scotland’s senior nurse. I simply do not recognise the portrait of nursing that Mrs McQueen paints. If Mrs McQuuen has evidence of individual bad practice then this is what she should comment on rather than speaking of “nurses”. My experience of nurses is that they work substantial hours unpaid and go without breaks in order to provide world class care rather than “nipping off for breaks” as is claimed and that nurses speak to patients and relatives with the greatest of respect and kindness rather than the way Mrs McQueen suggests. I think her comments do damage to nurses and nursing and the Scottish NHS of which we are so rightly proud of.

    • Gordon, I’m delighted that you don’t recognise any of the examples I wrote about. From one of the responders above who has commented, and also looking at SPSO reports, Patient Opinion, and other organisations who represent patients, sadly, at times a very small number of nursing staff do display a lack of professionalism. If I’m being honest, I did think it was implicit in my blog that lack of professionalism was unusual- so for the avoidance of doubt, I believe for almost all the time, patients and families receive professionally delivered care.

      For those who have read the whole blog, rather than being selective, it can be noted that I also emphasised my commitment to create an environment where all nurses have a voice, and my expectation that nurse leaders create a culture where nurses can flourish, and that there are enough resources for nurses to indicate that they have time to care for their patients.

      I hope my previous responses will have reassured readers that at no time did I intend to suggest all nurses display the poor behaviour I commented on.

      As with previous responses I would be delighted to come and meet with your colleagues to discuss how we support all nursing staff to flourish.
      Best wishes
      Professor Fiona McQueen

  8. Fiona
    I was angered, disappointed and frustrated when I initially read your blog. I considered an emotional and reactive response. However I felt it appropriate to reflect on the contents and respond when I had shared the content of your blog with my nursing colleague.
    I continue to feel angered and frustrated I must confess although I can see the logic in some of the content in terms of striving for excellence and promoting good practice. Obviously this is the aim for the majority of nurses working within the care sector.
    I can not support the idea that you feel nurses are “Skiving off for a break”. This makes me question if you are fully aware of the challenges within the clinical areas. I will fully support and promote that patient is priority but as your role involves leadership, surely there has to be some consideration for nurses to ensure they are well rested, hydrated during a 12 hour shift to optimize their well being.
    Quite often nurses go without breaks, meals, adequate rest to prioritise patient or go that extra mile, it causes me great concern that the first contact a relative may have is of a fatigued, stressed and agitated nurse. This is often a result of challenging working conditions and working through breaks. Any patient or patients relative should expect the best of what a nurse can offer in terms of communication, empathy and support. Therefore it is completely unacceptable to suggest that nurses should continue to sacrifice comfort breaks and label this as “skiving”. In my 10 years within nursing I have never witnessed a nurse doing this, this does not suggest that it doesn’t happen but it’s not common practice as your article would suggest. I feel you have caused offense and anger towards an already fatigued and stressed workforce.
    My experience of a certain health board has lead me to believe that the front line nurses are not the issue. The negative behaviours that you allude to within your article is a result of poor management, lack of support and negative cultures. It is this that should be addressed. I want to see role models as managers who support the nurses to ensure that stress is managed, engage with nurses to understand and respond effectively to the challenges. Give nurses the support to be the best they can be and this will be reflected in the care that is delivered. Comments like “Too long” in terms of how long an individual has worked in a ward suggest a bigger problem that needs resolved.
    I am passionate about my job, I am passionate about the patients in my care but as a staff side activist I am also passionate about the nursing workforce and I feel your comments has resulted in despair, frustration and apathy as opposed to inspiration, motivation and passion which is what I would expect.
    Ricky

    • Ricky, thank you for your considered response. At no time did I mean to suggest that all, or many nurses behave in the way I outlined as examples of the behaviour I ‘wished’ to end. I fully appreciate the upset I have caused some people, by not being explicit that the examples I gave are rare.
      I hope you noted in my blog my expectation that nurse leaders create the climate where nurses can flourish and that they must secure the right resources for staff. I also hope you noted my acknowledgement of outstanding care.
      I have had a mixed response to my blog. I didn’t expect having such a wide impact. I wonder how many of my previous blogs you and others have read? I also wonder why people think the media will ‘grab’ on to it. Unless they themselves make the media aware of the blog?
      The blog was for all practicing nurses-myself included. My role is to support the profession to reach excellence, and I fully appreciate the need to be positive and move forwards. However there continues to be areas where this is not always evident and we also need that to be addressed . I would be delighted to come and meet with your colleagues to discuss further. Please contact me to arrange for me to visit and discuss.
      And finally, I do know that nurses every day go the extra and miss their breaks. The extra mile is fantastic, missing breaks is not, that also needs to be addressed.
      Best wishes
      Fiona

  9. […] In a blog, McQueen urged her colleagues to show “unconditional positive regard” for patients after noting that some nurses can be patronising or dismissive. An established blogger before taking over as the Scottish government’s official nursing adviser, McQueen noted that some nurses also put their tea breaks above patient care: […]

  10. […] a blog post, Prof Fiona McQueen said her one wish for the year ahead would be […]

  11. Unfortunately I can identify with some of the stated behaviour of NHS staff. My wife recently gave birth and my view of the midwives, not all but a sizeable proportion, was that they were rude and unpleasant. I’d been told to expect this from friends who had gone through the experience but I was still surprised to encounter it. It’s unacceptable and I’m glad to see this is being addressed

  12. Rather pompos a ramble me thinks. 2016 needs a shift change from service users thinking they own us.

  13. Thank you for your blog post, which I read about in today’s Herald. While caring for my father who had dementia I encountered examples of those “outstanding nurses” who “delivered care that is so good it’s breath taking”. I am sure they must be cheering you on because surely they must be in despair about the nurses who behave in the ways you describe.
    I have experienced the dismissive behaviour of nurses who believed they knew my father better than I did, the disappearance of nurses at visiting times (that may have been because they saw me as a grumpy, interfering busybody). Once, when dad was admitted the nurse in the admissions unit spent at least an hour after her going home time to complete the form filling, including all kinds of details such as how we gave him his medication (his swallowing mechanism was compromised by then), foods he liked/disliked, how we got him to eat. We offered to come in at meal times and it was agreed the staff would do breakfast and we’d do lunch and dinner. Next day, just before lunch time, we discovered dad asleep having had no medication, nothing to eat and nothing to drink since we left him at 1am. I so felt for the nurse who had put in so much time and effort to ensure he would receive the care he needed.
    Your blog, and the backing it has received by June Andrews gives me hope that a genuine conversation can now begin and lead to a true professionalism.
    I blog about caring for my dad and will add a link to your blog. I know many of my blog followers will appreciate what you have written.
    I wish you well.

  14. Unlike others, I do not see this post as a negative thing in the slightest. Social media is always full of posts about how brilliant nurses are, but that simply isn’t true, and it ought to be acknowledged that sometimes nurses make hospital stays absolutely unbearable.

    During my last stay in hospital, one nurse was beyond rude. I have PTSD and had a bad flashback, so hid. She then got really angry with me and said I shouldn’t make claims about being hurt because ‘that could ruin those men’s lives, it’s not something to joke or lie about’. I understand that nurses on a general medical ward might now know much about mental health conditions, but she was the perfect example of what not to do when someone’s having a flashback or panic attack.

    During the stay, she also moved the table with my inhaler on so far away I couldn’t reach it, then wouldn’t give me it when I needed it, and when I couldn’t cut up my food due to being unable to use my right hand/arm, she didn’t provide any help at all. The nice lady who went round with the tea trolley did a better job at helping me cut up food and get my inhaler than the nurse who was meant to be looking after me!

    I was made to feel like a total burden the entire time I was there, and was pretty much left to fend for myself throughout my stay. In the end, my boyfriend had to come over dinner time to make sure I could eat, because nobody would cut the food up for me, and because the nurse was polite whenever he was there.

    That said, some of the nurses during that stay were amazing. One sat with me and talked about video games because I was feeling really anxious, and another gave up her break to take me to a different hospital so I could see my psychologist, and ‘made it her mission to make me smile’. And I have never had an issue with nurses at any GP surgery.

    I think it’s really important to highlight that not everyone is being professional or courteous when working with patients. Often, the thing that sticks in a patient’s mind is the bad experiences, and not the good. I’m now terrified of needing to see a doctor or go into hospital in case I’m treated in that way again. All the good work done by other nurses is undone by those who are rude and unprofessional.

  15. After some debate, the CNO has responded to my concerns on Twitter about her actions when she witnessed this and has informed me that she has raised the unacceptable language she writes about (Pishy pants) with the nurse involved’s line-management. As all health boards have disciplinary policies in place, and as the CNO makes clear in her post that use of language such as this is unacceptable (she wishes to hear it ‘never again’) I assume the nurse involved will be in some way sanctioned.

    That is how we should deal with poor standards, specifically, professionally, and immediately we witness them, rather than anecdotally in a blogpost at a later point, with no context, and in a manner which plays into the hands of those interested in bringing down nurses, nursing, and the NHS. The CNO should be careful when she goes public with her views.

  16. […] You can read Fiona McQueen’s blog post here. […]

  17. […] most senior nurse, Fiona McQueen, has publicly apologised after an outcry following her publishing a blog which called for greater professionalism in nursing and midwifery. She shouldn’t have felt she […]

  18. Hi Fiona
    I support your quest to ensure patient care is the best it can be, and applaud the nurses who deliver it. You rightly say that standards slip at times though, and our research has been looking at why this is. In the words of Valerie Ilse “Why do good people deliver bad care?”. Our work has led us to develop a deeper understanding of the emotional labour of nursing, and ways in which nurses can be supported in their endeavour. Would you be interested in learning more about this? This TEDx introduces the concept briefly https://www.youtube.com/watch?v=VC4FajTFpRU and I would be more than happy to share our research and ideas with you if that was helpful? Kind regards
    Yvonne sawbridge Senior Fellow University of Birmingham y.sawbridge@bham.ac.uk

  19. I am sorry to be late to this but came across it in the Nursing Times at the end of last week. I am a nurse and a researcher currently studying compassion in the hospital ward setting. I was distressed at reading these comments from a nurse in a leadership role and which had been delivered in this form. I think it is utterly unhelpful in terms of improving delivery of care. It demonstrates no insight into the complex and relentlessly demanding environments that healthcare staff work in and, more worryingly, a lack of interest in this. Fiona states “When I visit a ward and ask a member of staff how long they’ve worked there and if they enjoy it, I don’t want to hear ‘too long and it beats no job….” Why doesn’t she want to hear this? Is it not important to explore why a staff member feels this way? It is exactly this exploration that can help to create the conditions for staff to deliver excellent care.

    I also have to say I find the phrase:
    ‘No skipping off for a break when relatives need to speak to you’
    offensive, depressing and utterly inaccurate. In 12 years of nursing in various hospitals all over the country, and in 100 hours of observations in my current study, I have NEVER seen a nurse or HCA for that matter skip off for a break. Crawl maybe, but never skip. We need to be able to trust our clinical staff to decide when their breaks should be taken. If they wait for a moment when there is no one to be spoken to or no work outstanding they will not have a break. This is mainly what I have seen in my research and my experience and it is not possible for people to sustain outstanding care for others with out looking after themselves.

    If people are sincere about improving care in our health service they have to value and support those that provide it.


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