Essential Care and Team Nursing

Health Issues Group: Essential Care and Team Nursing 30 June 2015

Guest Speaker: Chief Nurse of the ACT Veronica Croome

On the 30^th of June Veronica (Ronnie) Croome, Chief Nurse of the ACT, came to talk at the HCCA Issues Group. These events are public forums where HCCA hosts members of ACT Health staff and other health professionals or service providers to come and provide insight into different aspects of our health system. These sessions are a great opportunity to learn more about our health system and also to ask questions of a range of people expert in their area of practice.

ACT Chief Nurse Ronnie Croome with HCCA President Sue Andrews

What follows is an overview of the discussion with the ACT Chief Nurse.

Ronnie started by introducing herself and her role. She has been Chief Nurse of the Act for six years. She explained, Chief Nurse is a very hierarchical title which reflects the military roots of nursing profession.

The session began with a question: why would the chief nurse have to talk about the two elements that seem essential to nursing? The answer is clear: it seems that the nursing profession has lost sight of some the principles of what fundamental nursing care is and how to work in teams.

So what is the Essential Care Program at Canberra Hospital?  It all started with a patient journey about nursing care at The Canberra Hospital.  Ronnie recounted the experience of one family. The attitude of staff in the wards was poor, and care and dignity seemed to be missing.  There was poor communication and a loss of personal integrity. Staff did not ever seem to smile and did not look like they wanted to be at work. This story really impacted Ronnie and she was determined to discuss it with the family effected and use this as a starting point for systemic change. Four main issues were identified:
·         poor communication between teams, nursing staff, shift to shift handover
·         little evidence of caring, the care was mechanical and the family felt that they needed to be with the patient from 6.30am – 9.30pm to ensure that he received appropriate care.
·         lack of empathy and dignity
·         treatment was not patient focussed

Many patient complaints reflect these issues. This seemed to be in part due to the attitude of ‘this is not my patient’ and the patient allocation model of nursing.

But as Ronnie pointed out, in the words of Florence Nightingale: ‘They are all our patients in one way or another’-  .

So how have we manage to get to this point? This is partly due to the fact that in Australia we have developed a nursing model of care which is about nursing in isolation. The way in which patients were allocated to nurses they were fostering the isolation of patients and nurses. Universities, who now train our nursing workforce, call it Total Patient Care but it is more about care in isolation. Nurses need the support of others and are at their best when they work collaboratively with others. There are also skill mix issues that need to be considered, as some care may be beyond what individual nurses are able to do and they need to use the skills of their peers.

How did we get here?

Put simply, one could argue that we have lost the balance between the art and science of nursing. It shifted the balance from the art (caring) in favour of the science (evidence). Nurses see themselves as deliverers of evidence based care and have lost sight of the art of caring. They are now going about trying to correct this balance and refocus on essential care.

This was also in the content of the Mid-Staffordshire Review where there was major systemic failure of nursing staff to address the basic concerns of essential care. Canberra Hospital did not want this to happen in the ACT.

They conducted four audits looking at fundamental care principles For example: teeth cleaned each day, wash hands after going to the toilet and wash their hands before they have their meals.

Canberra Hospital has also introduced the Patient Care and Accountability Plan.  This is a comprehensive document that the nurse (who admits the patient) uses it to identify risks and then everyone who is involved in the care of that patient has a part of the form that they need to complete. It becomes part of the record and it sets out the risks and critical issues around care including falls, skin integrity, weight, and nutrition. Nursing staff have embraced the form and they are about to make changes based on feedback and it will then be in place to identify essential care requirements. This in combination with team nursing will address the level of nursing care.

We also heard from a range of ACT community members and HCCA Consumer Representatives who raised questions or shared their experiences with nursing care. The questions and discussion broadly covered;

·         The importance of good communication to consumer experience of nursing care. How is improvement in communication skills measured in this new model and audits?

·         How do you instil ‘good nursing values’ and empathy into graduate nurses and all nurses?

·         How can we provide better supervision and reflective practice for nurses? and;

·         A general discussion about workforce and systemic pressure that impacts the roles nurses play today in Australian Healthcare.

We are grateful for Ronnie coming out to talk at our HCCA Health Issues Group and talking so openly with us.

Darlene Cox

Executive Director

Would you like to see the nurse?

 Would you be happy to see a nurse instead of a doctor for some of your medical care? Health Care Consumer’s Association, in partnership with the ANU, is asking just that question through an online Nurse Survey being conducted throughout June.

ACT Health estimates that Canberra needs another 74 GPs to satisfy our needs. This means that many Canberrans are not able to see a doctor when they need medical treatment. More than half of the respondents to HCCA’s ACT GP Snapshot Survey, conducted in 2009, had to wait for more than a day to see a doctor for an urgent matter. With this in mind the ACT Government have developed the newly opened Walk in Centre at the Canberra Hospital. This is entirely staffed by nurses. There are nurses working in general practices as well and there are going to be more.

The Federal Government announced in the budget that they will pour $393.3 million into general practices in Australia to employ practice nurses to deliver primary health care. That’s enormous. Yet, we don’t know how consumers feel about this. Are they, or would they be, happy to see a nurse for medical treatment instead of a doctor at their local general practice? That’s what we are trying to find out through our survey. It may be that consumers feel that seeing a nurse is second best, maybe they think it’s a great thing and there should be more of it. We just don’t know. No-one has ever asked the question. Until now.

Last year HCCA conducted a survey which took a snapshot of General Practices in the ACT and it revealed that women with children under 5 and the over 65’s were more likely to see a nurse working in a general practice. HCCA is hoping that these groups in particular will participate in this new survey though it is open to everyone living in and near the ACT.

“We want to flesh out the picture and find out whether people think seeing a nurse instead of a doctor is a good choice in some situations.”

Do the Nurse Survey now. A link can be found at http://www.hcca.org.au/

Darlene Cox was interviewed by Lousie Maher about the survey on the local ABC radio.  Part of the interview can be found on the ABC website.

Nursing and Midwifery Stakeholder Reference Group

I attended the first Stakeholder reference Group for the Department of Health and Ageing on 14 November 08.
Rosemary Bryant explained that the main purpose of the group is to provide a means for two-way exchange of information and advice between the CNMO and key nursing and midwifery experts. Members of the group are representatives of their respective organisations.

Maternity services review
Over 900 submissions have been received. The submissions have been prepared by consumers, health professionals and peak bodies.
The Chief Nurse and Midwifery Officer (CNMO), Rosemary Bryant, commented that there were lots of areas of agreement across the submissions including the importance of continuity of care, support for midwifery led models, and indemnity issues facing midwives. The Department is currently analysing the submissions and writing a report for the Minister of Heath, Nicola Roxon. It is up to the Minister whether this report will be made public. I think that this is a very important document that would contribute significantly to that this become a public document.

There was considerable discussion of membership of the Stakeholder Reference Group. In particular, there was discussion of the need for aged care nursing to be represented. The distinction between community based nursing and residential facilities was drawn.

The place of Community nurses around the table was also raised. This is a significant workforce for consumers, especially vulnerable people. With our work at Health Care Consumers Association we have heard a range of issues from advocates regarding competency standards and scope of practice of community nurses.

One issue that affects the wider consumer movement is that there is not a professional association for community nursing. The ACCNS folded around two years ago. For consumers this means that we need to work across a number of bodies to raise any issues we may have about standards and practice. This includes: the registration Boards, the Nursing Federation, the College of Nursing and Midwifery, deans of nurse education, CRANA and chief nurses in each jurisdiction.