Responsibility- the keyword
2
MANAGEMENT FORUM 4: THEORY AND PRACTICE Responsibility- the keyword ANTHONY CARR discusses nurse managers' responsibilities to their staff, patients andsociety. T HE number of times a word or concept is used . in a discussion is pro- portional to the group's or individual's lack of accep- tance of the meaning behind the word. For example, if the word "professional" is used often enough, a feeling of pride and confidence is engendered. Responsibility is a good wholesome word. Accor- ding to the Shorter Oxford English Dictionary, it means "the state or fact of being responsible; a charge, trust or duty for which one is responsible". Being respon- sible means "liable to be called to account; answerable to a charge; morally accountable for one's actions". Nurse managers are responsible to staff (other nursing colleagues), clients and society. Reorganisation allows reappraisal of nurses' duties and responsibilities. Over the years, ward sisters' responsibilities have chang- ed, although some would say diminished. The reduc- tion in hours of wor k and an increase in holidays must be taken into consideration, however. In the 1960s, ward sisters worked about 220 full days and a further 52 half- days annually and a 9 per cent longer working week with a split shift system. Unofficially, the 42-hour week was considerably Anthony Carr, SRN, NDNCert, QN, is chief nursing officer, New- castle Health Authority. more."Ward sisters seemed to be never "off-duty". To- day, however, the ward sister works 204 days an- nuallyat 37.5 hours a week, an official time reduction of about 22.5 per cent. Responsibilities should be clearly defined, of course, but the amount of time devoted to such respon- sibilities must be considered. Management's responsibili- ty is to define the role and function of the ward's team members. Senior manage- ment should be concerned that ward sisters are respon- sible for appointing their own staff and developing and controlling ward policy for 24 hours. Attempts are being made to alter night duty ar- rangements to ensure that the sister's responsibility for ward policy and care plans is acknowledged. This has to be undertaken with the knowledge that to cover one post for 24hours, seven days a week, would require . another 4.5 back-up staff. For senior management to be seen as responsible peo- ple, the 35-hour week is unacceptable. Although rotas can be altered, cover given if more nurses are trained and treatment given on time and effectively if staff are available, relation- ships cannot be adequately maintained between nursing and medical staff and pa- tients will not receive the necessary psychological, emotional and spiritual sup- port. Although qualified nurs- ing staff ate taught to be responsible initially to their own patients for the care they give, they should not object to their performance being monitored. Medicine would benefit enormously if medical audit was intro- duced on a wide scale.. Proper delegation of responsibility would remove a management level and change those staff into sup- port roles. Senior manage- ment must use what authori- ty it has to persuade new training bodies to radically rethink nurse training and education. Newly-trained staff are not sufficiently ex- perienced to take their place as trained members of the team unaided. Work under- taken by the nursing depart- ment of the DHSS, reported in "Professional Develop- ment in Clinical Nursing", and the Rcn document "A Structure for Nursing", in- dicate that considerable ad- ded input is required to enable the newly-trained nurse to take her or his pro- per place in the ward team. as "an object of anxiety or watchfulness" or "to pro- vide, look after, watch over". How should nurses care for clients and patients? A critically ill person is an object of anxiety and should be watched over. How should nurses look after, provide for or watch over those recovering from ill- ness? The fact that so many young people wish to come into nursing to care can be seen as an advantage and disadvantage. Can nurses be detached enough at the ap- propriate stage of a patient's recovery. to allow him to become independent of nur- sing and nurses? Some say it is a matter of education, but I wonder if formal educa- tion or others' examples changes a person or his or her feelings of what is right. Some nurses who care too much do their patients a disservice and consequently affect their recovery. On the other hand, some nurses care too little. Every terminally ill pa- tient must receive the ap- propriate nursing support and care at the time re- quired, as well as basic nurs- ing care. It is said that there is not enough time in NHS hospitals to care for dying people in the way hospices do, but I do not accept this argument. Senior nursing management are paid high salaries to meet the com- munity's changing needs. While patients die alone, frightened, in despair or resignation in hospitals because of faulty organisa- tion, inappropriate staffing or lack of care, we cannot be satisfied. Nursing management must influence the use of resources as well as use new monies. It will be interesting to see how nursing manage- ment copes with the in- troduction of the new in- sulin, U.100. How will it train its staff? How will pa- tients be re-educated and supported? Will schools of nursing have to cope with Preparation Managers must direct monies into continuous education so that staff are consistently prepared for their new and increasing responsibilities. Nurses' work will continue to ex- pand and extend. Legal im- plications are sometimes overdone when considering developing duties. When new duties arise, manage- ment must ask: • is .the nurse the right member of the caring team to do the.work? • who will take over the nursing work relinquished by those doing the new work? • how will the nursing care programme be enhanced? • what benefits can pa- tients expect to receive from the new procedure under- taken by nurses? "Care" is another impor- tant word. It can be treated 34 Nursing Mirror, September 29 1982
Transcript of Responsibility- the keyword
MANAGEMENT FORUM 4: THEORY AND PRACTICE
Responsibility-the keywordANTHONY CARR discusses nurse managers'responsibilities to their staff, patients andsociety.
THE number of times aword or concept is used
. in a discussion is pro-portional to the group's orindividual's lack of accep-tance of the meaning behindthe word. For example, ifthe word "professional" isused often enough, a feelingof pride and confidence isengendered.
Responsibility is a goodwholesome word. Accor-ding to the Shorter OxfordEnglish Dictionary, it means"the state or fact of beingresponsible; a charge, trustor duty for which one isresponsible". Being respon-sible means "liable tobe called to account;answerable to a charge;morally accountable forone's actions".
Nurse managers areresponsible to staff (othernursing colleagues), clientsand society.
Reorganisation allowsreappraisal of nurses' dutiesand responsibilities. Overthe years, ward sisters'responsibilities have chang-ed, although some wouldsay diminished. The reduc-tion in hours of work and anincrease in holidays must betaken into consideration,however. In the 1960s, wardsisters worked about 220 fulldays and a further 52 half-days annually and a 9 percent longer working weekwith a split shift system.Unofficially, the 42-hourweek was considerablyAnthony Carr, SRN, NDNCert,QN, is chief nursing officer, New-castle Health Authority.
more."Ward sisters seemedto be never "off-duty". To-day, however, the wardsister works 204 days an-nuallyat 37.5 hours a week,an official time reduction ofabout 22.5 per cent.
Responsibilities should beclearly defined, of course,but the amount of timedevoted to such respon-sibilities must be considered.Management's responsibili-ty is to define the role andfunction of the ward's teammembers. Senior manage-ment should be concernedthat ward sisters are respon-sible for appointing theirown staff and developingand controlling ward policyfor 24 hours.
Attempts are being madeto alter night duty ar-rangements to ensure thatthe sister's responsibility forward policy and care plans isacknowledged. This has tobe undertaken with theknowledge that to cover onepost for 24hours, seven daysa week, would require
. another 4.5 back-up staff.For senior management tobe seen as responsible peo-ple, the 35-hour week isunacceptable. Althoughrotas can be altered, covergiven if more nurses aretrained and treatment givenon time and effectively ifstaff are available, relation-ships cannot be adequatelymaintained between nursingand medical staff and pa-tients will not receive thenecessary psychological,emotional and spiritual sup-port.
Although qualified nurs-ing staff ate taught to beresponsible initially to theirown patients for the carethey give, they should notobject to their performancebeing monitored. Medicinewould benefit enormously ifmedical audit was intro-duced on a wide scale ..
Proper delegation ofresponsibility would removea management level andchange those staff into sup-port roles. Senior manage-ment must use what authori-ty it has to persuade newtraining bodies to radicallyrethink nurse training andeducation. Newly-trainedstaff are not sufficiently ex-perienced to take their placeas trained members of theteam unaided. Work under-taken by the nursing depart-ment of the DHSS, reportedin "Professional Develop-ment in Clinical Nursing",and the Rcn document "AStructure for Nursing", in-dicate that considerable ad-ded input is required toenable the newly-trainednurse to take her or his pro-per place in the ward team.
as "an object of anxiety orwatchfulness" or "to pro-vide, look after, watchover". How should nursescare for clients and patients?A critically ill person is anobject of anxiety and shouldbe watched over. Howshould nurses look after,provide for or watch overthose recovering from ill-ness? The fact that so manyyoung people wish to comeinto nursing to care can beseen as an advantage anddisadvantage. Can nurses bedetached enough at the ap-propriate stage of a patient'srecovery. to allow him tobecome independent of nur-sing and nurses? Some say itis a matter of education, butI wonder if formal educa-tion or others' exampleschanges a person or his orher feelings of what is right.Some nurses who care toomuch do their patients adisservice and consequentlyaffect their recovery. On theother hand, some nursescare too little.
Every terminally ill pa-tient must receive the ap-propriate nursing supportand care at the time re-quired, as well as basic nurs-ing care. It is said that thereis not enough time in NHShospitals to care for dyingpeople in the way hospicesdo, but I do not accept thisargument. Senior nursingmanagement are paid highsalaries to meet the com-munity's changing needs.While patients die alone,frightened, in despair orresignation in hospitalsbecause of faulty organisa-tion, inappropriate staffingor lack of care, we cannot besatisfied.
Nursing managementmust influence the use ofresources as well as use newmonies. It will be interestingto see how nursing manage-ment copes with the in-troduction of the new in-sulin, U .100. How will ittrain its staff? How will pa-tients be re-educated andsupported? Will schools ofnursing have to cope with
PreparationManagers must direct
monies into continuouseducation so that staff areconsistently prepared fortheir new and increasingresponsibilities. Nurses'work will continue to ex-pand and extend. Legal im-plications are sometimesoverdone when consideringdeveloping duties. Whennew duties arise, manage-ment must ask:• is . the nurse the rightmember of the caring teamto do the.work?• who will take over thenursing work relinquishedby those doing the newwork?• how will the nursing careprogramme be enhanced?• what benefits can pa-tients expect to receive fromthe new procedure under-taken by nurses?
"Care" is another impor-tant word. It can be treated
34 Nursing Mirror, September 29 1982
I
Il ;
Although qualified nursing staff are taught to be responsible initially to their own patients' they should not object to their performance beingmonitored.
the problem or will chiefnurses prepare a plan torevolutionise the care ofdiabetic patients, using theintroduction of U.100 in-sulin as a means of improv-ing these patients' prospectsin the health authority area?
Work in Geneva, Bostonand Los Angeles has shownthat active supervision ofdiabetics reduces the in-cidence of blindness,gangrene of feet and renaland cardiac failure. This isone effective health measurethat could be demonstratedto lay members of a healthauthority.
Many health workers donot consider separate com-munity nursing units andthere has been little develop-ment in the community inthose health authority areaswhere hospitals were com-bined with the communityservices in 1974. With somesenior nurse managers so ig-norant of the local com-munity's health needs, how
can they have any impact onlocal authority services ofhousing, education, socialand environmental health,particularly when so little at-tention is paid to this part oftheir service?
District health authoritiesand regional health auth-orities have the opportuni-ties and the Whitley Councilcriteria to grade communityposts high. If this happens,potential future directors ofnursing servicemay considera career in community care.Failure to grade appro-priately will mean anotheropportunity lost to give thecommunity the leadership itdeserves.
Concern must be shownabout expectant mothersmost at risk. Community,midwifery and healthvisiting services should beparticularly sensitive to theneeds of these families. Arethere plans for positivediscrimination in those areasof most need? Can each
community rest knowingthat a 24-hour nursing ser-vice is offered when it ismost needed? Nurses makelittle impact on society's im-portant .health problems.Research is often focused ondetailed nursing problems ofeither a clinical or nurseorientated nature, but what'progress is being made todeal with the main illnessesof a civilised, westernisedsociety, of obesity, smok-ing, alcohol and drug abuse?
When I read of the impactFlorence Nightingale madeon society, I wonder wherewe are now. What wentwrong and why? Now we areunable to stop nurses smok-ing, so it may be impossiblefor us as a profession tomake an impact on societybecause we are part of thatproblem. We are as much atrisk from drugs arid alcoholas the rest of society,perhaps at greater riskbecause of work pressuresand opportunities presented
to us. Until nursing leadersrealise that these modernproblems are illnesses thatneed solutions, are willing tobe unpopular and proposeaction to solve them, nurs-ing will not be seen as animportant movement forhealth.
Of course, no amount ofeducation can make nurseswhat they are not, but untilthe basic problems ofmodern living are identifiedand some solutions offered,nurses cannot enforcechanges. I do not wish tocondemn nursing but toawaken it to the fact thatnumbers can have an impacton positive health.
For nursing to establish alead in health in the nextdecade, it must focus someattention on communityneeds. Those who deliber-ately face the challenge ofchanging attitudes of nurs-ing and society should be ad-mired for their work and theresults of their efforts 0
Nursing Mirror, September 29 1982 35
