Happy New year to Evidence Based Nursing readers. I don’t know about you, but in these times of austerity I felt the need to be more discerning than ever when purchasing Christmas gifts for my friends and family. I wanted to get the best I could for them with the resources I had set aside. But with so much choice, to be quite honest I am increasingly finding being a discerning consumer quite exhausting! Even when you think you’ve got it spot on, you can still get it wrong and you are left wondering, shall I (just) give money next year, or shall I ask them exactly what it is that they want and buy if for them ……..and take away any element of surprise? Is that in the spirit of Christmas?
And is it just me, or does something ‘big’ always end up needing to be fixed or replaced at this time of year in your house too? If it’s not the boiler it’s the washing machine or the cooker. I really should learn from this and set up a contingency fund for the winter break because there is a definite pattern emerging in our house of needing to find additional resources we haven’t really (or actually) got, without which we’ll either freeze or not smell very fresh!
It was the TV that we needed to replace the week before Christmas this year. Admittedly, a television is arguably not an essential item, but it’s hard to imagine Christmas in our house without one. The array of choice when it comes to buying a new TV, like any new bit of techno-wizardry-kit, can be completely overwhelming. Thank goodness there are people out there who are on top of this, testing all the options, providing unbiased guidance on the pros and cons of the variety of models on the market and able to advise which ones offer the best value for money (www.which.co.uk). It really does help you make an informed decision, knowing that you are drawing on reliable research, that is not in itself tainted by commercial interests.
Evidence Based Nursing is effectively ‘The Which?’ guide to nursing. EBN helps those involved in the provision of nursing, make well informed decisions about care. It doesn’t, of course, absolve nurses of the need to make decisions. And providing evidence informed care is dependent upon having the resources required to apply the evidence in practice. The principles of making an evidence informed purchase are the same.
Educated to degree level, nurses are critical thinkers with the knowledge and skills to interpret any situation where care is required and draw on evidence published in Evidence Based Nursing and elsewhere to make care decisions. When done well, the complexity of nursing decision-making is often invisible to the untrained eye. Not only does it draw on the best available research evidence to offer the best possible outcome for patients, it uses finite resources to best effect. Nurses recognise patterns in individuals and in communities. They spend time with the people they care for and quickly learn what works for them. They spend time within communities and learn to recognise patterns such as winter pressures and plan for these events. But above all nurses build relationships with people in need of care and those closest to them, and they make decisions with these people that are for life and not just for Christmas.
And so the theory goes. However the realities of nursing, in these times of austerity, make it increasingly difficult for nurses to have the space to think which is clearly necessary to fully engage with and build relationships with patients and their carers and to keep up to date with the best available evidence, in order to jointly make, implement and evaluate care decisions. And in this regard parallels can be drawn between patients and friends and families at Christmas time. Patients are not homogenous and their desires to be actively involved in care decision-making are dependent upon individual context and preferences. I don’t mean to trivialise patient care by drawing comparisons with the giving of gifts at Christmas but simply to highlight similarities between the personal and the professional with regard to the complexities of relationships, decision making and the impact of austerity measures.
Uncritical cost-sitting initiatives are prevalent in the UK health services where targets are privileged over individual need. Cost cutting interventions appear to be guided by the principles of ‘scientific management’ 1 – a management approach designed for the assembly line where the output was a product or a widget. People with health care needs are not widgets. Mayo2, one of earliest critics of Taylorism argued that with the context of a factory these methods dehumanized the workforce. Applying such approaches in healthcare serves to dehumanise healthcare and squeeze compassion out of the system. It is not fit for purpose.
As the managerialist vice tightens in the name of efficiency, this false economy increasingly and insidiously serves to deny those concerned with care the capacity to make high quality decisions and apply them in practice. Educating nurses to degree level to enable them to make good quality complex care decisions and then denying them the space and time to do so is at best perverse. Indeed, is it not immoral to build capability and then deny people the capacity to use their capability in practice? Arguably the system is setting the profession up to fail. If so, this in turn means that by its own hand, the system, and not the individuals within it, is failing the very people it exists to serve.
So where does this leave nursing and health care? Well, we are clear that evidence informed decision making in health care leads to the better use of limited resources and better quality of care and health outcomes for patients. We are clear about this because we can prove it. Evidence is the key to making good decisions whether they be clinical or managerial or both. Austerity in this regard is a red herring because, by definition, management is about using resources efficiently. We are clear that management practices that focus on reducing costs without regard for their impact on quality and outcomes is disastrous. We are clear about this because there is compelling evidence that this is the case (e.g. Francis 3). We are not alone. Despite recent media coverage which suggest a fall in public confidence in nurses and nursing and evidence that nurses have not effectively engaged the media in promoting public awareness of the value of nursing 4, patients and the public are our strongest allies. We want the same thing, compassionate, effective care that uses (adequate) public resources to best effect. Our number one priority must be to work with patients and the public to this end. Until the public demand to be nursed by compassionate graduate nurses, sections of the media will continue to portray the profession as misguided and self serving. A system failing its purpose is a political issue. As the largest healthcare workforce nurses have the political power to turn this around. If we work with the public we are surely unstoppable.
Blog written by: Ann McMahon PhD RN blogging in a personal capacity.
Substantive role: Royal College of Nursing Research and Innovation Manager
in addition: Co-Editor in Chief, Journal of Research in Nursing and Honorary Research Fellow, University of Glasgow (Email: firstname.lastname@example.org)
1. Taylor FW. Principles and methods of scientific management. New York: Harper and Brothers 1911.
2. Mayo E. The Social Problems of an Industrial Civilisation. New Hampshire: Ayer 1945.
3. Francis R. Final Report Of The Independent Inquiry Into Care Provided By Mid Staffordshire NHS Foundation Trust. London: Department of Health, 2013.
4. Hoeve Yt, Jansen G, Roodbol P. The nursing profession: public image, self-concept and professional identity. A discussion paper. Journal of Advanced Nursing 2013: [Epub ahead of print].