In the UK there is much debate on the standard of nursing care offered in hospitals and in the community. This has been prompted by the Francis Report 2013, which highlighted that there were failures by individual nurses, various levels of management and regulators of nursing. More recently Dr Peter Carter of the Royal College of Nursing said 2013 was a horrible year for nursing as nurses are burnt out. To sum up in my opinion 2013 was annus horribilis for nurses.

So how do we move forward? I recently had to visit a neighbour in hospital and experienced poor nursing (in a London Teaching Hospital). A Twitter conversation with my followers tell me it will not get better until wards are properly staffed. I dug my heels and said there is no excuse for poor care my followers debated this while I stayed quiet. I was of the opinion that some nurses do deliver poor care riding on the coat tails of we are understaffed when they can perform better if they try, one follower said don’t let the bad apples…. Another follower said these nurses need to be identified and managed out if necessary. While another commented we need to help the nurse identify the bad practice leading to poor care and help them develop while improving staffing levels. So here I bring you the concept (which may not be new) that those nurses who seem unaware of how their practice contributes to poor care needs to be managed ‘out’ or managed ‘in’.

The National Health Service (or what’s left of it) is a large complex organisation with not just nurses but an entire compliment of health professionals. In my opinion managing someone out may be more difficult that managing someone in. I have some ideas but what tools or approaches would you use to manage in a nurse? Dare I suggest ratios and formulas for patient to nurse? Your comments are welcomed.