Another week and another initiative comes from the Secretary of State for Health. Recently Mr Hunt is launching the idea of a “named nurse” for every patient which is obviously a radically new solution that has never been tried before …. Unless you count that time in the 1990s when it was last tried. For those readers who perhaps weren’t in nursing in the 1990s, this was the “named nurse” initiative which was closely linked with the development of “primary nursing”. The problem wasn’t so much the idea itself which was mainly about giving the patient, their family and friends, etc a single named individual to approach about issues with care. The problem (as it often is) was wrapped up in the devil of the implementation. Without redesigning the staff rotas, what inevitably happened was that the “named nurse” could end up being someone the patient had never seen and was never on duty between the patient’s admission and discharge. In some places, the ward sister or charge nurse was allocated as the “named nurse” for every patient in an area which made the whole exercise pointless.
As with many issues, the key is to understand what the real problem is that the solution is trying to address. Many of the advocates of the approach use the justification of accountability, arguing that it is important that the patient knows who is accountable for their care. Unfortunately this is a very simplistic understanding of how accountability operates and wrongly assumes that there can be a single accountable individual who “the buck stops with”.
Every nurse is personally and professionally accountable for the care that they deliver. The nurse’s manager is also accountable for the care that is delivered, as is their manager, the Director of Nursing, the Chief Executive, the Chair of the Board and a myriad of commissioners, regulators and inspectors. All of them are accountable for the care that is delivered and they discharge this through varying schemes of delegation and monitoring. So there are a whole number of people who are accountable for the care that is derived and not a single individual. There is certainly no single place along this chain of accountability where “the Buck” stops and goes no further. Chief Executives are paid a huge amount of money to ensure that quality care is delivered across their organisation every day and they cannot duck this by pointing at less senior nurses deep in the grains atonal hierarchy.
The concept of responsibility is probably more helpful. The essence of responsibility is the ability to respond, in other words, the capacity and the capability to address problems and issues that arise. What I believe patients, family members, carers, etc mainly want is to know who to go to to find out key information about the care being deliver and who to go to to sort out problems or issues. For a single named individual to be able to be responsible, they have to have the authority to sort out problems and issues. There is no point going to this person with a complaint about cleanliness, food standards, the organisation of care, etc unless this person has the ability to do something about it.
If an organisation creates a culture where nurses are able to control the environment of care and organises staff rotas so that there is continuity between nurses and specific patients, then there will genuinely be “responsible nurses”. In this type of environment, then letting patients know who their “responsible nurse” is could be really valuable. Adding it as a form of window dressing applied uniformly across the NHS without fundamentally addressing these issues will just lead to an irritating time-wasting fiasco. Exactly as happened the last time this was introduced.