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                                                                                                                         NURSING AND EDUCATION PLATFORM


In the Nursing and Education Platform I will display work relevant to nursing in care homes and hospitals, and to education relevant to health and social care. Certainly, within nursing, most journals will only now publish commissioned articles. For many years I have been raising issues in nursing, which are only now being acted upon. I am sure that others have been similarly ignored. So, for those with points to make, there is a section for submitted articles; giving everybody a platform. Individuals need a 'voice', whether members of staff of varying grade, or even service users; for members of universities and other high profile people should not monopolise opinion. Professional jealousy can also 'drown' opinion, and people need to work together instead of competing. When making use of articles from Nursing and Education Platform, please be sure to reference it to the author. Carol Dimon, 2012.




Carol has 20yrs experience in care homes, as nurse, manager, teacher/researcher and 5 yrs experience as a lecturer (FE and HE). Carol has established care home development groups, and has been a speaker at national nursing conferences. Carol Dimon, RGN, Dip N, BSc (Hons) nursing studies, MMedSci, PGCE. Author of Decisions and Dilemmas in Nursing Homes (2006), which, although now out of date, with new regulations in force, remains of some relevance; exploring rationales of decisions made by nurses and carers in nursing homes, research into which has now become more popular. The book not only explores problems; it offers much needed solutions. Carol is available as a guest speaker at conferences, and as an ad hoc lecturer in HE establishments. Carol will also offer tuition regarding health and social care and nursing Degrees and advise regarding assignments.






Care in Crisis?


Despite examples of good care in the UK (RCN 2012) there have been a vast number of reports of poor care in many areas of health and social care on TV or in the press or from Individuals or groups, especially over the last 2 years. Yet poor care has always existed as evidenced by various earlier authors, such as Robb (1967) or Martin (1984), and the experiences of staff and patients. Poor care is not, however, confined to the UK; Vladeck (2003) reports of poor care in American care homes. In desperation, some nurses have actually reported poor care to the press or television. Whilst some nurses were initially removed from the NMC register (see Margaret Haywood;, they were reinstated following appeal. Others have attempted, some successfully, to change practice by educating staff in new methods (RCN 2012).


Others concerned with poor care have approached managers; not all managers are prepared to ‘rock the boat’. Indeed, Calkin (2011) writes of missing incident forms, and the failure of individuals to act. The failure of agencies or individuals to take action is further highlighted within the Parliamentary and Health service Ombudsman report (2011). Some staff have approached the NMC or inspection bodies. Yet, the NMC deals only with nurses and midwives. Some nurses or midwives may be Inappropriately reported to the NMC for trivial issues (Middleton 2012), or falsely accused in order to hasten their departure from their work place. There is often a delay in NMC hearings, and the process is not an easy undertaking for any individual or establishment (Middleton 2012). Any staff member who raises issues within the profession is at risk of jeopardising their career, or being forced out (Moore 2009). This is not totally confined to nursing, and may occur in other professions, such as social work, education, or construction, as examples.


Nurses and care staff who dare to speak out need support and reassurance; unions can play a vital role in this process, which warrants their recognition within the work place.


Student nurses may fear raising issues, due to the pressure on them to conform to the norms of their work placements ( Levett-Jones, Lathlean 2009), and their aim of obtaining nursing registration. Further evidence that students are reluctant to report mal-practice is given by Bellafontaine (2009); a need for a strong mentor relationship is identified as a means to overcome this. Education bodies need to focus upon the processes involved in challenging situations, and boost the confidence of students, some of whom may lack the experience of questioning mal-practice. Students need additional support when on placement. There will also be a need to support health care assistants; who give much in the way of 'hands-on' care, and are subject to the demands of their care institution.


Whilst much excellent care exists, until everybody admits that poor care exists, nothing will be done about it. It is a matter of being self-critical. Any individual, either intentionally or not, is at risk of providing poor care of some degree, for whatever reason.


The Government suggests the re-introduction of 2 hourly ward rounds to combat poor physical care (Triggle 2012).


Some instances of poor care are due to low staff levels, but not all. Low staff levels may mean, for example, that patients cannot be bathed, as an example. Yet low staff levels may be the result of staff sickness, and non-availability of agency nurses or care staff. Agencies must be contacted in good time. The nurse in charge (or senior care assistant in a residential home) needs to inform the manager in writing and take further action if nothing is done to ensure adequate staffing levels.


Action is also being taken by independent groups such as The Patients' Association and the Nursing Standard, which are leading the CARE campaign; the aim of which is to improve patient care in hospitals and care homes. It is important that we listen to them and acknowledge when things go wrong. I am sure all nurses and care staff can recall incidents of poor care. What did they do about it? If no action was taken or if action was ineffective, why not? We all need to learn together to stop such situations occurring. Be prepared to question and be questioned. There are four pivotal factors involved in the CARE campaign; these are: Communication with compassion, Assist with toileting and maintain dignity, Relieve pain effectively, Encourage adequate nutrition. Hospitals are requested to join this campaign, thus ensuring that patients or relatives can challenge poor care and staff adopt the principles ( Ten priorities are also identified for action, such as good staffing.

Inspectors in the past have not always taken action ( › Health › Health News) which can depend on many factors, such as available evidence. The problems are now being addressed by the CQC. There are several actions that may be taken if witnessing or being aware of poor care: Nurses must adhere to the NMC code of conduct and must therefore take action. There is also a NMC whistleblowers guidance, and a CQC guidance to further advise nurses and other staff.

Both care assistants and nurses must also adhere to work policies. There will be a whistleblowers policy. Records such as incident forms must be made and copies kept. Poor care situations must be reported to the manager immediately.


If it is NMC reportable, the manager must report it to them. If this is not done, approach somebody higher. If the manager takes no action, you must go higher yourself. You can also take advice from the CQC, and report the issue to them.


If you are in a Union, take advice from them. If not, you could obtain legal advice if you can afford it, or are eligible for legal aid. As indicated within the NMC and CQC guidelines, there is also the independent charity Public Concern at Work who will advise you. If the situation concerns direct physical abuse , the police must also be informed. Make notes in the patient’s care plan, but be careful that you do not make any instant judgement. Obtain psychological support from somewhere, but remember confidentiality. Try an internal counsellor if there is one, or your Union.


As Vladeck (2003) suggests, what is really needed is a change in the whole culture of care; or indeed, society.


Carol Dimon


Independent author and researcher.



Bellofontaine, N. (2009). Explore Whether Student Nurses Report Poor Practice They Have Witnessed On Placement. Web. 17 July 2012.

Calkin, S. (2011) Evidence of Mid Staffs Care Failures Vanished. Web. 17 July 2012.

Hayes, N. 'Professional development'. Web. 17 July 2012.

Telegraph. Health. Web. 20 July 2012

Levett-Jones, T. Lathlean, J. (2009) ‘Don’t Rock The Boat’: Nursing Students’ Experiences of Conformity and Compliance. Nurse Education Today. 29,342-349.

Martin, JP. (1984) Hospitals in Trouble. Oxford. Basil Blackwell.

Middleton, J. ‘The Regulator Must Not Be Seen as an HR Service’. Web. 17 July 2012.

Moore, T. (2009) Whistleblower Nurses Take NHS To Tribunal. Web. 18 July 2012.

Parliamentary and Health service Ombudsman (2011). Care and Compassion. London. The Stationary Office.

Patients' Association. Web. 3 August 2012.

Public service news. Web. 17July 2012.

Robb, B. (1967) Sans Everything. AEGIS.

Triggle, N.(2012) Nursing Standards: PM aims to tackle ‘care problem’. Web.

Vladeck, BC. (2003) Unloving Care Revisited: The Persistence of Culture. Journal of Social Work in Long term Care 2,1. pp.1-19.

Whistleblowing Margaret Haywood Reinstated. Web. 17 July 2012.